Doctors in France said they had performed the world’s first partial face transplant, forging the way into a risky medical frontier by operating on a woman disfigured by a dog bite.
The 38-year-old woman, who wants to remain anonymous, had a nose, lips and chin grafted onto her face from a brain-dead donor whose family gave consent. The operation, performed Sunday, was led by a surgeon already famous for a transplant breakthrough, Dr. Jean-Michel Dubernard.
“The patient’s general condition is excellent and the transplant looks normal,” said a statement issued Wednesday from the hospital in the northern city of Amiens where the operation took place. Dubernard would not discuss the surgery, but confirmed that it involved the nose, lips and chin.
“We still don’t know when the patient will get out,” he said. A news conference is planned for Friday.
Scientists in China have performed scalp and ear transplants, but experts say the mouth and nose are the most difficult parts of the face to transplant. In 2000, Dubernard did the world’s first double forearm transplant.
The surgery drew both praise and sobering warnings over its potential risks and ethical and psychological ramifications. If successful — something that may not be known for months or even years — the procedure offers hope to people horribly disfigured by burns, accidents or other tragedies.
The woman was “severely disfigured” by a dog bite in May that made it difficult for her to speak and chew, according to a joint statement from the hospital in Amiens and another in the southern city of Lyon, whose doctors collaborated in the surgery.
Such injuries are “extremely difficult, if not impossible” to repair using normal surgical techniques, the statement said.
“For pushing the bounds of science, they are to be applauded, as long as they have got full informed consent from the patient and the donor’s family,” added Dr. Iain Hutchison, chief executive of the London-based Facial Surgery Research Foundation.
Scientists around the world are working to perfect techniques involved in transplanting faces. Today’s best treatments leave many people with facial disfigurement and scar tissue that doesn’t look or move like natural skin.
Life or death
A complete face transplant, which involves applying a sheet of skin in one operation, has never been done before. The procedure is complex, but uses standard surgical techniques.
Critics say the surgery is too risky for something that is not a matter of life or death, as regular organ transplants are.
The main worry for both a full face transplant and a partial effort is organ rejection, causing the skin to slough off.
“It is not clear whether an individual could be left worse off in the event that a face transplant failed,” said Dr. Stephen Wigmore, chair of the ethics committee of the British Transplantation Society.
Complications also include infections that turn the new face black and require a second transplant or reconstruction with skin grafts, perhaps even one or two years later. Drugs to prevent rejection are needed for life and raise the risk of kidney damage and cancer.
Such concerns have delayed British plans to attempt the operation. In France, ethics authorities rejected an application to try a full face transplant last year, but left the door open for a partial procedure involving the mouth and nose.
In the United States, the Cleveland Clinic is among those planning to attempt a face transplant.
The French surgery “doesn’t change our plans,” said Cleveland surgeon Dr. Maria Siemionow. “We are really looking for the right candidate,” which she described as “severely disfigured patients which have already had the conventional treatment” and for whom a transplant is the last chance.
Dubernard, who is also a lawmaker in France’s lower house of parliament, collaborated in the operation with the Amiens hospital’s Dr. Bernard Devauchelle. Weekly news magazine Le Point reported that the recipient lives in Valenciennes, in northeast France, and that the donor’s facial organs were removed in a hospital in Lille, about 60 miles from where the transplant was performed.
Dubernard also led teams that performed a hand transplant in September 1998 and the world’s first double forearm transplant in January 2000.
The hand transplant recipient, New Zealander Clint Hallam, later had it amputated. Doctors said he failed to take the required drugs and his body rejected the limb.
The double-forearm recipient, Denis Chatelier from France, said in 2003 that he had regained “normal usage” of his hands and was even able to shave himself. His forearms were severed in a model rocket accident.
Doctors from Jinling Hospital in Nanjing, China, reported that in September 2003, they transplanted two ears, part of the scalp and other facial skin from a brain-dead young man to a 72-year-old woman with advanced skin cancer.
Four months later, there were no signs of rejection or tumor recurrence, but it is not known how the patient fared after that.
Doctors around the world have performed partial face transplants using the patients’ own skin, but these don’t require anti-rejection drugs.