In the coming weeks, the Cleveland Clinic will interview five men and seven women for the chance to have an operation that has never been tried anywhere in the world: a face transplant.Dr. Maria Siemionow is attempting to give people disfigured by burns, accidents or other tragedies a chance at a new life.
Current medical care, while life-saving, can leave patients maimed with a lost or shattered sense of identity. Existing facial reconstruction surgical regimens include the promise of dozens of operations to maintain skin grafts. Surviving the tragedy in this way has been described as "life by 1,000 cuts."
The skin grafts are done inch by inch with skin from the patients back, arms, and thighs. Each graft must be small because the procedure causes excessive bleeding. The pain from the graft site is often severe.
Surgeons have to return to the same areas every few weeks, re-applying new skin to old wounds to build up the skin. Patients can be under the knife for years. What this new face transplant offers is total application of the skin in one operation, providing less discomfort, less time in the operating room, and less chance of infection.
Critics of the operation say it is far too risky for something that is not a matter of life and death, like traditional organ transplants. The biggest fear of opposing surgeons is a transplanted face being rejected and sloughing off, leaving the patient worse off than before.
The operation involves removing the injured face and replacing it with one donated from a cadaver. The face will be matched for tissue type, age, sex and skin color. The procedure will last 8 to 10 hours; inpatient stay will last 10 to 14 days.
Complications are similar to those of regular skin grafts; infections could turn the new face black, which would require another transplant or reconstruction with skin grafts. The patients will have to take antirejectory for their whole lives.
Dr. Siemionow and her team are also worried about Psychological trauma after the surgery. Organ recipients often feel remorse, grief, or guilt toward the donor; and with something so directly linked to identity, the surgical team worries these reactions may be more dramatic. Siemionow has employed psychiatrists, social workers, therapists, nurses and patient advocates to help ease the process.
The face will not look like the donor, Siemionow said, but rather it will look like the patients face before the injury. Facial contours and expressions are dictated by the bone and muscle underneath the skin. Reactions and mannerisms are embedded in the brain and personality of the person. Some research suggests the operation may result in a blending of the two appearances.
Despite the initial shock factor, the face transplant is a compilation of simple microsurgeries. One or two pairs of veins and arteries will have to be connected to the new face, along with 20 nerve endings to restore sensation and movement. Small sutures will anchor the new tissue on the scalp, neck, and around the eyes and mouth.
When asked about the ethics of whether or not the procedure should be done, Dr. Karol Gutowski, member of Siemionow's surgical team, responded "Someone's got to push the envelope...In retrospect, we'll know whether it should be done."
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