Face transplant
Encyclopedia
A face transplant is a still-experimental procedure to replace all or part of a person's face. The world's first full face transplant was completed in Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...

 in 2010.

Beneficiaries of face transplant

People with faces disfigured
Disfigurement
Disfigurement is the state of having one's appearance deeply and persistently harmed medically, as from a disease, birth defect, or wound.Disfigurement, whether caused by a benign or malignant condition, often leads to severe psychosocial problems such as negative body image; depression;...

 by trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

, burn
Burn (injury)
A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns affect only the skin . Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured...

s, disease, or birth defects might aesthetically benefit from the procedure. Professor Peter Butler
Peter Butler
Peter Butler may refer to:* Peter Butler , Conservative Member of Parliament* Peter Butler , European Ryder Cup golfer* Peter Butler , English Football League player...

 at the Royal Free Hospital
Royal Free Hospital
The Royal Free Hospital is a major teaching hospital in Hampstead, London, England and part of the Royal Free Hampstead NHS Trust....

 first suggested this approach in treating people with facial disfigurement in a Lancet Article in 2002. This suggestion caused considerable debate around the ethics of this procedure at that time.

The alternative to a face transplant is to move the patient's own skin from their back, buttocks or thighs to their face in a series of as many as 50 operations to regain even limited function and a face that is often likened to a mask or a living quilt
Quilt
A quilt is a type of bed cover, traditionally composed of three layers of fiber: a woven cloth top, a layer of batting or wadding and a woven back, combined using the technique of quilting. “Quilting” refers to the technique of joining at least two fabric layers by stitches or ties...

.

L. Scott Levin MD FACS, Chair, Department of Orthopaedic Surgery at University of Pennsylvania School of Medicine
University of Pennsylvania School of Medicine
The Perelman School of Medicine , formerly the University of Pennsylvania School of Medicine, was founded in 1765, making it the oldest American medical school. As part of the University of Pennsylvania, it is located in the University City section of Philadelphia, Pennsylvania. It is widely...

, has described the procedure as "the single most important area of reconstructive research."

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
Threshing machine
The thrashing machine, or, in modern spelling, threshing machine , was a machine first invented by Scottish mechanical engineer Andrew Meikle for use in agriculture. It was invented for the separation of grain from stalks and husks. For thousands of years, grain was separated by hand with flails,...

. Sandeep's mother witnessed the accident. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag. An article in The Guardian
The Guardian
The Guardian, formerly known as The Manchester Guardian , is a British national daily newspaper in the Berliner format...

recounts: "In 1994, a nine-year-old child in northern India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

 lost her face and scalp in a threshing machine
Threshing machine
The thrashing machine, or, in modern spelling, threshing machine , was a machine first invented by Scottish mechanical engineer Andrew Meikle for use in agriculture. It was invented for the separation of grain from stalks and husks. For thousands of years, grain was separated by hand with flails,...

 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. Sandeep's doctor was Abraham Thomas
Abraham Thomas
Abraham George Thomas is a surgeon specializing in reconstructive plastic surgery and microsurgery. In 1994 in India, he successfully performed the world’s first full facial and scalp reattachment on a nine-year-old girl, Sandeep Kaur....

, one of India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

's top microsurgeon
Microsurgeon
Microsurgeon can refer to:* Microsurgeon, a videogame by Imagic for the Intellivision game system.* A surgeon who specializes in microsurgery....

s. In 2004, Sandeep was training to be a nurse.

In 1996, 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 27 November 2005 by Bernard Devauchelle
Bernard Devauchelle
Dr. Bernard Devauchelle is a French oral and maxillofacial surgeon. He is best known as the first surgeon to successfully complete the first face transplant in November 2005 at Amiens University Hospital.- References :...

, an oral and maxillofacial surgeon, and Jean-Michel Dubernard
Jean-Michel Dubernard
Jean-Michel Dubernerd is a medical doctor specializing in transplant surgery, as well as a former Deputy in the French National Assembly.Dr...

 in Amiens
Amiens
Amiens is a city and commune in northern France, north of Paris and south-west of Lille. It is the capital of the Somme department in Picardy...

