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Facial transplantation offers the potential
to restore humanity to persons who have suffered the devastating loss of their
face," said Dr. Kodi Azari, chief of reconstructive transplantation and
associate professor of surgery at the David Geffen School of Medicine at UCLA.
"People with massive facial injuries often have trouble breathing,
speaking and eating, as well as depression and social isolation. Early
surgeries have demonstrated very promising results in improving both appearance
and function."
The UCLA face transplantation team recognizes the
sensitivity required when it comes to working with patients who have
experienced a severe facial disfigurement. Understanding that a person's
identity and sense of self are closely tied to their facial appearance, the
team will also support the patient's emotional adjustment to their new face
after the surgery.
"Our goal in creating this program is to
return a sense of normalcy to our patients' lives," said Dr. Reza Jarrahy,
surgical co-director of the new program and assistant professor of plastic and
reconstructive surgery at the Geffen School of Medicine. "We hope that restoring
facial form and function will provide the opportunity for patients to lead
productive lives that are not defined or hampered by facial appearance."
UCLA is currently seeking patients willing to
participate in a face-transplant clinical trial and to be followed for five
years after their surgery.
Candidates for the clinical trial will undergo a thorough evaluation to
determine whether they meet the criteria for participation. The evaluation
includes a comprehensive medical history, a physical examination, lab tests,
X-rays and a psychological exam. Approved participants will be placed on a
waiting list until the center identifies a suitable match from a donor.
Recipients must match the donor's blood type, gender, ethnicity, skin tone,
hair pattern and other criteria.
Additional eligibility criteria for the clinical
trial include:
1.
The patient's facial disfigurement cannot be repaired by
conventional surgery.
2.
The disfigurement is not due to a birth defect.
3.
The patient's age is between 18 and 60 years.
4.
The patient has no serious infections, including HIV or
hepatitis B or C.
5.
The patient is in otherwise good general health.
6.
The patient must commit to extensive rehabilitation after
surgery, including soft-tissue massage and speech, swallowing and
facial-movement therapies.
7.
The patient must agree to follow a drug schedule to prevent
transplant rejection and attend all appointments at the transplant center.
Dr. Gerald Lipshutz, medical director of the new
face transplantation program and associate professor of surgery and medicine at
the Geffen School of Medicine, noted that face transplantation is still
considered experimental and is not without risk.
"Each patient will need to take drugs the
rest of their life to suppress their immune system and prevent rejection of
their new face," Lipshutz said. "One of our study's purposes is to
look at the effectiveness and safety of the anti-rejection drugs that will be
used."
To date, 19 patients worldwide have received
partial or complete facial transplants; five of these surgeries have been
performed in the United States.
The surgery takes from eight to 20 hours to
complete. Surgeons first remove the damaged portions of the patient's face and
then attach the donated face to the patient's supporting structures. This includes
joining soft tissue like skin, fat, muscles, tendons and ligaments and securing
the bones with screws and other hardware. The surgery's most delicate facet
involves painstakingly stitching the patient's nerves and blood vessels too
small to be seen by the naked eye to those in the new face.
While solid-organ transplants are common at UCLA
and other major medical centers, reconstructive transplantation a complex
surgery involving a variety of tissues (including bones, tendons, arteries and
nerves) marks a new direction for the field. Unlike organ transplants, which
are performed to save lives, reconstructive transplants aim to dramatically
improve them.
"Microvascular transfer of tissues to
reconstruct the face is not new. It is very similar to reconstructive surgery
after traumatic injury," said Dr. Ronald W. Busuttil, distinguished
professor and executive chairman of surgery at the Geffen School of Medicine,
who established the UCLA Liver Transplant Program in 1984, the first on the West
Coast. v
"What makes this study experimental is that
we are uniting the fields of microvascular reconstructive surgery and
transplantation medicine to transplant the face."
The demand for face transplantation procedures is
expected to increase due to long-term U.S. military action overseas. Experts
estimate that some 200 veterans have lost all or part of their face. In the
civilian sector, nearly 1,000 trauma and burn patients suffer extensive facial
injuries that drastically affect their lives.
The UCLA Face Transplantation Program plans to
partner with UCLA's highly successful Operation Mend, which offers facial and
hand reconstructive surgery to the nation's wounded soldiers.
The program will integrate specialists from
throughout the UCLA Health System, including the areas of head and neck
surgery, plastic and reconstructive surgery, oral surgery, psychiatry,
pathology, anesthesia, internal medicine, radiology, neurology, ethics, and
rehabilitation services.
In addition to principal investigator Azari and co-investigators
Jarrahy, Lipshutz and Busuttil, co-investigators include Dr. Keith Blackwell,
professor of head and neck surgery; Dr. Vishad Nabili, assistant professor of
head and neck surgery; and Dr. James Bradley, professor of plastic surgery, all
of the David Geffen School of Medicine at UCLA.
Source-Newswise
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