Facial Transplant
Scott Levin, chief of plastic and reconstructive surgery at the Duke University Medical Center, has described the procedure as "the single most important area of reconstructive research."
History
Self as donor (face replant)
The world's first full-face replant operation was on nine year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag.
An article in the The Guardian recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin." The operation was successful, although the child was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on.
In 2004, Sandeep was training to be a nurse.
In 1997, a similar operation was performed in the Australian state of Victoria, when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.
Partial face transplant
The world's first partial face transplant on a living human was carried out on November 27, 2005 by Professor Jean-Michel Dubernard, a plastic and microsurgeon in Amiens, France. Isabelle Dinoire underwent surgery to replace her original face that had been ravaged by her dog.
A triangle of face tissue from a brain-dead human's nose and mouth was grafted onto the patient. On December 13, 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine and documents that the patient is happy with the results but also that the journey has been very difficult, especially with respect to her immune system's response.
In April, 2006, the Xijing military hospital in Xian, China carried out a similar operation, transplanting the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear while protecting his sheep..
On December 21, 2008 it was reported that Li Guoxing had died in July in his home village in Yunnan Province.
Prior to his death, a documentary on the Discovery Channel showed he had stopped taking immuno-suppressant drugs in favor of herbal medication.This was suggested to be a contributing factor to his death by his surgeon, Dr Guo Shuzhong.
US Partial facial transplants
In 2004, the Cleveland Clinic in Ohio, USA, became the first institution to approve this surgery and test it on cadavers.
In October 2006, surgeon Peter Butler at London's Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out the face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals.
A 29-year-old French man underwent surgery in 2007.
He had a facial tumor called a neurofibroma caused by a genetic disorder. The tumor was so massive that the man couldn't eat or speak properly.
In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after having received what his doctors call the worlds first successful full face transplant.
The Cleveland Clinic became the first US hospital to approve the procedure four years ago.
Maria Siemionow and including a group of supporting doctors and six plastic surgeons (Dr. Francis Papay) performed the first face transplant in the US on a woman named Connie Culp. It was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date.
This operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw and even some teeth from a brain-dead donor.
The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure. They hoped the operation would allow her to regain her sense of smell and ability to smile and said she had a "clear understanding" of the risks involved.
The United States' second partial face transplant took place in a 17-hour operation in Boston on April 9, 2009 on James Maki, age 59.
He lost his nose, upper lip, cheeks, roof of his mouth, with associated muscles, bones and nerves after falling onto the electrified third rail at a Boston subway station in 2005. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (including the underlying fat, nerves and blood vessels, but no musculature).
The surgery may last anywhere from 8 to 15 hours, followed by a 10–14 day hospital stay.
After the procedure a lifelong regimen of immunosuppressive drugs is necessary to suppress the patient's own immune systems and prevent rejection. Long-term immunosuppression increases the risk of developing life-threatening infections, kidney damage, and cancer.
The surgery may result in complications such as infections that could turn the new face black and require a second transplant or reconstruction with skin grafts.
The transplant does not give the patient's face the appearance of the deceased donor's face because the underlying musculature and bones are different. Facial movements are controlled by the brain, so the personality as expressed by the face remains that of the patient..
Popular culture
1960: The procedure was very grotesquely, yet somewhat accurately, highlighted in Georges Franju's cult horror masterpiece called Les Yeux sans visage which translates to "Eyes Without a Face".
1964: Kōbō Abe, Japanese author and playwright, wrote The Face of Another (1964) about a plastics scientist who loses his face in an accident and proceeds to construct a new face for himself.
With a new face, the protagonist sees the world in a new way and even goes so far as to have a clandestine "affair" with his estranged wife. He uses this new material to disguise himself and hunt down the criminals responsible for his mutilation.
1996: Facial transplant surgery was featured in an episode of Star Trek: Voyager.
1997: The plot of the movie Face/Off was based on a face transplant operation that involved changing the underlying structure and actual face shape.
Maria Siemionow of Cleveland Clinic and Christine Piff, founder of Let's Face It, an organization based in the UK that supports people with facial differences.
2008: The Facial transplant was mocked in the Argentinian series "Los Simuladores."
2009: First facial transplant in world including jaws and tongue in La Fe Hospital, Valencia, Spain, by Dr. http:www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/03/23/wface123.xml.
http:www.google.com/hostednews/ap/article/ALeqM5g4njTcm3JxdkeF3xkWT4J5Dk5QtwD953UAC00.