, France. Isabelle Dinoire
Isabelle Dinoire
Isabelle Dinoire, born 1967, was the first person to undergo a partial face transplant, after her Labrador dog mauled her in May 2005.-Personal life:Dinoire lives in Valenciennes, northern France, and she is the mother of two children....

 underwent surgery to replace her original face that had been mauled by her dog. A triangle of face tissue from a brain-dead human's nose and mouth was grafted onto the patient. On 13 December 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...

and documents that the patient was 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, Dr Guo Shuzhong at the Xijing military hospital in Xian, China similarly transplanted the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear
Asiatic Black Bear
The Asian black bear , also known as the moon bear or white-chested bear is a medium-sized species of bear, largely adapted for arboreal life, which occurs through much of southern Asia, Korea, northeastern China, the Russian far east and Honshū and Shikoku islands of Japan...

 while protecting his sheep. On 21 December 2008 it was reported that Li had died in July in his home village in Yunnan. Prior to his death, a documentary on the Discovery Channel showed he had stopped taking immuno-suppressant drugs in favor of herbal medication – suggested by his surgeon to be a contributing factor to his death.

A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a neurofibroma
Neurofibroma
A neurofibroma is a benign nerve sheath tumor in the peripheral nervous system. Usually found in individuals with neurofibromatosis type I , an autosomal dominant genetically-inherited disease, they can result in a range of symptoms from physical disfiguration and pain to cognitive disability...

 caused by a genetic disorder. The tumor was so massive that the man could not eat or speak properly.

In March 2008, the treatment of 30-year-old neurofibromatosis
Neurofibromatosis
Neurofibromatosis is a genetically-inherited disorder in which the nerve tissue grows tumors that may be benign or may cause serious damage by compressing nerves and other tissues...

 victim Pascal Coler of France ended after he received what his doctors call the world's first successful almost full face transplant.

Full face transplant

On 20 March 2010, a team of 30 Spanish doctors carried out the first full face transplant on a man injured in a shooting accident. It became the first full face transplant in the world.

On 8 July 2010, the French media reported that a full face transplant, including tear ducts and eyelids, was carried out at the Creteil Henri-Mondor hospital.

In March 2011, a surgical team, led by MUDr. Bohdan Pomahač
Bohdan Pomahač
Bohdan Pomahač is the plastic surgeon who led the team that performed the first full face transplant in the United States.-Biography:Pomahač's parents were a chemical engineer and a school teacher...

 at Brigham and Women's Hospital
Brigham and Women's Hospital
Brigham and Women's Hospital is the largest hospital of the Longwood Medical and Academic Area in Boston, Massachusetts. It is directly adjacent to Harvard Medical School of which it is the second largest teaching affiliate with 793 beds...

 in Boston, performed a full face transplant on Dallas Wiens
Dallas Wiens
Dallas Wiens is the first United States recipient of a full face transplant, performed at the Brigham and Women's Hospital during the week of March 14, 2011...

 who was badly disfigured in a power line accident and was blind and left without lips, nose or eyebrows. The patient's sight couldn't be recovered but he has been able to talk on the phone and smell.

In the United Kingdom

In October 2006, surgeon Peter Butler
Peter Butler (surgeon)
Peter E M Butler, FRCSI, FRCS is Professor of plastic surgery at University College London, consultant plastic surgeon, clinical director of surgery and head of the face transplantation team at the Royal Free Hospital in London, England.-Education and training:The eldest son of Professor Norman...

 at London's Royal Free Hospital
Royal Free Hospital
The Royal Free Hospital is a major teaching hospital in Hampstead, London, England and part of the Royal Free Hampstead NHS Trust....

 in the UK was given permission by the NHS
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 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.

In the United States

In 2004, the Cleveland Clinic
Cleveland Clinic
The Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio, United States. The Cleveland Clinic is currently regarded as one of the top 4 hospitals in the United States as rated by U.S. News & World Report...

 in Ohio
Ohio
Ohio is a Midwestern state in the United States. The 34th largest state by area in the U.S.,it is the 7th‑most populous with over 11.5 million residents, containing several major American cities and seven metropolitan areas with populations of 500,000 or more.The state's capital is Columbus...

, United States, became the first institution to approve this surgery and test it on cadavers.

