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First U.S. Patient Receives Face Transplant

BY Admin  December 18, 2008 at 6:40 PM EDT

Surgeons; Photo Cleveland Clinic

Doctors there performed the most extensive face transplant ever, and the first in the U.S., replacing 80 percent of the woman’s face, including skin, muscles, bone, nerves and arteries.

“I’m very proud and emotional today to share with you what we finally did,” Maria Siemionow, the surgeon who led the team, said in a press conference. “The patient is doing well … I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw.”

To protect the patient’s privacy, her name, age and the details of her injuries were not specified. But doctors said that before the surgery the woman was missing her right eye, nose and upper jaw. She couldn’t speak or smell, and had to breathe through a hole in her windpipe.

Doctors said that they expect it will take two months for swelling from the surgery to subside, and another six months until feeling returns to her face. But eventually they expect that she will be able to eat, speak and breathe normally.

“We never thought for a moment that our sister would ever have a chance at a normal life again, after the trauma she endured,” the patient’s sibling said in a statement. “There are tears of joy, and tears of pain that it took one to pass for one to have a life.”

The achievement is the world’s fourth face transplant — in 2005, doctors replaced part of the face of a French woman mauled by her dog. Since then, two more face transplants have been completed, one in China and another in France.

The transplant announced Wednesday, though, was the most extensive ever, with doctors replacing 77 square inches of the woman’s face.

The doctors determined they had a donor match around 8 pm on a night sometime during the past two weeks — when they found a donor with similar sex, race, age and blood type. The surgeon spent more than nine hours carefully removing the donor’s face. They then spent another nearly 12 hours carefully stitching together the patient’s and donor’s blood vessels, arteries, nerves and veins.

The woman, however, will not look like her donor, because the donor tissue will mold to her own bone structure.

“[The new face] winds up being somewhere in between the two, but not like the patient looked before or like the donor exactly,” David Staffenberg, chairman of plastic surgery at Montefiore Medical Center in New York, who was not involved in the surgery, told Scientific American.

The patient has already passed her first test — her body did not immediately reject the donor tissue. However, she will have to take anti-rejection drugs for the rest of her life, and even these can’t ensure success.

Because of the dangers of the surgery and drug regimen, face transplants have been controversial. Some ethicists have argued that they are unnecessary, because facial disfigurement is not life-threatening.

But others disagree: “You need a face to face the world,” Siemionow said in a press conference. “Our patient was called names and humiliated [...] children ran away.”

Dr. Eric Kodish, chairman of the clinic’s bioethics department, said the patient underwent thorough psychological evaluation before the surgery and understood its risks. He also said in a statement that the hospital staff would do “everything we can” to prevent misuse of the surgery.

“We do not think this should be used for cosmetic enhancement,” he said. “A person who’s suffered trauma to the face suffers tremendously. We hope our patient will begin to smile again, begin to smell again. The relief of suffering is at the core of medical ethics and provides abundant justification for performing this procedure.”