The first near total face transplant to be carried out in the United States took place at the Cleveland Clinic in Ohio in a 22-hour procedure where a multidisciplinary team of doctors and surgeons replaced 80 per cent of a trauma patient’s face.
In the procedure, which took place within the last two weeks, the surgeons essentially replaced nearly the entire face of a woman who had suffered severe trauma: she was unable to smile, eat, talk, smell or breathe by herself. The only parts that were retained were the upper eyelids, forehead, lower lip and chin.
In a press conference on Wednesday the surgeons said that children were afraid of the patient, her disfigurement was so bad.
According to a report by the Los Angeles Times, the surgeons said it took eight surgeons to carry out the transplant. First, one group took nine hours to remove parts of the donor’s face: skin, mid-facial muscles, upper lip, nose, most of the nasal sinuses, upper jaw, some teeth, and facial nerve.
Then, another group took three hours to attach the blood vessels from the patient to the blood vessels of the donor so that blood flow could be restored. When the skin went pink it meant the procedure worked. The surgeons then took turns to put together the different layers of the face.
In the interests of privacy, no individuals have been identified, either on the donor or the recipient side. However, a sibling of the patient issued a comment that spoke about how the past two weeks have been “overwhelming” for the family:
“We never thought for a moment that our sister would ever have a chance at a normal life again, after the trauma she endured. But thanks to the wonderful person that donated her organs to help another living human being, she has another chance to live a normal life,” said the comment from the patient’s sibling, who thanked the surgical team, now regarded almost like “a second family”. While the sibling expresses “tears of joy” for the sister who lives, he or she expresses “tears of pain” for the donor who died, conveying deep sadness but also gratitude to the donor’s family.
The procedure was the largest and most complex face transplant “in the world” said a press statement from the Cleveland Clinic. It brought together different working parts of the face like the nose and lower eyelids, as well as different types of tissue such as skin, muscle, bone, blood vessels and nerves.
Dr Delos M “Toby” Cosgrove, President and CEO of the Cleveland Clinic, a not for profit academic medical center that integrates clinical and hospital care with research and education, told the press that he was proud of the surgical team who worked “tirelessly to make a difference” to this patient’s life.
“By advancing scientific research in microsurgery and transplantation, Cleveland Clinic is setting new standards of care,” said Cosgrove.
Dr Maria Siemionow, Director of Plastic Surgery Research and Head of Microsurgery Training, at the Cleveland Clinic led the transplant team. She has many years of experience in treating patients with severe facial disfiguration.
Siemionow said that:
“As a physician, one of the most rewarding things we can do is to restore the quality of life to a patient.”
“Patients with facial disfigurement have very difficult challenges in society. We hope that one day we may be able to help the tens of thousands of patients who are quietly suffering, ” she added.
Other members of the team included specialists in dermatology, plastic surgery, hand surgery, general and transplant surgery, bioethics, social work, psychology, psychiatry, nursing, infectious diseases, dentistry, pharmacy, ophthalmology. Staff from the environmental services and security departments were also significantly involved.
Because this was an experimental procedure the cost of the operation has been met by the hospital. No figures were mentioned, said the Los Angeles Times report.
With physiotherapy the patient should be able eventually to talk, blink, breathe and smile unaided.
Sources: Cleveland Clinic, Los Angeles Times.
Written by: Catharine Paddock, PhD