'Full Face' Transplant is a First, Spanish Doctors Say
Man who was disfigured in accident will have new jaw, teeth and just one scar.
April 23, 2010— -- Isabelle Dinoire, James Maki and Connie Culp all awed the public as some of the few on the planet to survive disfiguring accidents and benefit from cutting edge face transplants.
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.
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.
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.
Previous transplants did not include so many tissues in the face, or such a large area of the face. The entire operation took 24 hours to perform, according to the Associated Press. When he is completely healed, the patient will have one visible scar across his neck.
Earlier face transplants weren't as extensive. Dinoire, who was mauled by her pet Labrador, was one of the first person to receive a partial face transplant in 2005.
In 2008, Culp became the first woman 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 shot gun. Doctors called Culp's surgery a "near-total" face transplant.
Maki became the second person to receive a partial 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.