Image: Video snapshot of a woman who received a partial face transplant.
A woman who received a partial face transplant is shown here being taken from the operating room.
updated 1/18/2006 9:33:10 AM ET 2006-01-18T14:33:10

The recipient of the world’s first partial face transplant was thriving medically and psychologically a week after her groundbreaking surgery, one of her doctors said Sunday.

The woman, whose face had been partially disfigured by a dog, appeared relatively normal after the operation and doctors were pleased with her mental state, Dr. Jean-Michel Dubernard said in a telephone interview. Doctors had been worried about the potentially negative psychological effects of receiving part of someone else’s face.

“She is perfect,” Dubernard said. “Psychologically, she is doing very well.”

Dubernard, one of the woman’s two lead surgeons, said that the 38-year-old would remain hospitalized in the southeast city of Lyon for four to six weeks. She must take drugs to prevent her body from rejecting the donated facial parts, which Dubernard has said carry “a slightly more elevated risk of cancer.”

The woman received a section of a nose, lips and chin in the 15-hour transplant surgery on Nov. 27 in the northern city of Amiens, near her home. The woman, the divorced mother of two teenage daughters, has not been identified by name.

Disfigured in dog attack
She was mauled by a pet Labrador in May, leaving her with severe facial injuries that her doctors said made it difficult for her to speak and eat. The dog was put down.

The weekly newspaper Le Journal du Dimanche quoted one of the woman’s surgeons as saying she “had no more face” before the procedure. “She only had her eyes, and when she saw her daughters she cried,” Sylvie Testelin told the paper.

The partial face was donated by the family of a woman who was declared brain dead. Her identity has also not been made public.

Critics blast procedure
Despite the upbeat news, critics cast a shadow on the groundbreaking transplant, with some saying doctors rushed ahead with a radical — and untested — procedure, bypassing classic reconstructive surgery when the situation was not urgent.

“This is pure experimentation,” Emmanuel Hirsch, a medical ethics professor, told Le Journal du Dimanche. He said he felt surgeons rushed into the operation when “all the guarantees had not been given.”

Hirsch handles ethical issues at a new council within the French Health Ministry agency that coordinates organ procurement — and approved the transplant. Hirsch told the newspaper he was aghast that he had not been informed of the case.

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The council was formed only in September, and Carine Camby, who heads the agency, told Le Journal du Dimanche that there was a “certain urgency” in the case because scar tissue that was forming could have made the transplant impossible.

Surgeons have said the necessary precautions were taken.

“We explained everything to her, the benefits and the risks,” Testelin told the paper.

Dubernard led teams that performed a hand transplant in 1998 and the world’s first double forearm transplant in January 2000.

The hand transplant recipient later had it amputated. Doctors said the man had become “mentally detached” from his new hand and failed to take the required drugs. His body rejected the limb.

How doctors performed the surgery
The groundbreaking and risky face transplant began just after midnight on Nov. 27 at a hospital in Amiens. One team of doctors traveled to Lille, another northern town about 60 miles away, to collect the lips, nose and chin from the donor. The brain-dead woman’s family donated her facial tissue to the doctors and the rest of her organs to other recipients.

Engineers designed a silicone prosthetic mask that was fitted to the donor’s face after the tissue was removed. The prosthetic had the same stiffness, color and shape as the donor’s face, the doctors said.

Another team of surgeons prepared the disfigured patient. They cut away the fibrous tissue that had formed on her face since her accident.

When the transplant team arrived in Amiens, eight surgeons led by Dr. Bernard Devauchelle sewed the blood vessels in the woman’s face to those of the donor tissue. They then connected the nerves and muscles, then sewed in the lining of the mouth and the skin from the nose to the chin.

Four hours into the 15-hour operation, the blood was circulating normally between the graft and the rest of the woman’s face.

“When it was finished and we were washing the skin and applying the dressings, there was a big silence in the operating room. We were all surprised because the immediate result was completely outside our expectations — it looked marvelous,” Lengele said.

“There is simply a small scar around the outside of the graft. All the other scars are inside, in the mouth, in the nose. A small scar in the neck,” he said.

Devauchelle said the team was “totally stupefied” by how perfectly the transplant was integrated into her face in terms of the color and the thickness of the skin.

The woman already has some mobility in the new tissue. She can eat, drink and speak clearly, Devauchelle said. But it will be another six months before the nerves start to regenerate. It’s too early to tell how natural the transplant will look, but the doctors said they were optimistic.

The biggest hurdle now is the body’s acceptance of the transplant. The woman must take drugs for the rest of her life to prevent her immune system from rejecting the tissue. It’s still possible that the surgery will fail, that the new tissue on her face might die and turn black, even months later. In that case, reconstructive surgery or a new transplant would be needed.

Next obstacle
In an effort to keep her body from rejecting the new tissue, the doctors infused the woman with stem cells taken from the bone marrow of the donor. They hope that might make it possible to lower the dosage of anti-rejection drugs.

The woman is getting her main food pureed, but she has eaten chocolate and strawberries, Testelin said. For now, she can only show her gratitude by smiling with her eyes.

As for the dog that maimed her, the woman holds no grudge, Testelin said, as the circumstances surrounding the injury remained cloudy Friday.

“She doesn’t blame the dog,” the doctor said. “The dog liked her. He tried to wake her up, or whatever. I was not there. It was no more than an accident, and she thinks like that.”

Dubernard denied a French media report that the woman was attacked by the dog after she had passed out from taking pills in a suicide attempt. Instead, he said, the woman had taken a pill to try to sleep after a confrontation with one of her two teenage daughters and was bitten by the dog during the night.

The dog was euthanized, but since then, the patient has acquired a new dog, Testelin said.

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Video: Chronology of a face transplant


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