New framework measures the impact of facial transplants

A facial transplant is a procedure which impacts people mentally and physically -- but physicians and patients may not be aware of the full implications.

A facial transplant is a procedure which impacts people mentally and physically -- but physicians and patients may not be aware of the full implications.

Such radical surgery is far more than simply a before-and-after shot of someone's face, either partially or fully restored by using compatible donor tissue. It requires anti-rejection drugs over a lifetime -- but the mental implications can be just as serious.

Surgery which changes an element of someone's identity is never guaranteed. Not only can limbs or tissue be rejected by the body, but the psychological hurdles of accepting someone else's anatomy sometimes results in patients mentally rejecting the change.

The long-term implications of such procedures are still unknown, and if future patients are going to benefit -- potentially increasing the rates of success -- research has to be undertaken and documented.

Science Codex reports that researchers from The Johns Hopkins Hospital, Baltimore, MD, found that patient outcome data analyzed from a new scoring system has not been fully utilized for patients undergoing facial transplants.

The "FACES score" measures a patient's ability to return to a normal life after such a procedure. Using five criteria -- functional status, aesthetic deformity, comorbidities, exposed tissue, and surgical history -- a risk assessment is made based on a point-score system, as well as documenting how well they return to a normal life. Previous surgeries, how well vital organs work, lifestyle habits and the state of the facial wound itself all contribute.

19 face transplants have been performed worldwide. However, less than half of these cases have complete reports based on FACES data, which means patients may not be properly assessed or receive the best support and post-operative care.

This screening tool, combined with acceptable reporting, is designed to improve success rates following surgery. It can be used to choose who needs a procedure the most, as well as a means to understand the psychosocial and functional benefits -- as well as problems -- of face transplantation.

"Facial transplants are not just about reconstructive surgery," explained Chad Gordon, DO, assistant professor of surgery at The Johns Hopkins Hospital.

"The face represents so much to someone's life. It's about taking someone isolated from society and putting him or her back into society. We're spending millions to research and perform face transplants, but we don;t know if patients are getting back into society. Are they getting jobs? Are they able to live on their own? Or are they still socially disabled?"

Image credit: Shazeen Samad

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