If there's a medical advance that seized the public imagination this year, we'd venture to say it was facial transplant surgery.
Three transplants gave severely injured patients completely new faces in 2011. Now the doctors involved have revealed details about the complex cases in the New England Journal of Medicine.
The first patient, Dallas Wiens, suffered extensive burns in 2008 when he brushed up against a high-tension power line while painting a church. The accident essentially erased all of the features on his face. The second patient also suffered burns from a power line after a car crash. The third patient was Charla Nash, who was mauled by a chimpanzee.
Until now, a full transplantation was almost unimaginable. Technically, the surgery requires connecting the new facial tissue to the recipient's blood supply and nervous system. Beyond the operating room, there are thorny ethical and psychological issues.
All the patients developed infections after surgery, but they were treated successfully. Two of the patients showed signs of rejection, but recovered with the help of drugs to suppress their immune systems. All three will have to take immunosupressants for the rest of their lives to keep rejection in check. And there could be further complications in the future.
Overall, the transplants appear to have taken. Within days, Wiens, for instance, could smell again. After four months he could feel the right side of his new face. The other patients also had various degrees of sensation restored.
The success is heartening. "It's a wonderful thing," Dr. Joseph Losee, director for facial transplants at the University of Pittsburgh Medical Center. "It shows the medical field that this is a reality," he tells Shots. "It shows families of potential donors that when asked about it, this is something they should consider. And it shows patients that there is an opportunity."
The alternative to face transplants had been standard reconstructive surgery, which has significant limitations in such severe cases, according to Losee, who wasn't involved in these treatments.
To get on the waiting list for a face transplant, potential patients go through stringent testing. There's an in-depth psychological examination and also an evaluation of the family. One of the key factors in a procedure like this, according to Losee, is managing patients' expectations of what they will look like. "They will never ever again look like they were," he says. "That's just a reality."
Losee says that it may be difficult for donor families to deal with the idea of someone adopting their loved one's face, but the new face will actually look more like a combination of the two. "The patients don't totally look like the donor or the recipient," he says. "That is variable based on what is transplanted and how badly the person was deformed before the transplant."
Since 2005, 18 patient have had full or partial facial transplants. Only two patients have died, Losee says. One patient stopped taking his immunosupressants and another had an overwhelming infection immediately after surgery.
This is an emerging field, Losee says, and physicians around the world will be monitoring its progress, learning from every case.