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Entries in Face Transplants (2)

Friday
Oct192012

Face Transplants Then and Now: A Surgical Success Story

Richard Lee Norris - face transplant recipient (University of Maryland Medical Center)(NEW YORK) -- Face-transplant technology has come a long way in seven years.

Richard Lee Norris, a Virginia man who was severely disfigured after a gun accident in 1997, has made a notable recovery after undergoing the world's fullest face transplant in March.

"People used to stare at me because of my disfigurement," Norris, 37, said in a prepared statement. "Now they can stare at me in amazement and in the transformation I have taken."

Norris' 36-hour transplant of a donor face was one of 23 done worldwide since 2005, and the most recent of six done in the United States, including those of Charla Nash and Dallas Weins.

[To see other face transplants through the years, click here.]

"If you would have told me 20 years ago, would this be possible? I would say absolutely not," said Norris' surgeon, Dr. Eduardo Rodriguez, of the University of Maryland Medical Center. "It's hard to imagine it's the same person, isn't it?"

The goal for Norris' transplant, Rodriguez said, was to restore both form and function.

"I strongly believe that it is the most aesthetically acceptable result thus far," he said. "I am only hopeful that the functional result will be as good as the aesthetic result."

Compared to the first face transplant case in 2005, which included just the soft tissues of the nose, lips and chin, Rodriguez and his team transplanted the entire face from scalp to neck, complete with teeth, bones, muscles, nerves and skin.

They removed the entire face in one piece and used 3-D modeling software to ensure a perfect fit. Norris was also the first face transplant patient to receive a special anti-rejection drug before his treatment, in order to limit early rejection of his new face.

"Face transplantation is one of the biggest innovative breakthroughs in the last decade," said Dr. Maria Siemionow, a plastic surgeon at the Cleveland Clinic who led the country's first near-total face transplant in 2008.

"We are moving forward," Siemionow added. But "it takes time."

Face transplant recipients rely on a cocktail of drugs to prevent their immune systems from attacking the new face, drugs that come with a hefty price tag and serious side effects. Early research suggests it might be possible someday to engineer new faces using the patient's own stem cells seeded on a donor framework, but that's still decades away.

In Norris' case, the transplanted jaw bones contained donor stem cells to help coax his body into accepting the new face. Such an approach was based on a decade of animal research at the University of Maryland transplant team's laboratory.

But face transplant experts have learned tough lessons after some heart-breaking disappointments. One Chinese partial face transplant patient died of unknown causes in 2008. His transplant surgeons reported in Agence-France Press that he had stopped taking his anti-rejection drugs in favor of herbal medications.

"Patient selection is very important," said Dr. Joseph Losee, director of the reconstructive transplantation program at the University of Pittsburgh Medical Center, explaining that the results can be disastrous if patients don't remain committed to their follow-up treatment. "Not everybody should get reconstructive transplant surgery."

One critical factor in Norris' transplant success was his commitment as a patient, surgeon Rodriguez said.

Copyright 2012 ABC News Radio

Wednesday
Dec282011

Full Face Transplants: A Cutting Edge Closer Look

Face transplant recipient, Dallas Wiens, speaks at a press conference with Dr. Bohdan Pomahac (L) in Boston, Massachusetts in May 2011. Adam Hunger/AFP/Getty Images(BOSTON) -- Surgeons lift the face off one person and transplant it onto another person. Sounds like a scene out of a John Travolta and Nicholas Cage movie.

But when Dr. Bohdan Pomahac, director of plastic surgery and transplantation at Brigham and Women's Hospital in Boston, performed the first full face transplant in the nation, he transformed a science fiction concept into reality.

Now, he says, there's no going back.

"I think it's important for people to realize this is becoming a reproducible technique," said Pomahac.

Pomahac recalled feeling uncertain about the procedure when he received the file of his first patient in need of a full face transplant. Dallas Weins, 25, a construction worker from Dallas, Texas suffered severe burns to his face two and a half years ago when the boom lift he was operating drifted into a high voltage power line.

After 22 surgeries, Wiens was left with a face void of features, except for a lipless mouth and a goatee. Even his eye sockets were smoothed over with skin taken from other parts of his body.

Pohomac looked at the chart of the potential face transplant recipient and thought the risks were high.

"I was worried the defect was too extensive," said Pohomac. "I was worried that his nerves were damaged to the point that we wouldn't be able to reconnect them."

But Wiens was young, and his face could be repaired back to the way it was should something go wrong.

"We don't want patients to end up with worse deformity than before if the face is rejected," said Pohomac.

There was even a donor face that matched, so he became the perfect candidate for the procedure. Screening and preparation took months.

"It's the most extensive consenting I've ever done," he said.

Since 2005, 18 patients have received facial transplants, most of them designed to restore partial face defects. But Weins' case became the first procedure out of three Pomahac performed this year to replace a full face.

Pomahac called the novel technique a "unique way to simplify anatomy." Facial tissues are extracted from the donor as one block, including the skin and underlying muscles and nerves and reconnected to the recipient. In Wiens' case, the nasal bone was also transferred.

Pomahac reports on Wiens and the two other full face transplant patients in an article published Wednesday in the New England Journal of Medicine.

Within four hours, the patients recovered sensation and movement in their faces.

"All patients had postoperative infections of differing severity, and they all recovered," the authors wrote. But the procedure is not exactly science fiction come to life.

The surgeons expected the recipients wouldn't look like themselves before their injuries, and they also expected that the facial changes they would experience as their new faces molded onto their frames would keep them from looking like their donors.

"We anticipated that the underlying skeleton and facial volume would shape the final facial appearance, making resemblance to the donors unlikely," the authors wrote. "It is our subjective opinion, as well as that of two of the donor families, that the patients do not look like their donors."

With each patient, the surgeons refined their technique to cut down on the small revisions that were originally necessary after the initial surgery.

Each patient's surgery was described in separate televised press conferences that Pomahac says may have made the procedure seem like isolated cases that were difficult to reproduce. But his team is working to make the procedure accessible. Pomahac said one patient is now listed for the transplant and waiting for a suitable donor.

"We can do it now so much better than the first cases," said Pomahac. "The extent of how it will be used is undetermined, but it's here to stay."

Copyright 2011 ABC News Radio 







ABC News Radio