Face transplantation (photos are not for the faint of heart!)

Welcome to the iCover blog pages! The topic of our today's publication is plastic surgery and transplantology, or to be more precise – the most complex operation in the entire history and unprecedented in terms of the level of performance of a full face transplant. It took a team of plastic surgeons from the Langone Medical Center at the University of New York, led by Dr. Eduardo Rodriguez, more than a year to prepare and conduct it, and more than a million dollars were spent. Read more about this extraordinary event…

The familiar plot of the film “Without a Face” with the participation of Nicolas Cage does not seem to be something fantastic today, because the first successful face transplant operation was performed by French plastic surgeons more than 10 years ago. At the same time, according to the level of complexity and the technologies used, as well as the result achieved, the operation performed at the Langone Medical Center at the University of New York (Langone Medical Center) can be confidently recognized as unprecedented.

The tragedy with 41-year-old American firefighter Patrick Hardison occurred while extinguishing a fire in 2001 while trying to rescue a woman from a building engulfed in flames. 

Patrick Hardison before the Tragic Day

The resulting burns disfigured Patrick's face beyond recognition. He almost lost his sight. The face, head, neck and upper torso were completely burned. The nose was almost completely lost and the ears, lips, eyebrows, eyelids and hair were completely lost. 

After the tragedy, shortly before the operation

The face donor for Hardison was the artist David P. Rodebaugh, who crashed on a motorcycle in his incomplete 26 years a year before the operation and bequeathed his body as a source of donor organs. The mother of the deceased also gave her consent to the transplant in favor of Patrick. The organs transplanted from David subsequently saved the lives of several terminally ill people. 

According to the results of the examination, a group of plastic surgeons led by Dr. Eduardo Rodriguez, head of the Hansjorg Wyss Department of Plastic Surgery, decided to completely transplant not only the patient's face, but also part of the facial bones, nose, ears (including ear canals), eyelids (including muscles that provide their movement) and the scalp of the donor. The operation, in which more than 100 doctors, including junior medical staff, took part, lasted 26 hours. 

In preparation for the operation, which took more than a year in total, Patrick had to undergo more than 70 preliminary intermediate operations, each of which solved some specific task. The possibilities of computer 3D modeling and 3D printing technology were used. The latter was required to recreate the models of the donor and recipient heads and to make a preliminary assessment of the scope, direction and specifics of the planned work. 

At the same time, despite the most carefully carried out preliminary calculations and the preparatory measures taken, in its practical part the operation turned out to be so difficult that it required repeated ”reshaping” of the shape of the recipient's skull so that the bone, cartilage tissues and skin took the optimal position.

 The stage of preparation, planning, the actual operation carried out in August 2015 and subsequent rehabilitation cost the University of New York $ 1,000,000. 

After 3 months, taking into account the patient's condition and the dynamics of the recovery process, the clinic's specialists came to the conclusion that Patrick Hardison could be discharged. Of course, in order to prevent rejection of donor tissues, he will have to take more than one course of special drugs for at least some time. You will also need a set of special exercises that allow you to develop facial expressions and learn how to talk with new lips. 

Before and after surgery

Before discharge from the clinic

Dr. Rodriguez (center) and the medical staff involved in the preparation and conduct of the operation

Of course, the result is impressive, but any plastic surgeon knows that the probability of rejection of donor tissues always remains. At the same time, life with a face and hope for the future is nothing compared to the prospects that his recent existence opened for Patrick. The recent patient himself looks at the future quite optimistically, and reflects on continuing the work that he considers his vocation.

“I express my deepest gratitude to my donor and his entire family," Patrick Hadison does not hide his emotions in one of his interviews. – Despite the fact that I do not know them personally, I pray for them every day, knowing what a difficult decision they made to help me. I would also like to thank Dr. Rodriguez and his entire team for giving me something more than a new face. They gave me a new life.”

The father of plastic surgery is considered to be Harold Gillis, who carried out the first operations to restore the appearance back in 1917. One of the first patients to successfully undergo plastic surgery on the face and head was an English sailor from the First World War, Walter Yeo. He received a severe head injury in the famous Battle of Jutland – the largest naval battle of the First World War. Indirectly, it is with this name that the birth of a new direction of medicine is associated. 

The first patient who successfully underwent a face transplant operation in 2005 was a 38–year-old Frenchwoman, Isabelle Dinoire, who lost her appearance after an unsuccessful suicide attempt. Distraught from stress, the dog, a Labrador, in an attempt to bring the mistress to her senses, gnawed Dinoire's face beyond recognition. The nose, mouth, and chin were in a condition that, according to the surgeons who performed the operation, completely excluded the possibility of plastic reconstruction by any existing methods.

Plastic surgeons Bernard Devochel and Jean-Michel Dubernard from the clinic of the University of Amiens in northern France proposed to carry out the world's first partial face transplant from an anonymous donor – a woman who died a year before. Isabelle agreed. The operation, during which donor facial muscles and tissues, arteries and veins were used, lasted 15 hours. 

Unlike Patrick, Isabelle Dinoire had the face of an anonymous donor transplanted from the city of Lille and the former patient still has no information about the woman who donated her face or her loved ones. In accordance with French law, she will not know this name until the end of her days. 

Isabelle Dinoire

In total, more than 10 such operations have already been carried out in the world, including countries such as the USA, Turkey, China, Spain. Their complexity and cost, unfortunately, will not allow us to talk about putting on stream for a long time, and the moment when, if necessary or at will, we can change the person who does not suit us, is still in the immeasurably distant future.

Portal "Eternal youth" http://vechnayamolodost.ru

19.11.2015