First near total facial transplant at Cleveland Clinic by Dr.Marie Siemionow
The first near total facial transplant was performed at the Cleveland Clinic, with nearly 80 percent of the patient’s face being replaced. The team was led by Dr. Maria Siemionow, head of the plastic surgery research at the Cleveland Clinic. She is the first U.S. physician to receive Institutional Review Board approval for facial transplantation surgery in 2004.
Facial transplant can be done from a dead donor who has similar facial characteristic and antigen type as the recipient. The first facial transplant was done in France to Isabelle Dinoire in 2005. Isabelle face was disfigured when a dog bit her face. It was a partial face transplant where a triangle of facial tissue from a brain-dead human's nose and mouth was grafted onto the patient. The procedure was done at Amiens University Hospital by a team led by Dr. Bernard Devauchelle, a French oral and maxillofacial surgeon. In a later review Isabelle Dinoire mentioned that she is happy with the results of the facial transplant. Subsequently, another facial transplant was done by a group of Chinese doctors on a man who had been a victim of bear attack at Xijing military hospital in Xian, China.
The major issue with the facial transplant is tissue rejection by the recipient immune system. And the patients need to be put on immunosuppressive drugs to prevent the immune system from rejecting the donor tissue. The immunosuppressive therapy is associated with several potential complications including serious systemic infections, renal dysfunction and cancer. Other issues include psychological problems resulting in depression, grief and guilt.
Why do we need a donor when we can use the patient own skin? The reason is that skin grafts taken from other parts of the body of the patients, do not allow movement or sensitivity, creating a mask-like effect. Patients whose faces have been seriously disfigured by cancer, burns or accidents could be helped by such transplants. There needs to be a moral and an ethical debate regarding the procedure.
Dr.Marie Siemionow, the lead facial transplant surgeon at the Cleveland Clinic was awarded her medical degree by the Poznan Medical Academy and after her residency in orthopedics, did fellowship at the Christine Kleinert Institute for Hand and Microsurgery in Louisville, Ky. Since 1995 she has been Director of Plastic Surgery Research, and Head of Microsurgery Training in the Plastic Surgery Department of Cleveland Clinic. She had previously publiced a book "Transplanting a Face: Notes on a Life in Medicine”.