Is a 'Full Face Transplant' Possible?

Doctor questions what Spanish surgeons really mean by "full face."

April 23, 2010, 5:16 PM

April 24, 2010— -- A team of Spanish doctors announced Thursday that they are the first in the world to successfully complete a "full facial transplant."

But a doctor who led the team that completed the first partial face transplant in the U.S. questions what "full facial transplant" actually means.

"This is an important contribution, but there was no available picture of the patient before so it is difficult to judge," said Dr. Maria Siemionow, who led the Cleveland Clinic team that performed the first U.S. face transplant /a> in 2008.

Siemionow went on to say that technically, a "full face transplant" would likely never happen.

"For someone to have no face at all -- they would not survive to start with," said Siemionow, who operated on gunshot victim Connie Culp. "They would not be a patient without a face, only with the neck."

Aside from semantics, Siemionow said doctors would not perform a face transplant without enough of the patient's original face in case the transplant did not work.

"Only patients who have enough skin or tissues in their own body ...[can] be a candidate so in case of a failure we would have the skin to cover them," said Siemionow.

She also noticed a few differences between news reports the operation performed in Spain and his teams operation on Culp.

"We have not done part of a lower jaw transplant as they are claiming," said Siemionow. "They are not mentioning any part of the eyelids and eyelids are a very important part. We have transplanted part of the lower eyelid not the upper."

Siemionow said whatever the difference between the operations, each feat is worth celebrating.

"This is another contribution and valuable," said Siemionow.

But Spanish doctors say no previous operation compares to the feat performed at Vall d'Hebron Hospital in Barcelona last month.

The lead surgeon is calling it a "full face transplant" that included all of the donor's jaw, teeth and even bone behind the lips.

Under Dr. Joan Pere Barret, a team of 30 doctors transferred skin and muscles, nose, lips, palate, teeth, cheekbones and the jaw. The team used both plastic surgery and micro-neurovascular reconstructive surgery techniques. The operation reportedly took 24 hours to perform.

Doctors Protect Identity of Spanish Face Transplant Recipient

Doctors declined to share the name or age of the patient, saying only that he is a Spaniard who suffered severe disfigurement in an accident five years ago.

The injuries left him unable to swallow, speak or breathe properly. Nine previous surgeries failed to help him, the hospital said in a statement. When he is completely healed, the patient will have one visible scar across his neck.

Most of the earlier face transplants, Siemionow counts 10, weren't as extensive.

Isabelle Dinoire, who was mauled by her pet Labrador in France, was the first person to receive a partial face transplant in 2005.

In 2008, Siemionow's patient Culp became the first person in the U.S. to receive a face transplant. Nearly all of Culp's face was destroyed when her ex-husband shot her in the face with a shotgun. Doctors called Culp's surgery a "near-total" face transplant.

James Maki became the second person to receive a face transplant in the U.S. after he fell head first into the electrified third rail of a commuter line outside of Boston. In 2009, doctor revealed his new face included a completely new nose from a donor.

Barret told reporters in a presentation not to assume the patient will look like the donor.

"He absolutely does not look like the donor patient and I think this is important for society to know, for future donations of faces, that there is no such danger," he said, in a press conference.

The anonymous patient cannot speak yet, but Barret said he is recovering well and already walking, swallowing on his own and watching television.

Plastic surgeon Dr. David Staffenberg said such feats could be transferred to help a greater number of patients with less severe disfigurements.

"Sewing together of skin, sewing together muscle, and nerves, and arteries and veins -- these are things that plastic surgeons do every day," said Staffenberg, who is chief of the division of plastic surgery at Montefiore Medical Center at New York City.

Others May Benefit From Groundbreaking Face Transplants

Staffenberg said what surgeons learn from collaborating with a team of 30 doctors of various specialties might also translate into better medicine for the rest of us.

"We can't work as surgeons in a vacuum," said Staffenberg, added that anesthesiologists, doctors to manage the cocktail of drugs needed to keep patients from rejecting the donor tissue, even therapists to teach the patient to control their new muscles are all essential.

Staffenberg said turning to a radical face transplant is not about ambition. In some cases, it becomes the most practical choice considering the intricate details involved to make a person's face look uniform and function well.

"Although we can usually do some kind of reconstruction, at the end of the day, what would be better to replace a ravaged face than a face?" he asked.

Still, Siemionow notes that the procedures carry great risks.

"We don't have such a long follow up. So far the longest follow up is only four years," said Siemionow.

Not only are there extensive risks during surgery, the patient's immune system might reject the tissue afterwards. Siemionow noted that two face transplant recipients -- one in China and one in France -- have already died.

"For these [transplant] patients there is no other chance, so they take the risk," said Siemionow. But she said the risks "it should be very clearly indicated to the patient it has to be weighed by the patient and the family."

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