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Two workforce have undergone face transplants -- unmatched after being attacked by
a bear and another after hurt from a large facial tumor -- and
they have indicated promising results. These cases indicate that the
procedure might be used more than regularly for long-term restoration of
facial disfigurement, and are described in deuce articles released in The
Lancet on August 22, 2008 describe face transplants that were
performed in 2006 and 2007 which appear to have promising results.
Organ transplants can contain on many forms. In a process called an
autograft, expendable tissue from one person is transplanted from one
part of the eubstance to another. Examples of autografts include skin grafts
and vein extraction for use in a coronary thrombosis bypass surgery. In contrast,
transplants of the warmness, lung, or kidney use a somewhat different
process known as an allograft. This involves transplantation of the
organ from one person to another someone, often to replace a
non-functional hammond organ in the latter.
Allografts can frequently suffer complications that autografts do non, in
special due to the immune response of the recipient role against the
foreign "material" from the latter. Transplantation of the face already
has many challenges due to its shape, variety of expression, and
social significance. As a resolution, experimentation in allograft case
transplants is relatively undeveloped, with only one antecedently
documented endeavor.
In October 2004, the first subject, a 30 year old Chinese humanity, was
attacked by a bear, departure him facial disfigurement. On April 13,
2006, homograft transplantation was performed in the Xijing Hospital
and Fourth Military Medical University, Xi'an, China. This surgery had
many facets to integrate with the existing physiology, including the
connection of arteries and veins, as well as nose, lip, and venous sinus
repair, among others. In addition to drugs to prevent subsequent
infection, the patient was administered a combination of four drugs to
help mitigate the immune response and so decrease chances of
rejection.
According to the clause, this new tissue flap had good survival in the
unexampled facial environment. Three sharp rejection episodes occurred, at
three, five, and 17 months after the surgery. These were brought second
into control by adjusting the sexually transmitted disease of one of the immune modulating
drugs or through organization of a steroid. His kidneys and liver,
a great deal susceptible to complications after surgeries, functioned
normally, and no infection was experient. The authors concluded that
there is great potential difference for facial transplantation in extreme cases:
"Facial transplantation could be successful in the short term, but the
procedure is not without complications...This case suggests nervus facialis
transplantation might be an option for restoring a severely disfigured
face, and could enable patients to readily integrate themselves second
into company."
The instant patient, a 29-year-old male, suffered from a seriously
disfiguring facial nerve tumor in the middle and depress parts of his face,
classified as a neurilemoma. On January 21, 2007, he underwent the
transplantation surgery at the Henri Mondor Hospital (APHP) of Creteil,
France, and was afterward administered drugs to stamp down immune
rejection. After the surgery, he was evaluated for motor function and
psychological response.
The patient experience 2 clinical rejection instances, at days 28 and
64, with the latter attack associated with a cMV infection
that was linked to the donor tissue paper. Both rejection episodes resulted
in favorable outcomes, allowing doctors to reduce the immunosuppressive
intervention regimen. As of one year of followup, the patient's sensation
and motor function had returned in the transplant region, and the
patient showed first-class psychological recovery and societal
reintegration. He was able to begin working wide time 13 months afterward
the surgical procedure.
The authors conclude that this procedure also shows promise for future
facial transplants: "Our case confirms that face transplantation is
surgically feasible and effective for the correction of specific
disfigurement, due in this caseful to a genetic disorder...Long-term
follow-up is needed to appraise the risks linked to the immunogenicity of
allogenic composite tissues, particularly as regards life expectancy.
Following this initial success, other patients are presently being
assessed."
Dr Jean-Michel Dubernard, E Herriot University Lyon I Hospital, France,
and Dr Bernand Devauchelle, Amiens-Nord University Hospital, Amiens,
France, contributed an resultant comment on both articles, stating
that by collaborating, the teams developing these operations could make
capital strides "to answer the many technical, functional, immunologic,
and psychological questions raised by face transplantation." They
conclude that other types of conditions that may indicate transplant
may be improved as a result: "The definition of the topper indications --
eg, psychic trauma, malformations, benign tumours, robert Burns -- will also greatly
benefit from this cooperation. The International Registry on Hand and
Composite Tissue Transplantation would be an idealistic forum to help resolve
these challenges and define new indications. Our main objective is to
give back a normal living to disfigured patients."
Human facial allotransplantation: a 2-year follow-up study
Shuzhong Guo, Yan Han, Xudong Zhang, Binglun Lu, Chenggang Yi, Hui
Zhang, Xianjie Ma, Datai Wang, Li Yang, Xing Fan, Yunjing Liu,
Kaihua Lu, Huiyuan Li
Lancet 2008; 372: 631-38
Click Here For Journal
Repair of the lower and middle parts of the face by composite
tissue allotransplantation in a affected role with massive plexiform
neurilemoma: a 1-year follow-up study
Laurent Lantieri, Jean-Paul Meningaud, Philippe Grimbert, Frank
Bellivier, Jean-Pascal Lefaucheur, Nicolas Ortonne, Marc-David Benjoar,
Philippe Lang, Pierre Wolkenstein
Lancet 2008; 372: 639-45
Click Here For Journal
Face transplantation
Jean-Michel Dubernard, Bernard Devauchelle
Lancet 2008; 372: 603-604
Click Here For Journal
Written by Anna Sophia McKenney
Copyright: Medical News Today
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Tuesday 2 September 2008
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