Posted by Cockney Robin | Lancet has reported on two successful facial transplants: one to a Chinese man savaged by a bear and the other to a man with a massive melanoma growing on his facial nerves.(BBC News 26-8-08; more)
The latest operations were just as complex, but involved different challenges for French and Chinese surgeons.
The first operation took place in April 2006. The patient was a farmer from a remote village in Yunnan province in China, who had been attacked by a bear 18 months earlier, leaving a huge section of tissue missing from the right side of his face.
The operation, at Xijing Hospital in Xi'an City, used the face of a 25-year-old man who had died in a traffic accident....
The second operation, carried out in Paris in January 2007, involved a 29-year-old man disfigured by a neurofibroma, a massive tumour growing on his facial nerves.
Its removal was timed to coincide with a face transplant, and a year later, doctors again declared the operation a success.
The patient told them that previously he had been considered a "monster", but now felt like an anonymous person in the crowd. (BBC News 26-8-08; more)
After much dispute about the ethics of the procedure, the first facial transplant was performed in France in 2005. The patient had been attacked by her pet labrador. As a result, she lost her nose, lips, and chin. (BBC News 4-11-05).
In the controversial operation, tissues, muscles, arteries and veins were taken from a brain-dead donor and attached to the patient's lower face.
Doctors stress the woman will not look like her donor, but nor will she look like she did before the attack - instead she will have a "hybrid" face.(BBC News 4-11-05).
A hybrid face is better than no face at all. An "after" photograph is here.
A team of surgeons, led by Bernard Devauchelle, from Centre Hospitalier Universitaire Amiens, made history by transplanting tissues, muscles, arteries and veins, taken from a brain-dead donor, onto Mrs Dinoire's lower face.
The scientists report that one week after the operation, Mrs Dinoire was able to eat and drink almost normally, and her speech had improved quickly. They said the return of sensation to her face was "excellent", although she would need more physiotherapy to restore movement around her lips.
They said the patient did experience signs of mild rejection of her new tissue, but this had been successfully suppressed with drugs. (BBC News 3-7-06)
Her recovery was not free from problems. But, as she said afterward, "Now I have a face." (Times Online) The following is from a report on 6 Feb. 2006:
Although Isabelle Dinoire, a 38-year-old mother of two, is still unable to move her lips properly and her speech is slurred and hard to understand, she thanked the doctors who undertook the operation and the family of the donor who gave her new lips, a chin and a nose....
Since then she has gradually being regaining sensation, although it is too early for her to have full nerve function, if she ever does.
"I can open my mouth and eat. I feel my lips, my nose and my mouth," said Mme Dinoire, who lifted a cup to her lips and appeared to drink while one of her surgeons was speaking. (ToL)
You can see more recent footage of her discussing the outcome here. Her speech is still slightly slurred, but certainly understandable.
The ethical questions arise because the tissue must come from a living, though brain-dead, donor.BBC News 4-11-05). Donor questions are particularly touchy ones. (MSNBC.com)
In the UK, surgeons are preparing to perform similar operations in suitable circumstances. People with severe burns or oral cancer would be prime candidates (msnbc.com), though the procedure remains a risky one for the patient. (BBC News 26-8-08; more) One major risk is transplant rejection.
[T]he drugs used to prevent rejection by the body may fail, leaving the recipient with the nightmare of the transplant being rejected and, with death likely to quickly follow, no other options. In addition, the drugs involved are so toxic that cancer, kidney failure and other problems are likely to eventually occur, even if the initial surgery is successful. (MSNBC.com)
Another is the potential psychological impact.
Even more challenging is the problem of adjusting to a new face. While those with severe facial deformities might hope for any alternative, a transplanted face that does not work right, looks strange or reminds people of someone who is dead, would pose very difficult challenges to anyone who receives it. (MSNBC.com)
A strange face is better than half a face if you ask me. This world being what it is, I can well understand why people might not be only willing but even eager to accept this risk. It's a shame it has to be this way. But it can't be denied that the face matters, perhaps inordinately, to our species.
The BBC has some photographs of the process. As they warn, some people might find them disturbing.
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