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Plastic surgeons countdown first full facial transplantation

March 02, 2006

First studies reveal next steps in historic procedure

Even after news of the first partial facial transplantation performed in France spread around the world, plastic surgeons have continued to research how to make the first full facial transplantation a reality. In the first peer-reviewed, scientific studies of their kind, U.S. plastic surgeons demonstrated how to successfully complete a full facial tissue transplantation from one human body to another, reports the March issue of Plastic and Reconstructive Surgery® (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS).

"For the first time, we have scientific data that takes us beyond traditional reconstructive techniques and partial facial transplantation," said ASPS President Bruce Cunningham, MD. "What we thought of as a possibility - reconstructing the entire face of someone with a severe facial disfigurement, in one surgery, from one complete facial skin flap taken from a donor - is no longer just theory, but will become an actuality."

"Through these particular studies we have determined that full facial tissue transplantation is a successful approach in helping patients horribly disfigured by burns, accidents and other trauma," said study lead author Maria Siemionow, MD, director of plastic surgery research at the Cleveland Clinic. "The transplantation of a facial tissue flap from one cadaver to another has allowed us to do the following: estimate the time it takes to perform this particular transplantation, perfect our technique and visually confirm that a facial tissue flap is a match when covering severe burns and other trauma."

Although traditional methods for facial reconstruction, which include skin grafts and flaps, are reliable and effective techniques for reconstructing the face, they may not be ideal, according to the studies. It is nearly impossible to match the skin quality, texture and color of the face with any other tissue available on the body. In addition, it takes multiple grafts and surgeries to successfully reconstruct the entire face. Many patients are left with a patchy, unfavorable appearance, including large scars and mismatched skin. The studies found the only way to surgically match facial skin texture, pliability and color is through facial transplantation.

"There is no doubt that facial transplantation can improve the quality of life for patients, however, facial transplantation will not replace traditional techniques," said Rod Rohrich, MD, editor of PRS. "This is an exciting time in plastic surgery, but it is important to remember that, at least in the near future, facial transplantation will be a last resort procedure performed on carefully selected patients on a case-by-case basis."

In the studies, doctors used cadavers to perform mock facial transplantations in order to outline the necessary steps to transplant a human face. Through these trials, they were able to visually show the full extent of the procedure's outcome.

During the procedure it took surgeons approximately five hours to perform the mock facial transplantation, this did not include vessel and nerve repair. In living recipients, the authors estimate the total length of surgery will be approximately 11-15 hours.

"Plastic surgeons have historically been at the forefront of transplantation medicine," said Dr. Cunningham. "The first successful hand transplantation was performed by a plastic surgeon in 1998, as was the first kidney transplant in 1954. The idea of tissue transplantation has opened a new era in this field of medicine."

American Society of Plastic Surgeons