December 28, 2011— -- 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 Pomahac. "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 Pomahac.
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," Pomahac and his colleagues 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."