Three people received full-face transplants at Brigham and Women’s Hospital in Boston this year.
Now, physicians are reporting the details of the extensive procedures — which include grafting not only the skin, but also nerves, muscles, blood vessels, and structures like the nose. The report appears in the New England Journal of Medicine.
We’ve covered some of the medical developments in those cases: The first patient in the U.S. to undergo the extensive operation, Dallas Wiens, reported regaining his sense of smell just a few days after surgery. He was injured in 2008 when he came into contact with a power line. The second patient also experienced a severe electrical burn.
The third patient to undergo a full-face transplant, Charla Nash, was a victim of a chimpanzee attack in 2009. She underwent surgery in May.
Dr. Bohdan Pomahac, director of the plastic surgery transplantation program at Brigham and Women’s, is the lead author of the report describing the three cases. He says the chief obstacle to the surgery had been the belief that you’d need to connect four arteries and a corresponding number of veins in order to provide enough blood flow to the transplanted tissues.
“If that were the case, it would be extremely complicated,” he says. But the team at the hospital used a simplified method, connecting just one artery and one vein on each side of the face.
The team also connected all the main available motor and sensory nerves, in an attempt to restore function to the face. “When the patient wants to blink,” he can do so, says Pomahac. He says patients can expect to get back between 75 percent to 90 percent of facial function. That may take time, however; Nash, for example, experienced a return of sensation, but not yet motor function, at the three-month mark, the report says.
The chief complication experienced by the patients was infection, due to the immunosuppressive drugs they took to prevent rejection of the transplanted tissues. All of them recovered. And, says Pomahac, over time their drug regimen has been tapered down from four drugs to two, to minimize the chance of side effects.
The hospital has a Defense Department grant to fund these transplants in civilians and veterans. Potential candidates must meet certain requirements, including the loss of at least 25 percent of the facial tissue or a major, irreplaceable part of the face such as the nose or the lips.
“They look like someone completely new,” Pomahac says, though because their body language and speech is the same, it’s “remarkably easy” to identify them.