Boston hospital team performs first full face transplant in U.S.

March 21, 2011

Doctors at a Boston hospital last week performed the first full face transplant in the United States, attaching a donor face to a 25-year-old Fort Worth man whose face was severely burned when his head touched a high-voltage line three years ago.

The operation was funded under a grant from the U.S. Department of Defense as part of the military’s efforts to expand research in innovative medical procedures.

In a statement Monday, doctors at Brigham and Women’s Hospital said a team of more than 30 surgeons, nurses, anesthesi­olo­gists and residents worked for about 15 hours to transplant the forehead, nose, lips, facial skin, underlying muscles “and the nerves that power them and provide sensation” from an anonymous donor to Dallas Wiens, a day laborer who was on a cherry-picker Nov. 13, 2008, when his head came in contact with a high-voltage line.

Bohdan Pomahac, the lead plastic surgeon, said the team was not able to restore Wiens’s vision. But Wiens, who has a young daughter, should be able regain up to 90 percent of normal sensation on the right side of his forehead, right cheek, most of his upper lip and his entire lower lip, Pomahac said at a news conference. Nerve damage was too great for there to be more than minimal sensation in the left check and left forehead, Pomahac said.

Doctors say the goal of the operation was to improve Wiens’s ability to breathe, eat and talk and restore his face’s social expression. Wiens has spoken on the telephone to his parents and siblings since the operation and has asked for — but is not yet allowed to have — his favorite soda, Dr Pepper.

His grandfather, Del Peterson, said the operation was a miracle.

When Wiens recovers, he will not look like he once did, nor will he look like the donor, but “probably somewhere in the middle,” Pomahac said. The donor/recipient match was made based on gender, race, approximate age and blood type.

The operation last week was the second face transplant procedure at the hospital.

The Cleveland Clinic performed the nation’s first near-total face transplant in 2008.

In 2009, the Brigham performed a partial face transplant on James Maki, who had suffered severe burns when he fell on the electrified third rail at a subway station.

After that procedure was successfully completed, the Defense Department awarded a $3.4 million grant to the hospital in December 2009 to fund five face transplants, including Wiens’s, according to Col. Janet Harris, director of the Clinical and Rehabilitative Medicine Research Program for the Army Medical Research and Materiel Command.

“Our interest is in research that is going to further us being able to provide better care for our troops injured in combat,” she said.

The conflicts in Iraq and Afghanistan have resulted in an increasing number of cranial and facial injuries to U.S. soldiers, she said, noting that many injuries were from improvised explosive devices.

The Defense Department has talked with military patients who would be interested in being on a waiting list for such transplants at the Brigham, she said.

Two other patients are on already the list, hospital officials said. They identified them as Mitch Hunter of Indianapolis, an Army veteran who was in a car crash after his Army stint, and Charla Nash, a Connecticut woman who lost her hands, nose, lips and eyelids in 2009 when she was mauled by a chimpanzee.

Doctors said the family of the donor for last week’s transplant wished to remain anonymous. Consent for the donation of the tissue graft from the face was obtained by the New England Organ Bank staff after conversations with the family.

Pomahac said he was worried the operation would not be successful when he first saw Wiens. His injuries were so extensive that doctors weren’t sure there were enough residual nerves or structures to connect to a new face.

Pomahac said he was determined to try his best because of what a patient with similar injuries had told him some years ago.

That patient had numerous surgeries, with only modest results. When Pomahac asked why the patient sought repeated surgery, he told the doctor: “I just want a cab to stop when I’m at the curb.”

Lena H. Sun is a national reporter for The Washington Post, focusing on health.
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