Second-ever face transplant hailed as a success

Medical Tribune October 2008 P9
David Brill

Two years after the world’s second face transplant, the operation seems to have been a success.

Despite some complications, including three episodes of acute rejection, the patient is now healthy, able to eat, drink and talk as normal and has accepted his new face, the Chinese surgical team reported in The Lancet. [2008 Aug 23;372:631-8]

The tissue graft survived well, regaining normal skin temperature, texture and color, and did not become infected at any point.

Professor Shuzhong Guo and colleagues from the Fourth Military Medical University in Xi’an, Shaanxi Province, China, performed the procedure in April 2006. The recipient is a 30-year-old man from Yunnan Province whose face was badly disfigured by a bear in October 2004.

The graft, which was taken from a 25-year old male who had died in a road traffic accident, comprised the top lip, the whole nose, the intact parotid gland, zygomatic bone, the front wall of the maxillary sinus, and a section of the infraorbital wall.

The patient experienced an acute rejection episode three months after surgery and again at five and 17 months. These episodes involved reddening of the skin, swelling and inflammation, but were all successfully controlled with various regimens of tacrolimus, methylprednisolone and prednisone.

Hyperglycemia developed after three days but was controlled with insulin therapy. Renal, hepatic and gastrointestinal function were not adversely affected by the procedure.

“This case suggests that facial transplantation might be an option for restoring a severely disfigured face, and could enable patients to readily reintegrate themselves back into society,” the doctors wrote in the study.

The first-ever partial facial transplant was performed in November 2005 by a team of surgeons led by Professor Bernard Devauchelle from the Centre Hospitalier Universitaire Amiens, France. The recipient was a 38-year-old woman whose face had been bitten by her dog. [Lancet
2006;368:203-9]

The Chinese case differed in that the graft included bone as well as skin, and was taken following cardiac death rather than brain death.

A third transplant was carried out in January 2007 by another French team, which reported their 1-year follow-up in the same journal issue as the Chinese case. [Lancet 2008 Aug 23;372:639-45] The recipient was a 29-year-old man who had a massive plexiform neurofibroma affecting the middle and lower part of his face. He experienced two rejection episodes but has otherwise made a good functional and psychological recovery, the doctors reported, lending further support to the viability of the procedure.