First U.S. facial transplantation procedure: Functional, psychological, and social outcome excellent

Jan 23 2010

Detailed information on the first facial transplantation procedure performed in the United States is presented in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

"We are pleased to report an excellent functional, psychological, and social outcome for our patient at 8 months following transplantation," write Dr. Maria Z. Siemionow and colleagues of the Cleveland Clinic. Their article describes not just the transplant operation itself, but also the prolonged, arduous process of gaining approval, planning, and preparing for the groundbreaking procedure.

Five-Year Effort to Prepare for Facial Transplantation Procedure

The first U.S. facial transplantation procedure was performed in December, 2008, at the Cleveland Clinic. However, the process started in 2003, when a multidisciplinary team of plastic surgeons, psychiatrists, immunologists, bioethicists, and other professionals submitted a proposal to perform a "composite facial allograft transplant" to the Cleveland Clinic's institutional review board. Approval was granted in 2004, followed by painstaking efforts to develop an appropriate informed consent procedure and win approval from organ procurement organizations.

With careful consideration, the first patient was chosen: a 45-year-old woman with severe, disfiguring facial injuries caused by a short-range shotgun blast. The patient was left with severe disabilities after exhausting all conventional reconstructive surgery options. The transplant team devoted countless hours to preparation, including mock cadaver operations designed to simulate the patient's specific deformity and disabilities.

After months of preparation, an acceptable deceased donor was found. The article describes each step of the 22-hour procedure, in which over 80 percent of the craniofacial anatomy was replaced. The operation was followed by extensive rehabilitation and physical therapy, including "re-education" to help the patient adjust to and accept her new face.

Smooth Recovery and Excellent Outcomes

The patient has recovered well, with no serious complications through eight months of follow-up. With "true dedication" to her recovery, the patient has regained most facial functions, including sense of smell, speech, and the ability to eat solid foods and drink from a cup. Her facial sensation is near-normal, and motion is recovering slowly but steadily. The authors report that their patient is strong "socially, emotionally, physically, and spiritually." She is confident about re-entering the public arena and looking forward to helping other patients with severe facial injuries.

Including the Cleveland Clinic case, nine facial transplants have now been performed worldwide. Dr. Siemionow and the transplant team are encouraged by progress in the medical/surgical, legal, and ethical approaches to this procedure. "We share our enthusiasm of supporting facial allograft transplantation, at early reconstructive stages, in a carefully selected group of severely disfigured patients with multiple functional deficits," they write.

At the same time, they sound a note of caution regarding the risks associated with such complex and intricate surgery—as illustrated by the reported deaths of two face transplant recipients in France and China. The authors conclude, "[I]f, at some point, the paradigm shift in reconstruction of massive facial injuries is rushed or unjustified, this may have a tremendous negative impact on the entire field of composite tissue allograft transplantation."

SOURCE American Society of Plastic Surgeons (http://www.plasticsurgery.org/)