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

Beneficiaries of face transplant

People with faces disfigured by trauma, burn, 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."

History

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 Indiamarker 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 Indiamarker's top microsurgeons. In 2004, Sandeep was training to be a nurse.

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

Partial face transplant

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 Amiensmarker, Francemarker. Isabelle Dinoire 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 an Asiatic black 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.

US Partial facial transplants

In 2004, the Cleveland Clinicmarker in Ohiomarker, USAmarker, became the first institution to approve this surgery and test it on cadaver.

In October 2006, surgeon Peter Butler at Londonmarker's Royal Free Hospital in the UKmarker was given permission by the NHS ethics board to carry out the 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 partial face transplant took place in a 17-hour operation in Boston on April 9, 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.

Surgery and post-operation treatment

The procedure consists of a series of operations requiring rotating teams of specialists. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (including the underlying fat, nerves and blood vessels, but no musculature). The surgery may last anywhere from 8 to 15 hours, followed by a 10–14 day hospital stay.

After the procedure a lifelong regimen of immunosuppressive drugs is necessary to suppress the patient's own immune systems and prevent rejection. Long-term immunosuppression increases the risk of developing life-threatening infections, kidney damage, and cancer. The surgery may result in complications such as infections that could turn the new face black and require a second transplant or reconstruction with skin grafts.

The transplant does not give the patient's face the appearance of the deceased donor's face because the underlying musculature and bones are different. Facial movements are controlled by the brain, so the personality as expressed by the face remains that of the patient..

Popular culture

1960: The procedure was very grotesquely, yet somewhat accurately, highlighted in Georges Franju's cult horror masterpiece called Les Yeux sans visage which translates to "Eyes Without a Face".

1964: Kōbō Abe, Japanese author and playwright, wrote The Face of Another (1964) about a plastics scientist who loses his face in an accident and proceeds to construct a new face for himself. With a new face, the protagonist sees the world in a new way and even goes so far as to have a clandestine "affair" with his estranged wife. This novel was made into a film of the same name by Hiroshi Teshigahara in 1966.

1990: In the movie Darkman, the central character Peyton Westlake grafts himself a synthetic face after his skin was burned in a lab accident. He uses this new material to disguise himself and hunt down the criminals responsible for his mutilation.

1996: Facial transplant surgery was featured in an episode of Star Trek: Voyager.

1997: The plot of the movie Face/Off was based on a face transplant operation that involved changing the underlying structure and actual face shape. In the film, the transplant is shown to be reversible, with the patient being able to replace his original face if desired.

2003: The villain in the movie Once Upon A Time In Mexico underwent a face transplant.

2005: Facial transplant surgery was featured in an episode of Nip/Tuck.

2007: In the nonfiction book Heroes With a Thousand Faces, an entire chapter is devoted to facial transplant, including the pros and cons of the procedure. The chapter also includes interviews with Dr. Maria Siemionow of Cleveland Clinicmarker and Christine Piff, founder of Let's Face It, an organization based in the UK that supports people with facial differences.

2008: The Facial transplant was mocked in the Argentinian series "Los Simuladores."

2009: First facial transplant in world including jaws and tongue in La Fe Hospital, Valencia, Spain, by Dr. Cavadas. Facial transplant surgery was featured in an episode of Grey's Anatomy.

References

  1. Face transplants 'on the horizon'
  2. BBC News - Woman has first face transplant
  3. Outcomes 18 Months after the First Human Partial Face Transplantation, New England Journal of Medicine, December 13, 2007
  4. Face-Transplant Patient 'Satisfied': Some Who Criticized Procedure Are Impressed With Results, By Rick Weiss, Washington Post, Thursday, December 13, 2007; Page A22
  5. usatoday artcle Face transplant recipient 'happy' with results


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