Risk vs. Benefit of Facial Transplant
The world's first face transplant was done a year and a half ago on a woman in France who had been mauled by her dog. Those who argue against face transplants say if the body rejects the tissue, another operation to remove the tissue could leave the patient more scarred than before. However, some doctors argue that face transplants can dramatically transform the lives of people who are disfigured to the point where they do not work or go out.
A face transplant first requires a donor. A donor is typically someone who has been declared brain dead but with blood still flowing to the tissue to be used. The healthy tissue is extracted from the donor. Then the traumatized tissue is removed from the patient. The healthy tissue from the donor is then surgically attached to the problem-area of the recipient patient.
A complete face transplant, which involves applying a sheet of skin in one operation, has never been done before. The procedure is complex but would use standard surgical techniques. The French did not appear to have tried conventional reconstruction with skin grafts before doing the risky and radical partial face transplant, raising ethical concerns about subjecting a patient to the risks of immune suppression without first exhausting normal remedies.
There are two steps:
Step one: Skin and muscle tissue, eight different blood vessels, four arteries and four veins cut away from donor's face
Step two: Blood vessels and nerves from face section connected to recipient using microvascular surgery
But surgeons and ethicists alike pointed out the medical risks and ethical conundrums inherent in this procedure. For a patient with severe facial deformity, there may be benefits in function, appearance, and psychological adjustment, but not without the risks of long-term immunosuppression, graft rejection, and psychological harms.
It very clear that face reconstruction is also a social reconstruction. Of course her life will never be the same as it before, for hundreds of reasons. A lifetime on anti-rejection drugs would increase the recipient's risks of getting cancer. The fear in a patient of losing the face completely would be extremely damaging, psychologically. A repeat transplant is not very likely, so a patient would have to go back to a traditional reconstructive procedure. Having to go back to square one, or square minus one, would be horrible.
As with all transplants, the doctors said, there was about a 33 percent risk of death, a 33 percent risk that the body would reject the graft and only a 33 percent chance that the transplant would prove successful. We think of all the people who have been disfigured to whom we could give new hope.
Facial Fat Rejuvenation, more commonly known as Fat Grafting, free fat transfer, autologous fat grafting/ transfer/ transplantation, volume restoration, micro lipoinjection, fat injections and even the "Space Lift. It is the method of the extraction of your own fat cells to replace fat or augment with fat where you may need or want it. You could have an allergic reaction to the anesthesia if applicable or the local anesthetic that is used in the area of removal, hematoma and asymmetry. There is a risk of infection as well the extremely rare possibility of permanent discoloration due to a ruptured superficial blood vessel at the treatment site during an injection. There is the possibility, although rare, of calcification.
The problem of transplanting skin has recently been overcome, paving the way for researchers to attempt a face transplant, Barker said. Unlike the transplant of solid organs -- such as hearts and kidneys, which have been routine for decades -- procedures such as hand transplants require multiple types of tissue, including skin.
Researchers found that a cocktail of drugs used for kidney transplants would also work with skin transplants. Doctors currently are limited to grafting skin and muscles from other parts of the body in patients who have suffered catastrophic damage to their faces, but the result is typically cosmetically unsatisfactory.
The risk-benefit equation is at the center of controversy over facial transplantation. Physicians and scientists question whether the risks of life-long immunosuppression for patients justify the benefits of this new treatment. In considering the most recent and relevant data, we came to the conclusion that the expectations for face transplant recipients should be significantly better than those previously published.
Researchers in Cincinnati and Louisville report that immunosuppressive risks associated with facial transplantation may be lower than thought, possibly making the procedure a safer option for people who have suffered severe facial injuries. U.S. researchers also reported that immunosuppressive risks associated with facial transplantation might be less than thought.
The world's first full face transplant, which was authorized by a UK medical watchdog, is hedged with technical, psychological and ethical challenges, experts say. Nerves and the main vessels that carry blood to the face are connected by surgery under a microscope.
This task is common in reconstructive surgery and has a high success rate. Of the 24 hand transplants that have been carried out on 18 people over the past eight years, only two have failed. But microsurgery also carries a 5-10% risk of transplant failure from clots that may form within the connected blood vessels in the first few days after surgery.
For a transplant recipient, the primary long-term medical risks associated with the procedure are posed by the drugs needed to suppress the immune system and prevent rejection. The question of how the transplanted face will look is critical not only to the recipient, but also to the relatives of potential donors. You would want to be sure that the family understands that the appearance of their loved one will not at all be replicated.
Transplanted muscles might not recover normal function: "Even if we take all the muscles, you never know how they will regenerate," noted Siemionow. "This is a little too risky to do all at once.” researcher’s warned. Potential candidates for a facial transplant must also have sufficient areas of intact skin elsewhere on their bodies to provide autologous grafts for a rescue operation, should the transplantation fail or the transplant be rejected.
Critics of the face transplant note that the unknown risks of the procedure could even include death. They raise further concerns about the recipient’s psychological state and the questionable circumstances of injury. Researchers agreed that psychological counseling, one of the standard preparations for solid organ transplantation, should be mandated for anyone considering a face transplant.
The long-term risk that a facial transplant will be rejected by the recipient appears to be lower than previously estimated, based on a review of data for other type of transplants.
Just three facial transplants have been performed to date. Fear that the transplant will be rejected after surgery is one of the major concerns slowing the widespread use of this operation.
The risks of rejection "are lower than previously reported thus changing the risk vs. benefit balance," study co-author Dr. John H. Barker, from the University of Louisville in Kentucky, told Reuters Health.
Barker said that rates of long-term rejection and toxic effects are lower than previously estimated. The former finding he chalks up to quick "detection and reversal of (early) rejection episodes," while the latter, he believes stems from facial transplant recipients generally being healthier than other recipients and, therefore, more able to tolerate toxic drug effects.
According to the report in the journal Plastic and Reconstructive Surgery, the previously reported rejection risks of facial transplantation are inaccurate because they are based on data from studies that have used different immune-suppressing drugs and featured patients ranging from very ill to relatively healthy, among other factors.
In the current study, the researchers assessed the risks by using data from studies of kidney and hand transplantations, which they believe reflects what is likely to occur with facial transplantation.
While the risk of rejection in the short term could be as high as 70 percent, this problem was easily treated with steroid drugs. Over a 5-year period, by contrast, the risk of rejection was generally below 10 percent.Other problems related to the immune-suppressing drugs, such as kidney failure, diabetes, and high blood pressure, were also fairly uncommon.
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