Nation's First Face Transplant Done In Cleveland

A woman so horribly disfigured she was willing to risk her life
to do something about it has undergone the nation's first
near-total face transplant, the Cleveland Clinic announced Tuesday.

Reconstructive surgeon Dr. Maria Siemionow and a team of other
specialists replaced 80 percent of the woman's face with that of a
female cadaver a couple of weeks ago in a bold and controversial
operation certain to stoke the debate over the ethics of such
surgery.

The patient's name and age were not released, and the hospital
said her family wanted the reason for her transplant to remain
confidential. The hospital plans a news conference Wednesday and
would not give details until then.

The transplant was the fourth worldwide; two have been done in
France, and one was performed in China.

Details of the Cleveland surgery were not disclosed, but
surgeons generally transplant skin, facial nerves and muscle, and
often other deep tissue. That is done so that the new face will
actually function and not just be a mask.

Surgeons not connected to the case reacted cautiously since
little was known about the circumstances, but they generally
praised the operation.

"There are patients who can benefit tremendously from this.
It's great that it happened," said Dr. Bohdan Pomahac, a surgeon
at Harvard-affiliated Brigham and Women's Hospital in Boston who
plans to offer face transplants, too.

Dr. Laurent Lantieri, a plastic surgeon at Henri Mondor-Albert
Chenevier Hospital, near Paris, who did a face transplant on a man
disfigured by a rare genetic disease, said: "This is very good
news for all of us that doctors in the U.S. have done this."

Unlike operations involving vital organs like hearts and livers,
transplants of faces or hands are done to improve quality of life -
not extend it. Recipients run the risk of deadly complications and
must take immune-suppressing drugs for the rest of their lives to
prevent organ rejection, raising their odds of cancer and many
other problems.

Arthur Caplan, a leading bioethicist who has expressed grave
concerns in the past about such surgery, withheld judgment on the
Cleveland case but said the woman's doctors should give her the
option of assisted suicide if they wind up making her life worse.

"The biggest ethical problem is dealing with failure - if your
face rejects. It would be a living hell," said Caplan, bioethics
chief at the University of Pennsylvania. "If your face is falling
off and you can't eat and you can't breathe and you're suffering in
a terrible manner that can't be reversed, you need to put on the
table assistance in dying."

Siemionow's long and careful preparation should help prevent
such a horrific outcome, those familiar with her said. Siemionow,
(pronounced SIM-en-now), 58, a noted hand microsurgeon, has been
testing the surgical approach and ways to temper the immune
system's response in experiments for more than a decade.

She considered dozens of burn victims and other potential
candidates over the past four years, ever since the clinic's
internal review board gave her permission to attempt the operation.
She said she would choose someone severely disfigured as her first
case.

"She's a leader in this field. She's been investigating this
for a long time. She has done the most amount of research in small
animals looking at this," said Dr. Warren Breidenbach, a surgeon
at Jewish Hospital in Louisville, Ky., who did the nation's first
hand transplant, in 1999. Siemionow trained with him in Louisville.

The world's first partial face transplant was performed in
France in 2005 on a 38-year-old woman who had been mauled by her
dog. Isabelle Dinoire received a new nose, chin and lips from a
brain-dead donor. She has done so astoundingly well that surgeons
have become more comfortable with a radical operation considered
unthinkable a decade ago.

Two others have received partial face transplants since then - a
Chinese farmer attacked by a bear and a European man disfigured by
a genetic condition. Both are believed to be doing well, though
details, especially of the Chinese case, have been scant.

In the Cleveland case, "it is very important what kind of
recipient they selected," and how great the need was, Pomahac
(POE-ma-hawk) said. "Hopefully it will open the door both to the
public and to other centers" wanting to do these operations.

In an interview in 2005, Siemionow spoke of the terrible need
she saw in people horribly disfigured, and how badly it scarred
their social and emotional lives, not just their bodies.

"There are no really good alternative therapies for the
severely burned or patients with a facial injury or damage," she
said.

Her task now is to prevent organ rejection while managing the
risk of infection from taking strong immune-suppressing drugs.

Rejection is a possibility whenever someone receives an organ or
cells from someone else because the body regards this as foreign
tissue. Two types of problems can result.

The first is graft-versus-host disease, which could happen if
the new facial tissue were to attack the recipient's body. The
second is if the patient's body were to attack the bone marrow or
the transplanted face, causing inflammation and other problems at
the site of the new tissue.

Either of these can be life-threatening. They can come on
suddenly, within days or weeks of the operation, or set in slowly.
---
AP Medical Writer Maria Cheng in London contributed to this report.
---
On the Net:
Cleveland Clinic: http://www.clevelandclinic.org

(Copyright 2008 by The Associated Press. All Rights Reserved.)


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