Sur­geons suc­cess­fully per­form full face trans­plant

Tehran Times - - HEALTH -

A team of sur­geons has suc­cess­fully per­formed a face trans­plant for a 26-year-old man who had a self-in­flicted gun in­jury. The team used fa­cial skin from a donor to re­place much of the man’s face, as well as par­tially re­plac­ing his bone struc­ture.

Us­ing many in­no­va­tive tech­nolo­gies, a sur­gi­cal team has suc­cess­fully per­formed a full face trans­plant.

A team of over 100 med­i­cal pro­fes­sion­als at New York Univer­sity (NYU) Lan­gone in New York City per­formed the trans­plant.

Dr. Ed­uardo D. Ro­driguez — the He­len L. Kim­mel pro­fes­sor of re­con­struc­tive plas­tic surgery and chair of the Han­sjörg Wyss De­part­ment of Plas­tic Surgery at NYU Lan­gone — led the sur­gi­cal team.

The pa­tient’s name is Cameron Un­der­wood. He is a 26-year-old man who lost most of his lower jaw, teeth, and nose as a re­sult of a self-in­flicted ac­ci­den­tal gun­shot.

The man had also dam­aged his max­il­lary and palate as a re­sult of the ac­ci­dent.

Dr. Ro­driguez and his team per­formed the trans­plant surgery on Jan­uary 5, 2018. The pro­ce­dure lasted 25 hours and ended the fol­low­ing morn­ing.

Since then, the NYU Lan­gone spe­cial­ists have per­formed sev­eral fol­low-up pro­ce­dures, and they now re­port on their achieve­ment and the tech­niques they used.

’Max­i­mal aes­thetic and func­tional re­sults’

To carry out the trans­plant, the sur­geons used sev­eral cut­ting-edge tech­nolo­gies. For in­stance, the fol­low­ing tech­niques al­lowed the sur­geons to place the grafted face with a high level of pre­ci­sion:

* 3-D com­puter sur­gi­cal plan­ning * 3-D-printed cut­ting guides tai­lored to the pa­tient

* in­tra­op­er­a­tive nav­i­ga­tion * in­tra­op­er­a­tive CAT scan

The sur­geons used the en­tire mid­dle and lower parts of the donor’s face and skull to com­plete the trans­plant. In all, they re­placed and reconstructed the pa­tient’s up­per and lower jaws, 32 teeth and gums, the roof and floor of the mouth, the lower eye­lids and cheeks, and the nose and part of the nasal pas­sage.

Also, Dr. Ro­driguez and team used an in­no­va­tive ap­proach to pre­serve the iden­tity of the do­nated face: a 3-D-printed mask of the donor’s fea­tures.

Af­ter the trans­plant, when Un­der­wood’s face had healed and the in­flam­ma­tion had sub­sided, Dr. Ro­driguez and team con­ducted sev­eral mi­nor fol­low-up surg­eries to achieve the best aes­thetic re­sults.

“Tech­ni­cal ad­vances,” Dr. Ro­driguez says, “have in­creased our abil­ity to tackle the most com­plex cases more pre­cisely with max­i­mal aes­thetic and func­tional re­sults.”

He adds, “Ad­vances in med­i­cal tech­nol­ogy al­low us to more rapidly eval­u­ate donors and re­cip­i­ents for [a] face trans­plant, and to per­form surgery more safely and ef­fi­ciently.”

The doc­tors also note that the first sim­i­lar trans­plant they con­ducted lasted over

36 hours, so the fact that they man­aged to re­duce surgery time by 11 hours is a highly sig­nif­i­cant achieve­ment.

“Hav­ing al­ready done two face trans­plants, we iden­ti­fied even be­fore we en­tered the [op­er­at­ing room] where we could re­duce sur­gi­cal time,” Dr. Ro­driguez says.

“This is crit­i­cally im­por­tant,” he adds, “not only from a fa­tigue fac­tor for the sur­gi­cal team, but also for Cameron’s re­cov­ery. A shorter surgery of­ten trans­lates into less risk of com­pli­ca­tions.”

In com­par­i­son with the first trans­plant, the sur­gi­cal team also achieved sig­nif­i­cant re­duc­tions in the time ded­i­cated to post­op­er­a­tive care, as fol­lows:

* the to­tal length of stay in the hospi­tal was 37 days for Un­der­wood, com­pared with

62 days for the pa­tient who un­der­went the first trans­plant

* the num­ber of days spent in the in­ten­sive care unit was 23, com­pared with

51 for the first pa­tient

* the team man­aged to al­most halve the num­ber of days spent in re­ha­bil­i­ta­tion, from 13 to 7

Dr. Bruce E. Gelb, a trans­plant sur­geon at NYU Lan­gone who also par­tic­i­pated in Un­der­wood’s trans­plant, com­ments, “We are thrilled that Cameron is re­spond­ing so well to the trans­plant.”

“Our team has es­tab­lished a suc­cess­ful, novel, pa­tient-donor match­ing pro­to­col and im­mune sup­pres­sion reg­i­men that we be­lieve pro­vides the best out­comes for our pa­tients be­cause the risk of re­jec­tion and tox­i­c­ity is greatly min­i­mized.”

Dr. Bruce E. Gelb

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