Charla Nash, Victim of Chimp Attack, Evaluated for Face Transplant

Boston hospital considers face, hand transplant for disfigured blind woman.

November 11, 2009, 10:58 AM

May 10, 2010— -- Charla Nash, the Connecticut woman whose face and hands were destroyed by a chimpanzee, may yet be a candidate for a face and hand transplant, even though doctors initially told her she was not eligible for the lengthy and dangerous surgeries.

Nash, 56, who last week was discharged from the Cleveland Clinic, is currently being evaluated by a team of physicians in Boston to determine if surgery can replace the nose, lips, eyes and fingers she lost in February 2009, when she was mauled by a 200-pound chimpanzee owned by her friend and employer.

"Charla Nash is at Brigham and Women's Hospital for a preliminary evaluation to determine if she is a potential candidate for face and hand transplant. We expect her to be at Brigham and Women's for a couple of days," hospital spokesman Peter Brown said in a statement.

Nash underwent several surgeries at the Cleveland Clinic, but physicians there said it was unlikely face and hand transplants could be performed simultaneously.

"Charla has a number of options before her, all of them positive options," said John Orr, Nash's spokesman.

"Further evaluation and consultation are necessary. There are still a lot of dots to connect here. She's getting better and she is mentally bright. We're considering a lot of scenarios at a number of places around the country. Right now she moved to Boston to be closer to her home, daughter who is starting college and her brothers," he said.

Nash left Cleveland on May 6, after nearly a year and half there, where she underwent surgery and regular rehabilitation. After her evaluation at Brigham and Women's she will live at an assisted living center near Boston.

Doctors said Nash's blindness made it unlikely that she would be approved for a hand transplant, given the difficulty she would have using a new hand if she were unable to see.

"A double transplant makes finding a donor more difficult, although face is the primary determinant of donor selection, hand must match as well," said Dr. Richard Winters of the department of facial and plastic surgery at Hackensack University Medical Center in New Jersey. He spoke to earlier this year when Nash first revealed on the Oprah Winfrey show both her mangled face and her desire to receive a transplant.

Charla Nash, Victim of Chimp Attack, Evaluated for Transplant

Winters said the operation would be more difficult than the typical single transplant because of the precision and coordination necessary.

"A double transplant needs to be orchestrated simultaneously or preferably in sequence, for example the face followed in several days by the hand," Winters said. "Timely restoration of blood flow to transplanted parts is key -- so this requires unorthodox management of the donor."

Winters said even if the surgery was initially successful, many patients' bodies reject transplanted faces and hands.

"There have been postoperative issues with many of the hand and facial transplant patients done in the U.S.," he said. "Although the science has been elegantly outlined, the translation into clinical practice is very close… but not yet where it needs to be to consider a case like this."

If Nash were to receive both hand and face transplants, the risk of rejection would increase, he said.

"Should problems arise with one transplant or the other, as they often do in this type of surgery, one operation can compromise the other ... or more significantly can synergistically affect the overall morbidity/mortality of the patient," he said.

Nash was attacked in February 2009 when her friend and boss, Sandra Herold, asked for help luring Travis, a 200-pond chimp, back into the room-sized cage she kept in her suburban Connecticut home.

Nash lost most of both hands, but had a thumb surgically replaced on her left hand. Doctors removed her eyes and grafted a piece of her leg where her nose used to be.

She has a small slit where her mouth once was. Through it, she takes all her meals by straw.

Charla Nash, Victim of Chimp Attack, Evaluated for Transplant

"She's doing a little bit better," said Monaco. "She still has challenges and still must take food by liquid or pureed. She is at a stage where she is stable, but still has physical issues."

"I'm not a candidate for a hand transplant because I have no eyesight. I hope somewhere along the way to get a face transplant and get a hand transplant at the same time," Nash told Winfrey in her one interview since the attack.

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