In 2005, the Cleveland Clinic became the first US hospital to approve the procedure. In December 2008, a team at the Cleveland Clinic, led by Dr Maria Siemionow
Maria Siemionow
Maria Siemionow is a Polish surgeon at the Cleveland Clinic in Cleveland, Ohio. She gained public notice in December, 2008, when she led a team of six surgeons in a 22-hour surgery, performing the first face transplant in the United States on Connie Culp. She is currently Director of Plastic...

 and including a group of supporting doctors and six plastic surgeons (Dr Steven Bernard, Dr Mark Hendrickson, Dr Robert Lohman, Dr Dan Alam and Dr Francis Papay) performed the first face transplant in the US on a woman named Connie Culp
Connie Culp
Connie Culp is the first United States recipient of a face transplant, performed at the Cleveland Clinic in December 2008.-Facial disfigurement:...

. 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. As doctors recovered the donor's facial tissue, they paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures. 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. She had been disfigured to the point where she could not eat or breathe on her own as a result of a traumatic injury several years ago, which had left her without a nose, right eye and upper jaw. Doctors 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 second partial face transplant in the US took place at Brigham and Women's Hospital
Brigham and Women's Hospital
Brigham and Women's Hospital is the largest hospital of the Longwood Medical and Academic Area in Boston, Massachusetts. It is directly adjacent to Harvard Medical School of which it is the second largest teaching affiliate with 793 beds...

 in Boston on 9 April 2009. During a 17-hour operation, a surgical team led by MUDr. Bohdan Pomahač
Bohdan Pomahač
Bohdan Pomahač is the plastic surgeon who led the team that performed the first full face transplant in the United States.-Biography:Pomahač's parents were a chemical engineer and a school teacher...

, replaced the nose, upper lip, cheeks, and roof of the mouth – along with corresponding muscles, bones and nerves – of James Maki, age 59. Mr. Maki's face was severely injured after falling onto the electrified third rail at a Boston subway station in 2005. In May 2009, he made a public media appearance and declared he was happy with the result. This procedure was also shown in the eighth episode of the ABC documentary series Boston Med.

The first full face transplant performed in the US was done on a construction worker named Dallas Wiens
Dallas Wiens
Dallas Wiens is the first United States recipient of a full face transplant, performed at the Brigham and Women's Hospital during the week of March 14, 2011...

 in March 2011. He was burned in an electrical accident in 2008. This operation, performed by Dr. Bohdan Pomahač and Dr. Jeffrey Janis, was paid for with the help of the US defense department. They hope to learn from this procedure and use what they learn to help soldiers suffering from facial injuries. One of the top benefits of the surgery was that Dallas has regained his sense of smell.

57 year old Charla Nash, who was mauled by a chimpanzee in 2009, underwent a 20-hour full face transplant in May 2011 at Brigham and Women's Hospital
Brigham and Women's Hospital
Brigham and Women's Hospital is the largest hospital of the Longwood Medical and Academic Area in Boston, Massachusetts. It is directly adjacent to Harvard Medical School of which it is the second largest teaching affiliate with 793 beds...

 in Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...

. Nash's full face transplant was the third surgery of its kind performed in the United States, all at the same hospital.

Surgery and post-operation treatment

The procedure consists of a series of operations requiring rotating teams of specialists. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (sometimes including the underlying fat, nerves, blood vessels, bones, and/or 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 system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...

s 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.

Popular culture

  • The procedure was very grotesquely, yet somewhat accurately, highlighted in Georges Franju
    Georges Franju
    -External links:* at Allmovie...

    's 1960 cult horror
    Cult film
    A cult film, also commonly referred to as a cult classic, is a film that has acquired a highly devoted but specific group of fans. Often, cult movies have failed to achieve fame outside the small fanbases; however, there have been exceptions that have managed to gain fame among mainstream audiences...

     film Les Yeux sans visage
    Eyes Without a Face
    Eyes Without a Face is a 1960 French-language horror film adaptation of Jean Redon's novel, directed by Georges Franju, and starring Pierre Brasseur and Alida Valli. During the film's production, consideration was given to the standards of European censors by setting the right tone, minimizing...

