PARIS: The world’s first partial face transplant, carried out by French doctors last November, has been acclaimed by a pillar of the medical establishment as a historic achievement, although major risks remain unresolved.
Controversy had swirled around the pioneering operation carried out by a team led by Bernard Devauchelle in Amiens, northern France, with critics suggesting it was fraught with surgical and psychological peril.
But, in a sign that the exploit has been accepted by the core of the medical community, Devauchelle provides a detailed account of the transplant procedure in the prestigious, peer-reviewed journal The Lancet.
He also says that the patient’s state, at the four-month mark, was fine.
“The technical feasibility of the procedure has been clearly demonstrated, with no surgical complication,” says Devauchelle, whose paper is published online on Tuesday.
“The functional result will be assessed in the future, but this graft can already be deemed successful with respect to appearance, sensitivity, and acceptance by the patient.”
The patient, Isabelle Dinoire, 38, lost her nose, lips and right cheek after she was savaged by a dog.
On November 27, a triangular-shaped part of the face of a 46-year-old woman, who was declared brain dead after suffering a severe stroke, was grafted on to Dinoire’s face.
Micro-surgery was used to suture arteries, veins and motor nerves, and Dinoire was given immunosuppressor drugs aimed at thwarting rejecting of the transplanted organ.
She was also given two grafts of bone marrow, four days and 11 days after the transplant, to help produce white blood cells to fight off infection, which is a frequent consequence of taking immunosuppressors.
Bone-marrow transplants are themselves risky, sometimes causing life-threatening complications.
One of the surgeons who took part was Jean-Michel Dubernard, who carried out the world’s hand-forearm transplant.
Two analyses of the operation, also published online by The Lancet,pay tribute to Devauchelle’s work.
But they also raise questions over the longer term.
German facial surgeon Patrick Warnke of the University of Kiel hailed the operation as “a new milestone”.
But he warned, “failure of the (immunosuppressor) regimen chosen could prove devastating, with the possible loss of the transplanted face at any time.”
In addition, heavy use of these drugs also boosts the risk of cancer, meaning that a woman who before the operation was otherwise healthy despite her major handicap “is now at great risk,” he said.
Edgardo Carosella of the St. Louis Hospital in Paris and Thomas Pradeu of Sorbonne University said the ethical dilemma of a face transplant remained unresolved.
In the case of the first hand transplant, the recipient, New Zealander Clint Hallam began to view the organ as alien, stopped taking immunosuppressor drugs and eventually begged, successfully, for the hand to be amputated.
“Every graft of a visible organ leads to an identity split, the consequences of which can be very serious if the recipient does not succeed in psychologically accepting the organ and in rebuilding its social expression in everyday life,” said Carosella and Pradeu.
These and other issues are being mulled by British medical watchdogs as they vet an application by London surgeons to carry out the world’s first full-face transplant.—AFP
