Face Transplants Show Promising Results

2 cases demonstrate efficacy of surgery, but tissue rejection must be monitored, reports say

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THURSDAY, Aug. 21, 2008 (HealthDay News) -- Two cases of face transplantation demonstrate the procedure can be used for long-term restoration of serious facial disfigurement.

The first case involves a 30-year-old Chinese man who had part of his face torn off in a bear attack in October 2004. In April 2006, the man underwent transplantation that included connection of arteries and veins, along with repair of the nose, lip, sinuses and other damaged facial structures.

The man received four different drugs to modulate the immune system and decrease the chances of tissue rejection, along with drugs to prevent infections. There were episodes of acute tissue rejection at three, five and 17 months after transplantation. These were controlled by dose adjustment of one of the immunomodulatory drugs or by use of a steroid.

The man's kidneys and liver functioned normally, and he had no infections.

"Facial transplantation could be successful in the short term, but the procedure is not without complications... This case suggests facial transplantation might be an option for restoring a severely disfigured face and could enable patients to readily integrate themselves back into society," concluded Shuzhong Guo, of the Institute of Plastic Surgery, Xijing Hospital and Fourth Military Medical University in Xi'an, and colleagues.

The case report was published in this week's issue of The Lancet.

The second article describes a 29-year-old male patient in France with a seriously disfiguring facial tumor called a neurofibroma that had infiltrated the middle and lower part of his face.

His transplantation surgery in January 2007 -- meant to restore both appearance and function to his face and to help him regain the ability to communicate and socialize -- involved removal of a large part of his face and replacement with donor tissue.

The patient experienced episodes of tissue rejection 28 and 64 days after the transplant, but both episodes were successfully managed by doctors. One year after the surgery, sensation and motor function had returned in the transplanted area.

The man's psychological recovery was excellent, and he achieved complete social reintegration. He also began full-time work 13 months after the transplant.

"Our case confirms that face transplantation is surgically feasible and effective for the correction of specific disfigurement, due in this case to a genetic disorder...Long-term follow-up is needed to assess the risks linked to the immunogenicity of allogenic composite tissues, particularly as regards life expectancy. Following this initial success, other patients are currently being assessed," concluded Laurent Lantieri, of the department of plastic and reconstructive surgery, CHU Henri Mondor in Creteil, and colleagues.

In an accompanying editorial about both reports, Dr. Jean-Michel Dubernard, of the E Herriot University Lyon I Hospital, France, and Dr. Bernand Devauchelle, of the Amiens-Nord University Hospital, Amiens, France, wrote that cooperation between the pioneering teams responsible for these operations is necessary "to answer the many technical, functional, immunological, and psychological questions raised by face transplantation."

"The definition of the best indications - e.g., trauma, malformations, benign tumors, burns -- will also greatly benefit from this cooperation," they added.

The world's first face transplant was performed in Amiens, France, in November 2005. It involved 38-year-old Isabelle Dinoire, who was mauled by her dog and had a nose, lips and chin grafted onto her face. The donor was a brain-dead 46-year-old woman.

Eighteen months after the landmark transplant, Dinoire was able to eat, drink and smile.

More information

MedlinePlus has more about face and head reconstruction.

SOURCE: The Lancet, news release, Aug. 21, 2008


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