Thursday, December 29, 2011

Three transplants, three lives recovered


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       The faceless man, the woman deformed by a chimpanzee and the man who did not go out to the streets for fear t of the comments.These three people have regained their normality thanks to face transplants performed at the Brigham and Women's Hospital (BWH) in Boston (USA).Physicians who participated in these three operations are now in the medical journal'The New England Journal of Medicine' which are the keys to these transplants and how it has been the evolution of patients.

    Dallas Wiens, 25, lost all his face after a spectacular electrical accident in 2008I could not breathe through the nose, had no facial expression ... He had no face, in short. But after 17 hours in surgery, receiving 24 units of red blood cells and plasma13, ie three to four liters of blood, came out with a new face that enabled him, months later, to appear publicly to thank the family of donor. Details of this operation, and theother three carried out at BWH, are now published to share this experience with other doctors who are, or want to be, involved in a face transplant.

       "Unlike the conventional reconstruction, the face transplant to transform otherdistorted faces an almost normal appearance and function, rather than conventionalsurgical techniques in reconstructive plastic surgery can not achieve," said Dr.Bohdan Pomahac, lead author the study, director of Plastic Surgery at BWHtransplants and chief surgeon at the three interventions is now published.

         This surgeon, along with the rest of his team, tells how they used certain donor nerves, such as arms, to unite to face flaps recipients. "Our strategy uses all grades surgery motor and sensory nerves to provide proprioceptive feedback [graft signalsthe body] as the graft recovers, facilitating cortical integration of the new face," saythe doctors at the BWH.

        As for the facial circulation, surgeons explain that planned the recovery of tissues implanted through a simplified vascular supplement "guided by a precise map of the vessels in the recipient," because, they explain, would introduce complicated by the glass vessel and prolonged recovery of the graft. With this technique got facialrecovery of three patients in less than four hours.




      Despite the dramatic result was seen in each of these three patients, postoperative was not an easy ride. Charla Nash, the woman who was attacked by a chimpanzee and he ran out of nose, eyes, lips and jaw, suffered an acute rejection and a half months of being operated, suffered a deep vein thrombosis in his left leg in the third month, and had various infections. However, it has made ​​progress in his recovery.Before being tapped could not breathe, he spoke with difficulty, had no facial expression and was unable to close his mouth. Thanks to transplant two months could not breathe through your nose and mouthSensitivity has also been acquired in different areas of your face, although it has not yet recovered motor function.



        Mean while, James Maki, who lost her nose, upper lip, cheeks, palate and various muscles and nerves of his face after falling on a rail electrified Boston's subway in 2005, suffered pneumonia on the second day to be tapped. Despite this setback, being discharged from the ICU, four days after surgery, I could eat, drink and see his new face. However, two weeks later she had a rejection from which he recovered andwas discharged two months later. At the time of data collection for this article, the patient had sensation in his forehead and chin and moved his lips roughly.

"Our goal remains to document the progress of patients who have received a face transplant, and develop the use of immunosuppressants," said Pomahac. In fact, in an article published now these surgeons say they expect imminent and gradual changes in facial appearance of these patients. "We anticipate the facial skeleton and the volume could shape the final look, making it unlikely the resemblance to the donors. It is our subjective opinion, as well as the families of two donors, saying that patients do not seem to relatives (the other family has chosen to remain anonymous), "say the doctors.



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