Preparing for the world's first face transplants

A better solution for injuries
It took more than a year to win approval from the 13-member Institutional Review Board, the clinic’s gatekeeper of research. Siemionow assembled surgeons, psychiatrists, social workers, therapists, nurses and patient advocates, and worked with LifeBanc, the organ procurement agency she expects will help obtain a face.

At first, not everyone was on her side, acknowledged the board’s vice chairman, Dr. Alan Lichtin. After months of debate, Siemionow brought in photographs of potential patients.

Looking at the contorted images, Lichtin said he was struck by “the failure of the present state of the art to help these people.” He decided he didn’t want to deprive the surgeon or patients of the chance.

The board’s decision didn’t have to be unanimous.

In the end, it was.

Surgeons wished they could have done a transplant six years ago, when a 2-year-old boy attacked by a pit bull dog was brought to the University of Texas in Dallas where Dr. Karol Gutowski was training.

Other doctors had tried to reattach part of the boy’s mauled face but it didn’t take. The Texas surgeons did five skin grafts in a bloody, 28-hour surgery. Muscles from the boy’s thigh were moved to around his mouth. Part of his abdomen became the lower part of his face. Two forearm sections became lips and mouth.

“He’ll never be normal,” said Gutowski, now a reconstructive surgeon at the University of Wisconsin-Madison.

Surviving such wounds can be “life by 1,000 cuts.” Patients endure dozens of operations to graft skin inch by inch from their backs, arms, buttocks and legs. Only small amounts can be taken at a time because of bleeding.

Surgeons often return to the same areas every few weeks, reopening old wounds and building up skin. Years later, many patients are still having surgeries. A face transplant — applying a sheet of skin in one operation — could be a better solution.

Despite its shock factor, it involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor the new tissue to the recipient’s scalp and neck, and areas around the eyes, nose and mouth.

“For 10 years now, it could have been done,” said Dr. John Barker, director of plastic surgery research at the University of Louisville, where the first hand transplant in the United States was performed in 1999.

Several years ago, these doctors announced their intent to do face transplants, but no hospital has yet agreed. They also are working with doctors in the Netherlands; nothing is imminent.

However, Siemionow had been doing experimental groundwork. She already had creatures that resembled raccoons in reverse — white rats with masks of dark fur — from years of face transplant experiments. She developed a plan and got clinic approval before going public, and insists she is not competing to do the first case.

“I hope nobody will be frivolous or do things just for fame. We are almost over-cautious,” she said.

Siemionow, 55, went to medical school in Poland, trained in Europe and the United States, and has done thousands of surgeries in nearly 30 years. The success of this one depends on picking the right patient.

MORE FROM MORE HEALTH NEWS

More Health News Section Front

It’s back-to-school time for bedbugs   Now hear this: Don't remove earwax 1 in 10 Native American deaths alcohol related Flying’s a literal headache for many travelers Cells switch identity in biological breakthrough Indonesia's 'tree man' home after surgery Tongue's sixth 'taste' discovered — calcium Spike in vitamin D testing creates confusion Look out! 'Beer goggles' are real Babies born 8/8/08 at 8:08; 8 lbs., 8 oz. More Health News Section Front   Add More Health News headlines to your news reader: