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Face Transplant..

July 3, 2009 LifeStyle

A face transplant is a still-experimental procedure to replace all or part of a person’s face.

People with faces disfigured by trauma, burns, disease, or birth defects might benefit from the procedure.

The alternative to a face transplant is to move the patient’s own skin from their back, buttocks or thighs to their face in a series of as many as 50 operations to regain even limited function and a face that is often likened to a mask or a living quilt.

Dr. L. Scott Levin, chief of plastic and reconstructive surgery at the Duke University Medical Center, has described the procedure as “the single most important area of reconstructive research.”

Self as donor (face replant)

The world’s first full-face replant operation was on nine year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher. Sandeep’s mother witnessed the accident. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag. An article in the The Guardian recounts: “In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin.” The operation was successful, although the child was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on. Sandeep’s doctor was Abraham Thomas, one of India‘s top microsurgeons. In 2004, Sandeep was training to be a nurse.

In 1997, a similar operation was performed in the Australian state of Victoria, when a woman’s face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.

The world’s first partial face transplant on a living human was carried out on November 27, 2005 by Professor Jean-Michel Dubernard, a plastic and microsurgeon in Amiens, France.Isabelle Dinoire^[5] underwent surgery to replace her original face that had been ravaged by her dog. A triangle of face tissue from a brain-dead human’s nose and mouth was grafted onto the patient. On December 13, 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine and documents that the patient is happy with the results but also that the journey has been very difficult, especially with respect to her immune system’s response.

In April, 2006, the Xijing military hospital in Xian, China carried out a similar operation, transplanting the cheek, upper lip, and nose of Li Guoxing, who was mauled by a bear while protecting his sheep.

On December 21, 2008 it was reported that Li Guoxing had died in July in his home village in Yunnan Province. Prior to his death, A documentary on the Discovery Channel, showed he had stopped taking immuno-suppressant drugs in favor of herbal medication.This was suggested to be a contributing factor to his death by his surgeon, Dr Guo Shuzhong. A post mortem could not be conducted as his body had already been buried and his family would not give permission.

In 2004, the Cleveland Clinic in Ohio, USA, became the first institution to approve this surgery and test it on cadavers.

In October 2006, surgeon Peter Butler at London‘s Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out a full face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals.

A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a neurofibroma caused by a genetic disorder. The tumor was so massive that the man couldn’t eat or speak properly.

In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after having received what his doctors call the worlds first successful full face transplant.

The Cleveland Clinic became the first US hospital to approve the procedure four years ago. In December 2008 a team at the Cleveland Clinic, led by Dr. Maria Siemionow and including a group of supporting doctors and six plastic surgeons (Dr. Steven Bernard, Dr. Mark Hendrickson, Dr. Robert Lohman, Dr. Dan Alam and Dr. Francis Papay) performed the first face transplant in the US on a woman named Connie Culp. It was the world’s first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date. This operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw and even some teeth from a brain-dead donor. Doctors paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures, as they recovered the donor’s facial tissue. The surgeons then connected facial graft vessels to the patient’s blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure. She had been disfigured to the point where she could not eat or breathe on her own as a result of a traumatic injury several years ago which left her without a nose, right eye and upper jaw. They hoped the operation would allow her to regain her sense of smell and ability to smile and said she had a “clear understanding” of the risks involved.

The United States’ second full face transplant took place in a 17-hour operation in Boston in April 2009 on James Maki, age 59. He lost his nose, upper lip, cheeks, roof of his mouth, with associated muscles, bones and nerves after falling onto the electrified third rail at a Boston subway station in 2005. In May 2009 he made a public media appearance and declared he was happy with the result.

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