7th surgery shows face transplants gaining ground

(Agencies)
Updated: 2009-04-13 16:39

Pomahac was born in Ostrava in the Czech Republic, and graduated from Palacky University School of Medicine in Olomouc, Czech Republic. He came to Brigham for a surgical research internship in 1996 and now, at 38, is associate director of its burn center, where he treats trauma and plastic surgery cases.

The Boston hospital's board approved Pomahac's plans to offer face transplants a year ago.

The world's first transplant in 2005 was led by Dr. Jean-Michel Dubernard in Amiens, France, who treated Isabelle Dinoire, a woman who had been mauled by a dog and grotesquely disfigured. Dinoire's appearance today is virtually normal.

The first U.S. face transplant, and the most extensive operation so far, was done in December by doctors at Cleveland Clinic. They replaced 80 percent of a woman's face with that of a female cadaver. The woman's identity has not been revealed, nor the circumstances that led to the transplant.

The woman left the hospital in February, and is doing "phenomenally well," Papay said. "Her speech is improved so everyone can understand her now, and she has a great outlook on life. She's very comfortable with the way she looks now and she's very happy."

The early successes are encouraging, but should not lead to over-exuberance, and extending the operation too fast, said Finder, the Los Angeles ethicist.

"This is still very new and hence requires a hyper-vigilance about helping patients understand what they're getting into," he said.

People who have received other transplants — organs, hands — have sometimes discovered they traded one set of problems for another, and get sick of taking the medicines needed to maintain the transplant. At least one hand transplant recipient later had the hand amputated for this reason.

Pomahac originally was considering only people who had already received a kidney or other organ transplant, because they already would be on immune-suppressing medicines and would therefore have a low risk of rejecting a new face.

"I still think that's the best group of patients but we have enlarged the protocol" to include others with severe facial deformities, he said.

"It's really in its infancy in terms of knowing what will happen," he added. "Each of the cases is its own unique story."

Eventually, surgeons hope to form waiting lists of face transplant candidates "just like for any other organ," Pomahac said.

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