Nearly eight months to the day since undergoing the world's first partial face transplant, a French woman is smiling -- broadly.
The woman, Isabelle Dinoire, continues to improve more rapidly than expected, says Emmanuel Morelon, MD, PhD, a member of the Lyon-based team providing her follow-up care.
Morelon spoke at the World Transplant Congress 2006 here. In a talk peppered with dramatic before and after pictures, Morelon offered a glimpse of the recovery of Dinoire, 38, who was severely disfigured in May 2005 after a dog bite amputated part of her face.
French surgeons at Amiens University Hospital transplanted the nose, lips, cheeks, and chin of a brain-dead donor in a 15-hour operation on Nov. 27.
A Rapid Recovery
Dinoire started eating and drinking just one week after the operation, Morelon says. Her speech soon improved. By four months later, sensation had mostly returned.
At six months, the changes became even more dramatic. She could press her lips, which had been droopy, together. She could feel hot and cold sensations, even light touches.
Best of all, she could smile again, he says.
"She doesn’t have complete movement, but it’s very good," Morelon tells WebMD.
Dinoire is upbeat about her new image, he adds. Her social life is back to normal. Last week, she took a vacation in Italy.
"The very nice aesthetic results have led to good acceptance by the patient," he says, adding that the excellent outcomes could not have been achieved with traditional plastic surgery.
"Her face is more and more normal," Morelon says. "She’s happy."
Two Rejection Episodes to Date
That’s not to say her recovery has been easy.
Whenever someone receives tissue transplanted from another person, there’s a risk of rejection.
Doctors give them drugs that suppress the immune system in an effort to prevent that from happening.
But they don’t always work. And twice -- three weeks after the procedure, then just one month ago -- Dinoire suffered tissue rejection. Her new facial tissue swelled and turned red.
In both cases, temporarily increasing the doses of immune suppressing drugs resolved the problem.
Also last month, Dinoire developed herpes sores, a common infection in transplant recipients, on her lips. Antiviral drug therapy brought the condition under control.
The intricate transplant operation involved attaching muscles to muscles, nerves to nerves, and blood vessels to blood vessels, Morelon says.
Beforehand, surgeons put the donor face on iced sponges to keep it alive.
Then, the patient was prepped: Scar tissue was removed and the area was cleaned.
"The operation went perfectly," Morelon says.
Doctors also transplanted a flap of skin from the donor's arm under one of Dinoire's breasts. This allows them to do periodic biopsies to look for signs of rejection without scarring her face.
Before the procedure, Dinoire was evaluated by three psychiatrists, all of whom agreed with a fourth, independent, expert that she was fully able to psychologically cope with the procedure, Morelon says.
After the operation, she had psychological evaluations daily for the first month and then twice a week after that.
‘A Remarkable Recovery’
Laurent A. Lantieri, MD, head of plastic surgery at Hospital Henri Mondor in Paris, calls Dinoire’s recovery remarkable.
The big question has been whether she would regain movement, he tells WebMD.
"The goal is an animated face," says Lantieri, who plans to perform a partial face reconstruction in the near future. "And she has [one]. That makes this a breakthrough in reconstructive surgery."
By Charlene Laino, reviewed by Louise Chang, MD
SOURCES: World Transplant Congress 2006, Boston, July 22-27, 2006, Boston. Emmanuel Morelon, MD, PhD, Hospital Edouard Herriot, Lyon, France. Laurent A. Lantieri, MD, head of plastic surgery, Hospital Henri Mondor, Paris.