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This is the real extreme makeover

Doctor Pushes for First Face Transplant. I saw a program on the Discovery Health Channel about this and it creeped me out, even though logically, this is no different medically than many other transplants. It is however, a gray area of discomfort for lay people. I do understand why doctors would want to forge into this territory. One of the patients in the documentary was Jacqueline Saburido, who was severely disfigured when hit by a drunken driver.

Jacqui was pinned in the front seat on the passenger side. She was burned over 60% of her body; no one thought she could survive. But Jacqui lived. Her hands were so badly burned that all of her fingers had to be amputated. She lost her hair, her ears, her nose, her left eyelid and much of her vision. She has had more than 50 operations since the crash and has many more to go.

In the show she expressed her desire to have a transplant if one were available. After all, people with severe disfigurement from accidents, burns, disease and birth defects would benefit greatly by being able to receive a new face or parts of one, since today’s reconstructive surgical techniques are still not good enough to be able to render a “normal” facial appearance for someone after a catastrophic deformity. (AP):

Ultimately, it comes to this: a hospital, doctor and patient willing to try it. The first two are now in place. The third is expected to be shortly.

The “consent form” says that this surgery is so novel and its risks so unknown that doctors don’t think informed consent is even possible. Here is what it tells potential patients:

Your face will be removed and replaced with one donated from a cadaver, matched for tissue type, age, sex and skin color. Surgery should last 8 to 10 hours; the hospital stay, 10 to 14 days. Complications could include infections that turn your new face black and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.

After the transplant you might feel remorse, disappointment, or grief or guilt toward the donor. The clinic will try to shield your identity, but the press likely will discover it.

The clinic will cover costs for the first patient; nothing about others has been decided. Another form tells donor families that the person receiving the face will not resemble their dead loved one. The recipient should look similar to how he or she did before the injury because the new skin goes on existing bone and muscle, which give a face its shape.

All of the little things that make up facial expression — mannerisms like winking when telling a joke or blushing at a compliment — are hard-wired into the brain and personality, not embedded in the skin. Some research suggests the end result would be a combination of the two appearances.

…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.

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Pam Spaulding

Pam Spaulding