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Sunday, April 25, 2010

A new face after transplant.

Saturday, April 24, 2010.World's First Full Face Transplant in Spain - Full Surgery Video

  A hospital in Spain announced that it had carried out the world's first full-face transplant. The Vall d'Hebron Hospital in Barcelona said the patient, a young man, was given an entirely new face, including skin, jaws, chin, nose, cheeks, teeth and muscles. It said the 24-hour operation was performed in late March by a 30-member medical team.

In a statement on Friday, the hospital said the patient lost his face in an accident five years ago and has since been unable to swallow, speak, or breathe properly, and had to breathe and be fed through tubes. Speaking on Friday during a news conference at the hospital, Doctor Joan Pere Barret, who led the medical team that carried out facial transplant, said the patient asked to look in a mirror one week after the surgery, "and he reacted very calmly and with satisfaction" and in writing said "he said he was very grateful and satisfied." Dr Barret said that the man "absolutely does not look like a donor patient."

Barret declined to name the patient or give details of the accident in which the man lost most of his face, saying only that he was a Spaniard between 20 and 40 years old and was recovering well. The man cannot yet speak, eat or smile, but can see and swallow saliva, the surgeon said. The patient underwent psychiatric tests before the operation to determine if he would be able to confront having a totally new face, the hospital said. He is expected to remain hospitalised for two months.

Other transplant experts lauded the surgery but were not sure it could technically be called 'full-face.'

In Britain, the UK Facial Transplantation Research Team called the Spanish operation "the most complex face transplantation operation there has probably been in the world to date." It stopped short, however, of calling it the world's first full-face transplant. Barret said the operation involved removing what was left of the man's face and giving him a replacement "in one piece."

Barret said there have been 10 partial face transplant operations carried out in the world so far but that this is the first one involving a person's whole face. The world's first partial face transplant was carried out on a Isabelle Dinoire in France in November 2005. The 38 year old divorced mother of two received a new nose, chin and mouth from a brain-dead donor after being mauled by her pet Labrador. The 15-hour operation took place at the Amiens Teaching Hospital.

Face transplant: Computer generated image, Vall d'Hebron  University Hospital 

Face transplant: Computer generated image, Vall d'Hebron University Hospital
Face transpant images showing the squence of the procedure:  Computer generated images, Vall d'Hebron University Hospital, via  DailyMail.co.uk 

Face transpant images showing the squence of the procedure: Computer generated images, Vall d'Hebron University Hospital, via DailyMail.co.uk
'Before' image captured by MRI of man whose face had accidentally  been shattered: ©AP via DailyMail.co.uk

 Dr. Joan Pere Barret lead the team of surgeons and other medical personnel involved in two separate operations. First, the donor face had to be removed and placed in preservation liquids - not just the lips, cheek and forehead, but all of the veins, arteries, muscles, skin and subcutaneous fat attached to them. In the middle of this 4-hour process, the recipient was prepared for surgery, after making sure that things were going well with the donor's procedure.
Then began the really long surgery on the recipient, involving both the retrieval team and the transplant team. Once the repair work was completed on the donors blood vessels, they were attached by microsurgery to the patient's own. Then the donors bones, muscles, and connecting nerves were transplanted, before the donor's facial skin was sewn on.
The first face transplant patient will remain in the hospital for two more months to insure that his body will not reject the transplant. That is the main reason that prior partial face transplants have not been successful in the past. But this patient has seen his new face and, though he is unable to talk yet, he is reportedly pleased with it.
Doctors say that the recipient will not look exactly like the donor, but will look somewhat like the donor and somewhat like himself.
Doctor Peter Butler, a British surgeon who has been waiting for a donor in Britain to carry out his first facial transplant, congratulated the Spanish team, saying that the lives of millions of people will be benefitted by this technology. In acknowledging the importance of this work, Dr. Butler showed enormous empathy for facially disfigured persons.
"Their quality of life is indescribably poor and many seldom leave their homes. They live an almost twilight existence, hiding in shadows and afraid to expose themselves to unforgiving public scrutiny.... If facial transplantation is successful, it will be the first option offered to those who live in that awful twilight zone, and not the last. It will give them the opportunity to once again walk along a street in broad daylight with nobody noticing."
Isabelle Dinoire
The woman who underwent the world’s first face transplant raised serious ethical questions about the pioneering operation today.
It comes as British medics prepare to carry out a similar procedure.
Isabelle Dinoire admitted that, exactly three years on from the medical breakthrough, she remained uncertain as to whose face she looked at in the mirror every day.

Isabelle Dinoire 

Medical breakthrough: Isabelle Dinoire who underwent the world’s first face transplant.

Referring to the dead donor, Miss Dinoire said: ‘It’s not hers, it’s not mine, it’s somebody else’s.’
Miss Dinoire, a 41-year-old divorced mother of two from northern France, added: ‘Before the operation, I expected my new face would look like me, but it turned out after the operation that it was half me and half her.’
Suggesting that she had not yet worked out her new identity, Miss Dinoire said: ‘It takes an awful lot of time to get used to someone else’s face. It’s a peculiar type of transplant.’
Such psychological difficulties will concern British medics from the Royal Free Hospital in London who, two years ago, were given permission by the NHS ethics board to carry out the world's first full face transplant.
Surgeons have been transplanting livers, kidneys and hearts for many years, but faces have always been different.
They are seen as a sacred, untouchable parts of a person’s identity.
Unlike other organs, face transplants are not life-saving operations. As a result, ethical committees frequently blocked them from going ahead.
But transplant surgeon Jean-Michel Dubernard said after carrying out the operation: ‘Once I had seen Isabelle's disfigured face, no more needed to be said. I was convinced something had to be done for this patient.’
Isabelle Dinoire

New identity: Miss Dinoire has raised ethical questions about the pioneering operation on her face
Miss Dinoire, from Valenciennes, northern France, was given a new nose, mouth and chin at the nearby Amiens Hospital in November 2005.
She was rushed to hospital after her pet dog apparently ripped off the vital features.
Miss Dinoire herself had no memory of what happened.
After taking sleeping pills, all she could remember was waking up with blood on the ground.
When she tried to light up a cigarette, she realised her facial features were missing.
In spite of some early signs of immune rejection, Miss Dinoire soon regained sensation back in the transplanted face.
Rejection of the new tissue was brought under control by increasing the doses of immunosuppressant drugs, which Miss Dinoire is still taking.
Miss Dinoire made her latest comments in an exclusive interview with journalist Vanessa Pontet on ‘Reporters’, a programme about face transplants which will be broadcast on French channel NT1 tomorrow.
Despite her worries about the identity of the new face, Miss Dinoire admits that, technically at least, ‘it’s mine’, adding ‘it’s part of me.
‘I have the feeling of looking at something beautiful, I accept looking at myself now, but it was wasn’t easy at the beginning.’
She said she had ‘lots of physio to reactivate the muscles, and everything is back to normal as far as sensitivity is concerned.
Saying that face transplants should not be a taboo subject, Miss Dinoire said: ‘it’s important to get people to think about it because it completely changes your life.’

1. OBESITY surgery,
3. FACIAL TUMOR (Neurofibromatosis),
5. Blind man sees through tooth.
6. 31 fingers and toes

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