In 1994, 9-year-old Sandeep Kaur’s hair became entangled in a threshing machine pulling off her entire face, scalp and hair. Doctors successfully reattached her face and while she never regained full mobility, she has been able to lead a normal life. This facial reattachment surgery was essentially the first human face transplant.
Since that time 17 facial transplant surgeries, some partial and some full, have been carried out. Prior to doctors learning how to perform this challenging surgery, a person’s only option was to have skin grafts taken from other areas of the body or from cadavers. Grafted skin does not resemble facial skin nor move like facial skin and each surgery is subject to failure if the skin graft does not take to the new location.
Successful facial transplant surgery starts with finding a suitable donor of similar age and skin tone. However, more importantly, the donor and recipient must have similar blood and tissue type. Doctors use HLA typing (Human Leucocyte Antigen) to determine if the two are a match. HLA typing tests whether the antigen proteins from the donor’s skin will allow for the immune system of the recipient to accept the transplant.
After determining the two are a match, surgeons will remove the amount of facial skin needed by the recipient along with the underlying fat, muscle, cartilage, nerves and blood vessels. The donor face is then placed on ice for transport to the hospital where the recipient is in the operating room being made ready to accept the transplant.
Surgeons use microscopic needles and threads to first connect the blood vessels from the recipient to the donor’s so that oxygen-rich blood can perfuse the transplanted face. Nerves and muscles are also connected so the recipient will regain sensation and movement as the transplanted face heals. Immunosuppressant drugs will need to be taken by the recipient for the rest of their life to prevent tissue rejection.
Defining what a facial transplant is, is based on the needs of the recipient. According to WebMD, “the face extends from the bottom of the eyes to below the chin. The brow is not transplanted, as it is part of the skull and has a different blood supply than the lower face. Eyes are not transplanted, either, although eyelids may be part of a face transplant.” Additionally bone may be transplanted and tear ducts.
The surgery can take over 20 hours and the skills of over 50 medical personnel. Dr. Siemionow, the doctor who performed Connie Culp’s surgery in 2005, stated that her team included eight reconstructive surgeons, four anesthesiologist, and two transplant surgeons.
Here in the United States, the two hospitals that have performed facial transplants are Brigham and Women's Hospital in Boston, and the Cleveland Clinic. Other hospitals such as the University of Pennsylvania are considering adding facial transplantation to their repertoire of surgeries performed.
One facial transplant recipient Mitch Hunter had his surgery at Brigham and Women's Hospital after suffering severe facial electrical burns after a car crash. He told ABC news that “Ten years from now this (kind of surgery) might be an everyday occurrence.” Maybe it will.
Face transplants starting to gain acceptance. By KEVIN B. O'REILLY, amednews staff. Posted Sept. 19, 2011. Retrieved 2, Oct. 2011.
What Face Transplants Can, Can't Do. Daniel J. DeNoon. WebMD. Aug. 12, 2011. Retrieved 2, Oct. 2011.
How Face Transplants Work by Stephanie Watson. How Stuff Works: Discovery Health. Retrieved 2, Oct. 2011.
Indiana Man Receives Nation's Third Full Face Transplant. By KIM CAROLLO. April 27, 2011 ABC News Medical Unit. Retrieved 9, Oct. 2011.
Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues. Other articles by Michele are at www.helium.com/users/487540/show_articles
Edited by Jody Smith