Health

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Burn Victim Makes Medical History

April 08, 2009 01:04 PM
by Shannon Firth
This past weekend, doctors in France performed the first simultaneous transplant surgery on a man burned in a 2004 accident.

First transplant of its kind

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The world's first double hand and face transplant surgery took place at Henri Mondor Hospital in Créteil, Paris, over a 40-hour period. These same doctors performed the world’s first face transplant and hand transplant in 2005 and 1998, respectively.

According to health officials, Dr. Laurent Lantiéri oversaw the face transplant while Dr. Christian Dumontier directed the double hand transplant.

"The hands had been grafted on to the patient above his wrists while the entire upper part of the man’s face — including his nose, eyelids, forehead, scalp and ears — was also replaced," the Times of London reported.

Dr. Lantiéri, who has conducted three of only six face transplants ever performed, told the Times the operation went well and the patient will remain at the hospital for the next two weeks.
Three years after undergoing the world’s first partial face transplant, French woman Isabelle Dinoire is still coping with the psychological aftermath of her surgery. In November 2008, Dinoire told The Daily Telegraph, “Before the operation, I expected my new face would look like me but it turned out after the operation that it was half me and half her.”

Her statement may cause concern among the doctors of the Royal Free Hospital in London who received permission from England’s National Health System’s ethics board to complete the world’s first full facial transplant.

Dinoire conceded, “I have the feeling of looking at something beautiful … but it wasn't easy at the beginning."

In a press release following a 2006 lecture at the Royal College of Surgeons in England, Nichola Rumsey, professor in appearance and health psychology, explained that the psychological effects of facial transplants had yet to be discovered. In addition, critical anti-rejection drugs, required post-surgery, must be taken on a permanent basis and can “significantly lower life expectancy.”

Background: The first partial and first full facial transplants; Hand transplant research

In November 2005, French doctors Jean-Michel Deubernard and Bernard Devauchelle performed the world’s first partial facial transplant after Dinoire’s pet Labrador ripped off a portion of her nose, mouth and chin while she was sedated on sleeping pills. Dinoire, a mother of two, had had a difficult week and “took some drugs to forget,” the Associated Press quoted her as saying. After she woke up, Dinoire said, “I tried to light a cigarette, and I didn't understand why I couldn't hold it between my lips.”

While British doctors say they are preparing for the world’s first full facial transplant, ABC News reported that Dr. Lantieri has already completed the landmark surgery on Pascal Coler at Henri-Mondor Hospital in France in early 2008. After suffering for 24 years from a condition similar to that of Joseph Merrick, known as “The Elephant Man,” Coler said, "I'd love to find a wife. Settle down and have children."

More recently, however, a study from the Proceedings of the National Academy of Sciences led by Angela Sirigu, explored 6 different hand transplant cases and examined how the individuals’ brains reasserted “neurological control” over their newly adopted appendages.

According to the researchers, "Our findings show that newly transplanted muscles can be recognized and integrated into the patient's motor cortex.”

Jon Kaas, who reviewed the study for the journal, explained that when a person loses a hand, because of the brain’s remarkable plasticity it re-organizes the specific roles of certain areas. After a transplant, the brain works in reverse, restoring the old order.

Curiously, both double hand amputees in the study were right-handed prior to their accidents, but found it easier to use their left-hand after surgery.

Video: The world’s first partial facial transplant

A 2006 BBC Horizon documentary of the first partial facial transplant surgery is not for those with a weak stomach. At the University Hospital in Amiens, Dr. Jean-Michel Deubernard and Dr. Bernard DeVauchelle completed Dinoire’s groundbreaking surgery in 15 hours.

Opinion & Analysis: How do people feel about facial transplants?

According to The West Australian, a study from the University of Louisville reported that even after being given a list of 20 immunosuppression-related side effects, 77 percent of respondents with facial deformities said they would still choose to have facial transplants. For healthy individuals who questioned on the basis of being hypothetically disfigured, 86 percent said they would agree to the surgery.

Related Topics: Recipients of transplants may inherit donor traits

Jaime Sherman, a 28-year-old psychology student at Arizona State University, told the Arizona Daily Star how she acquired a taste for Mexican food and an interest in sports after receiving a heart transplant. “I'm a psychology major, and my professors will tell you it's all in your mind," she said. "But the scientists, the psychologists—they don't have someone else's heart beating inside them. I do.”

In April 2008, Sonny Graham, a Georgia heart transplant recipient who married his donor’s widow, committed suicide in the same manner as the donor had—by shooting himself in the neck.

Reference: How a face transplant is performed

According to The Daily Telegraph, after arteries, veins and nerves have been reconnected during a facial transplant, it can take between six months and a year before transplanted facial muscles will function normally. After surgery, the recipient then begins a difficult lifetime regiment of immunosuppressant drugs. The alternative to face transplants is to use thick and thin skin grafts taken from areas such as the back. In these surgeries, the patient may only have slits in place of eyes and a mouth.
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