U.S. Doctors Behind Face Transplants Give Details of Procedure

WEDNESDAY, Dec. 28 (HealthDay News) — Full face transplants were
once the stuff of science fiction, but not anymore.

So far, 18 such transplants have been done worldwide, and U.S. surgeons
describe the intricate procedures in the Dec. 28 online edition of the
New England Journal of Medicine.

The article details the stories of three face transplants that were
performed at Boston’s Brigham Women‘s Hospital in 201l, including
the much-publicized case of Charla Nash, who lost most of her face in a
chimpanzee attack.

While some technical challenges remain, surgeons say they are getting
better and better at performing face transplants.

“We don’t know how common or rare this operation will be, but it is
here to stay,” said Dr. Bohdan Pomahac, the director of the plastic
surgery transplantation program at Brigham Women’s. He was the lead
surgeon on all three cases described in the journal report.

These lengthy and complex surgeries are reserved for individuals with
severe facial deformities, but as techniques and technology improve,
transplants could become an option for patients with lesser degrees of
facial deformity.

Who’s a candidate? According to the doctors, prospective recipients
first undergo extensive medical and psychological evaluation. If they are
deemed to be appropriate candidates, surgeons then begin their search for
suitable donors and start to plan the surgery.

Each operation is unique and can take more than 20 hours to complete.
In general, surgeons will first remove any non-viable or injured tissue
from the face transplant recipient. The healthy tissue, once procured from
suitable donor, is then attached. This is not a simple task — surgeons
must restore blood flow, reattach nerves, muscles and bony structures, and
then reconnect each layer of the new face.

Even so, “the hardest part is the recovery of the donor face,” Pomahac
said. After the transplant is complete, surgeons must be on the lookout
for any signs of rejection and other side effects, such as infection.
These risks are highest during the first 24 hours after surgery. “There
can be clotting in the vessels that are re-connected, and we use high
doses of immune suppression for a first couple of days so the patient is
more susceptible to infection,” he explained.

In the beginning, the patient’s new face is swollen and has no motion.
“Most of the swelling goes down in six weeks and then you regain motor
function in three to six months,” he said. Many of these patients are
eating within a few days. “They get better and better each time we see
them,” he said.

Unlike in the movies, the patient does not wake up with the face
of the donor, Pomahac stressed. Instead, the new face is more of a hybrid
between donor and recipient. “It is surprisingly easy to get used to,” he
said. “They have new faces, but they still have a way of speaking and have
the same body language.”

Another study author , Dr. Daniel S. Alam, is the head of the section
of facial aesthetic and reconstructive surgery in the Head and Neck
Institute at the Cleveland Clinic in Ohio. He said the new article is
important because it is the first time face transplants have been reported
as a series of cases.

Alam was involved with Nash’s surgery, and also performed the first
U.S. face transplant — on gunshot victim Connie Culp, in December of
2008.

“Five years ago, we didn’t know if this could be done. Full face
transplants can be done technically, they can be done safely and patients
can get a lasting benefit,” he said. The new study’s publication marks
“the end of the first chapter and now we need Chapter Two, to see who is
the right patient and work toward making the surgery better and better,”
Alam said.

That remains a work in progress. “Surgeons have been taking gall
bladders out for years [for example], but we are extremely early in our
learning curve for face transplants,” he said.

Another expert agreed.

“Face transplants are here to stay,” said Dr. Edwin F. Williams III, a
facial plastic surgeon in Albany, N.Y., and vice president of public
affairs at the American Academy of Facial Plastic and Reconstructive
Surgery.

However, he added, “we really need to move forward carefully and they
won’t be something that happen in every small town and city.”

More information

For more information on some of the issues surrounding face
transplants, visit the American Academy of Facial Plastic and Reconstructive
Surgery
.

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