An operation for replacing about 80 percent of a woman's face, transplanting bone, teeth, muscle and nerves and blood vessels is the first of such type carried out by eight surgeons in the United States, took place two weeks ago and lasted for 22 hours. The patient had been disfigured to the point where she could not eat or breathe on her own, doctors involved in the transplant told a press conference at the Cleveland clinic on Wednesday.
They did not name the female patient who suffered severe trauma that cost her sight of the right eye, much of her nose and her upper jaw and left her unable to breathe, smell, taste or smile properly.
About 77 square inches of tissue were transplanted from the donor, whose identity was also not been disclosed. A major obstacle was finding a donor whose sex, race, age and blood type matched that of the potential recipients. Specific consent procedures were developed.
Doctors said the woman had responded well to surgery and her body was showing no signs of rejecting the new face. Still, the woman will need to take anti-rejection drugs for the rest of her life, but those drugs do not guarantee success. Although rejection reactions seem more common in the first few months, they can occur at any time. Doctors can often reverse such reactions by adjusting the medication. After such transplant, the new face shall not look like the donor because its shape shall be altered by the muscles and bones of the patient's face.
The woman is eventually expected to eat, speak and breathe normally and even smell again. Feeling should return to her face in six months, and most facial functions in about a year, leading to her ability to smile after physical therapy to help train the muscles for that function.
But some experts have warned of possible psychological side-effects which may include remorse, disappointment, or grief and guilt towards the donor. Under the clinic’s scientific blueprint, Dr. Kodish said, the patient was not allowed to see a photo of the donor, in part because it could lead her to believe she would look like the donor.
Dr. Kodish added that in psychological testing the woman was asked questions like these: Is it you or someone else in your family who wants you to have the face transplant? How do you feel about the prospect of living with a face from a dead person?
Some controversy has surrounded the issue of face transplants, in part because face injuries are not seen as life-threatening. In this case, the doctors said, the patient practically had no life because of her injury. "We know that there are so many patients there in their homes where they are hiding from society because they are afraid to walk to the grocery stores, they are afraid to go to the street," Siemionow said. "Our patient was called names and was humiliated."
In late 2004, a Cleveland Clinic institutional review board said a face transplant was ethical and possible and approved Dr. Siemionow’s scientific blueprint for the experimental procedure. It was the first time any ethics committee in the world had given such permission.
Dr. Maria Siemionow said she was very proud of the success of the operation. “I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw” she added.
The world's first face transplant took place in Amiens, France in November, three years ago, on Isabelle Dinoire, a 38-year-old woman who had been seriously disfigured by her dog, a Labrador retriever. Last year, her doctors reported that she recovered slowly and steadily, overcoming two episodes of rejection. Surgeons used donor tissue to replace her nose, mouth, lips and chin, and Ms Dinoire has said she is satisfied with the results.
Since then, operations have been carried out on a Chinese farmer who was attacked by a bear while trying to protect his sheep, and on a French man disfigured by a genetic condition.