    , which translates to "Eyes Without a Face."
  • Kōbō Abe
    Kobo Abe
    , pseudonym of was a Japanese writer, playwright, photographer and inventor. Abe has been often compared to Franz Kafka and Alberto Moravia for his surreal, often nightmarish explorations of individuals in contemporary society and his modernist sensibilities....

    , Japanese author and playwright, wrote The Face of Another
    The Face of Another
    is a 1959 novel by Kōbō Abe. In 1966, It was adapted into a film directed by Hiroshi Teshigahara.-Synopsis:A plastics scientist loses his face in an accident and proceeds to obtain a new face for himself. With a new 'mask', the protagonist sees the world in a new way and even goes so far as to have...

    (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
    Protagonist
    A protagonist is the main character of a literary, theatrical, cinematic, or musical narrative, around whom the events of the narrative's plot revolve and with whom the audience is intended to most identify...

     sees the world in a new way and even goes so far as to have a clandestine "affair" with his estranged wife. This novel was made into a film of the same name by Hiroshi Teshigahara in 1966.
  • The plot of the 1997 film Face/Off
    Face/Off
    Face/Off is a 1997 action thriller film directed by John Woo, starring John Travolta and Nicolas Cage. The two both play an FBI agent and a terrorist, sworn enemies who assume the physical appearance of one another....

    is based on a face transplant operation that involved changing the underlying structure and actual face shape. In the film, the transplant is shown to be reversible, with the patient being able to replace his original face if desired.
  • An episode of The Simpsons
    The Simpsons
    The Simpsons is an American animated sitcom created by Matt Groening for the Fox Broadcasting Company. The series is a satirical parody of a middle class American lifestyle epitomized by its family of the same name, which consists of Homer, Marge, Bart, Lisa and Maggie...

    , The Bob Next Door
    The Bob Next Door
    "The Bob Next Door" is the twenty-second episode of The Simpsons twenty-first season and the 463rd episode overall on Fox Broadcasting Company...

    , features Sideshow Bob
    Sideshow Bob
    Robert Underdunk Terwilliger, better known as Sideshow Bob, is a recurring character in the animated television series The Simpsons. He is voiced by Kelsey Grammer and first appeared briefly in the episode "The Telltale Head". Bob is a self-proclaimed genius who is a graduate of Yale, a member of...

     using face transplants to exchange his face with a cellmate as part of an elaborate prison escape plan so he can murder Bart
    Bart Simpson
    Bartholomew JoJo "Bart" Simpson is a fictional main character in the animated television series The Simpsons and part of the Simpson family. He is voiced by actress Nancy Cartwright and first appeared on television in The Tracey Ullman Show short "Good Night" on April 19, 1987...

    .
  • The procedure is included in the eighteenth episode of fifth season of Grey's Anatomy
    Grey's Anatomy
    Grey's Anatomy is an American medical drama television series created by Shonda Rhimes. The series premiered on March 27, 2005 on ABC; since then, seven seasons have aired. The series follows the lives of interns, residents and their mentors in the fictional Seattle Grace Mercy West Hospital in...

    , titled Stand By Me
    Grey's Anatomy (season 5)
    Season five of Grey's Anatomy, an American medical drama television series developed by Shonda Rhimes, began airing on September 25, 2008 on ABC. The season concluded on May 14, 2009 after 24 episodes had aired.- Cast :- Main cast :...

    .
  • Episode 9 of Season 3
    Nip/Tuck (season 3)
    The third season of Nip/Tuck premiered on September 20, 2005 and concluded on December 20, 2005. It consisted of 15 episodes.- Main cast :* Dylan Walsh as Dr. Sean McNamara* Julian McMahon as Dr. Christian Troy* John Hensley as Matt McNamara...

     of Nip/Tuck
    Nip/Tuck
    Nip/Tuck is an American drama series created by Ryan Murphy, which aired on FX in the United States. The series focuses on McNamara/Troy, a plastic surgery practice, and follows its founders, Sean McNamara and Christian Troy...

     includes the procedure.
  • There are advertisement posters in Repo! The Genetic Opera
    Repo! The Genetic Opera
    Repo! The Genetic Opera is a 2008 horror-rock opera musical film directed by Darren Lynn Bousman. The film is based on a play written and composed by Darren Smith and Terrance Zdunich....

    that display "Replace Your Face, Coming in 2057", that promote cosmetic face transplants.

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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