June 29, 2013 at 12:57 AM ET
Without millions of dollars in funding from the U.S. military, the stunning advances in face transplant surgery -- such as the procedure that restored the features of gunshot victim Richard Lee Norris -- might never have been possible.
The Department of Defense has supplied $42 million in grants to at least 16 institutions -- including the University of Maryland School of Medicine where Norris received a facial transplant in 2012 -- to help devise and advance surgical techniques to rebuild extremely disfigured faces, according to the Cleveland Clinic, the hospital that performed the first near-total-facial transplant in the U.S. in 2008.
"The military has been way ahead of the curve on supporting research for cranial facial transplantation," said Dr. Stephen T. Bartlett, chair of the Department of Surgery at the University of Maryland School of Medicine and Surgeon-in-Chief at the University of Maryland Medical Center.
Seven civilian patients in the U.S. -- including Norris whose story is recounted during Ann Curry Reports: A Face in the Crowd -- have received full or partial face transplants, helping prepare top transplant surgeons to heal some of the estimated 200 Iraq and Afghanistan veterans whose physical appearances were mangled by bomb blasts in combat, according to doctors at two of the grant-receiving hospitals.
In fact, facial transplant surgery would still be just a theory without the U.S. military's money and muscle, said Dr. Bohdan Pomahac, of Boston's Brigham and Women's Hospital, who in 2011 performed the nation's first full facial transplant on Dallas Wiens, a Texas man who got too close to a high-voltage line while at work. That facility has received $3.4 million in military grants, according to a hospital press release.
"Without the military, there would be no composite tissue transplant, and that’s no exaggeration," Pomahac said. "They’re not only an integral part, they’re critical and probably the most important for progress in this field. They should get the credit for how far we’ve moved it along and how far the technology has improved because without them we would still be hypothesizing whether it’s a good idea or not to do it."
The military's involvement began in 2000 when Bartlett began talking with a Navy transplant surgeon about funding for programs to develop facial transplants for troops injured in blasts. Since then, the University of Maryland has been supported by grants from the Office of Naval Research, culminating on the successful face transplant performed by Bartlett's hospital on Norris, wounded in a 1997 gun accident at his home.
"This medical procedure (on Norris) is the culmination of a $13 million research grant over seven years from the Office of Naval Research (to the University of Maryland), which I believe is one of the largest naval scientific investments for a surgical procedure," said Dr. Michael Given, the ONR Combat Casualty Care program officer.
"ONR along with the Army, Air Force and multiple government agencies continues to pool resources through the Armed Forces Institute of Regenerative Medicine, which is researching and developing clinical therapies to heal and repair burn wounds as well as reconstruct and regenerate limbs," Given said.
While no combat veterans have yet received face transplants, several former service members who were disfigured by bomb blasts in Iraq and Afghanistan have been evaluated as possible candidates for the procedure by physicians at Brigham and Women's.
Although the military is essentially paying for the operations through those grants, the cost of a facial transplant in this country now averages $260,000 per patient, Pomahac said. Medication for those transplant patients costs about $10,000 a year.
After seven successful face transplants in this country, surgeons like Pomahac feel they've now "developed a technique that is fairly routine (and) the operation is customizable to pretty much any facial defect."
The next frontier is figuring out how to prevent the body's immune system from rejecting the tissue parts and pieces provided by other human bodies.
"In the future, and what I’m hoping for, is to continually explore what happens in immunology between the donor and the recipient and how we can minimize immune suppression - and whether in the future ... the recipient will no longer reject the donor," Pomahac said.
For example, following the first successful kidney transplant in 1954, there were "10 dark years" until the next advance in that surgical technique because doctors didn't have the proper immune-suppression drugs at their disposal to ward off rejection, Pomahac said.
"I don't think we’re quite in the 10 dark years period of time but I think we’re in a similar stage where if we can figure out that one last step to either minimize or eliminate immune (system) suppression, the field of reconstructive surgery in general would be completely turned upside down," Pomahac said.
"If you can imagine we could then transplant individual fingers. We could transplant small parts of the face. You could transplant any part of the body," he added. "If immune suppression is no longer an issue, there is no boundary. That would be a huge revolution."