Details of three face transplant cases revealed

New details about three face transplant surgeries conducted last year outline some of the medical challenges and psychological implications of the procedure.

Last week, doctors who performed three face transplant surgeries in 2011 released the details those successful surgeries in the New England Journal of Medicine.

Their report outlined some of the medical challenges of face transplant surgeries, as well as the psychological impacts of giving someone a donor's face.

The first patient was Dallas Wiens, a man whose face was essentially erased by extensive burns when he accidentally touched a high-tension power line while painting a church. Last March, doctors reconstructed his forehead, nose, lips and facial skin. They also gave him muscles and nerves that would enable him to move his face and feel sensation with it.

Patient 2 (pictured here several months after surgery) was Mitch Hunter, a man who also was burned by a power line, this time after a car accident. The third patient, Charla Nash, was mauled by a friend's chimpanzee.

The medical challenges of face transplant surgery

The surgeries, among the 18 that have been performed worldwide since 2005, took place at Brigham and Women’s Hospital in Boston. Bohdan Pomahac, director of the plastic surgery transplantation program at Brigham and Women’s and lead author of the NEJM report told the Wall Street Journal that "the chief obstacle to the surgery had been the belief that you’d need to connect four arteries and a corresponding number of veins in order to provide enough blood flow to the transplanted tissues."

But he and his colleagues were able to use a simpler method that required connecting only one artery and one vein on each side of the face. (Even so, a single operation can take more than 20 hours.) They also brought back facial functions such as blinking and facial sensation by connecting all the main motor and sensory nerves available.

The most common complication due to the surgeries was infection due to the the drugs they took to suppress their immune system in order to prevent their bodies from rejecting the transplants. They all recovered, and their drug regimens have even been reduced, though they will have to continue taking the drugs for the rest of their lives.

Still, the facial transplants have largely been successful. Though at first, the patient's new face is swollen and cannot be moved, that swelling dies down within six weeks, and motor function is regained in three to six months. The patients can often begin eating again within a few days.

It only took a few days for Wiens to be able to smell again, and after four months, he could feel sensation on the right side of his face. Nash could breathe through her nose and mouth within two months, and Hunter was able to talk, eat and drink within four days.

Psychological implications of the new faces

However, their faces do not resemble their original faces, or those of their original owners. The face -- which is composed of skin, fat, muscle and bone -- is combination of the donor's face and the recipient's, resulting in a unique look.

However, the new face "allows recipients to regain an identity, because they can now be seen in the social world. Moreover, they may regain expressivity, allowing for them to be seen even more by others, and to regain an identity to an even greater extent, according to this article in the Journal of Medical Ethics. In fact, all three patients got used to their new faces easily.

Still, the patients receive counseling in the first three months after the surgery. “We want them to cope well with what they’ve been through,” Pomahac told the Wall Street Journal, adding that although they look different, their body language and speech are the same, making it “remarkably easy” to identify them.

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photo: Patient 2, Mitch Hunter (screenshot/New England Journal of Medicine)

via: Wall Street Journal, U.S. News

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