Monday, 6 February 2012

Full Face Transplant

I know it's a bit shocking but get over it.  Really it is amazing.  Today Kevin Fong and I met the surgeon who masterminded America's first full face transplant.  It happened last March.  Kevin interviewed surgeon Bohdan Pomahac for a Radio 4 feature, Hurricane Rash, on plastic surgery.  It will air in the next few months.

26 year old Dallas Wiens had his whole face burnt off in an electrical accident.  The Texan was being lifted on a platform to paint a church (cheers God) and got too close to a passing high voltage power line.  A bolt of electricity arced into his face, obliterating all his features bar a lipless slit where his mouth had been.

A flap of skin and muscle was transplanted from his back over the front of his skull to cover the devastation.

However just under a year ago, Dallas became the recipient of the USA's first donor face, thanks to Dr Pomahac and his team of 30 medical colleagues at Brigham and Women's Hospital in Boston.

Bohdan took us through the epic op:  "In many ways, the most stressful operation I've ever done in my life".

It started one evening in March at 9 pm with Dr Pomahac and a colleague flying to another hospital in New England where a donor had become available.  By midnight they were carefully removing the brain dead man's face.  The face transplant would only remain viable for 4 hours after being  severed from its blood supply.  Meanwhile Dallas had started his journey from Texas to Boston and heading for the Brigham to be prepared for this new face.

Bohdan arrived at the Brigham operating theatre with the face in a cooler box to discover that surgical work still need to be completed on Dallas' ruined face before the transplant could proceed.  To keep the replacement face alive, they needed a holding strategy.  They nipped out the main facial arteries and veins in his neck and plumbed them into the corresponding vesselse on the donor face.  The white, lifeless, fleshy mask of skin, muscle, lips, eyelids, nerves and complete nose and nasal bone, pinked up as Dallas' blood revived it.

Once the foundations of Dallas' facial area were ready, hours and hours of microsurgery got underway - connecting lips, nose to bone, nerve to nerve, skin to skin, etc etc.  The team finished the surgery at 9 pm, twenty hours after Bohdan started removing the face of the dead donor.

Eleven months later, Dallas has the sense of touch over most of his face and he can move the muscles of face to smile at his daughter.  He can eat without food falling out of it, and his daughter is no longer terrified to look at him.  His is one of three full face transplants the Brigham team have now done.  Surgeons in France performed the very first full facial transplantation.  Here's a video of selected highlights of the Dallas op.

Surgery DW from BWH Public Affairs on Vimeo.

Surgeon Bohdan Pomahac told us today: "We just had patient who came for evaluation and when I told him that surgically he would be a good candidate for transplantation, he burst into tears.  He said, 'I have been living in seclusion for 25 years.  For three years, I didn’t even walk out of my apartment....For all those years I’ve heard there’s nothing we can do.'  Finally, there is emerging hope -  there is something we can provide."

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