Surgeons in France claim to have performed the world鈥檚 first face transplant, although not of a whole face. A 38-year-old woman severely disfigured in May by a dog attack received a 鈥減artial鈥� triangular graft, consisting of the chin, lips and nose from a dead woman donor.
鈥淭oday, the patient is in excellent general condition, and the graft is normal,鈥� the surgical team, led by Jean-Michel Dubernard of the Edouard Herriot Hospital in Lyon, said in a statement.
The operation was performed on Sunday 27 November at the University Hospital Centre (CHU) in Amiens, northern France, and the surgical team says further details of the procedure will be issued on 2 December.
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The woman鈥檚 injuries were so severe that she could scarcely speak or chew. 鈥淭his type of injury is extremely difficult, if not impossible, to repair by the usual maxillofacial surgical techniques,鈥� the statement says.
The breakthrough ends a race between teams in France, the US and Britain to perform the procedure first. 鈥淣ow they鈥檝e done it, I can breathe a sigh of relief,鈥� says Peter Butler, head of a team hoping to perform a similar procedure, but with a whole face, at the Royal Free Hospital in London, UK. 鈥淣ow, the pressure鈥檚 off, which is great.鈥�
Aesthetic unit
Butler says the woman鈥檚 graft will consist of skin, fat and muscle tissue, including veins, arteries and nerves. 鈥淩ight now, she will be very swollen, and it will take 14 days or so for that to disappear,鈥� he told a briefing in London. 鈥淲ithin 24 hours they鈥檒l know if the graft will survive and, beyond that, failure is unusual.鈥�
Butler thinks that scarring will probably be minimal because the transplanted zone is a so-called 鈥渁esthetic unit鈥�, meaning it attaches at natural junctions that should hide the scars. Surgeons will monitor the transplanted flap every 2 hours to ensure it鈥檚 perfused with blood. They will also monitor for tissue rejection, which will be a risk during the first two weeks.
鈥淚f the blood vessels become blocked, there鈥檚 a risk of the operation failing,鈥� says Iain Hutchison, consultant facial surgeon at St Bartholomew鈥檚 Hospital in London. 鈥淎nd there鈥檚 a medium-term risk of the immunosuppressive drugs failing to control rejection.鈥�
Even if the graft takes, the patient will need to take immunosuppressive drugs for the rest of her life. This raises the risk of virally-induced cancers by decreasing the patient鈥檚 ability to keep dormant viruses in check.
Identity crisis
The patient and her family must also confront psychological consequences of the procedure, including possible crises of personal identity.
鈥淔acial appearance is very closely associated with an individual鈥檚 sense of personal identity, so the recipient must adapt to this new 鈥榠dentity鈥�, as well as to other people鈥檚 responses to it,鈥� says Stephen Wigmore, chair of the ethics committee of the British Transplantation Society.
Likewise, families of the donor must adjust to the possibility that they may see a living person resembling their dead relative, although computer simulations suggest that a transplanted face will have a 鈥渉ybrid鈥� appearance in which the facial features of the donor are altered by the bone structure of the recipient.
Closely followed
Butler says his team is about to start screening potential patients for a whole facial transplant. But it would be 6 to 12 months at the earliest before he attempts the procedure, which must also be cleared by the ethics committee of the Royal Free Hospital.
Other teams vying to perform the procedure are at the Cleveland Clinic Foundation in Ohio, and at the University of Louisville School of Medicine in Kentucky, both in the US.
鈥淭his is an exciting development,鈥� says John Barker, who leads the effort at the University of Louisville. 鈥淲e will be following the outcome closely for the medical, psychological and ethical information that may be gained.鈥�
