First full face transplant to be done in UK

Published on 26/10/2006 01:29

Key quote "These patients will have already undergone reconstructive surgery - perhaps they will have had 50 to 70 reconstructive operations. They have reached the end of the reconstructive ladder and there's nothing more it can offer them" - Peter Butler, surgeon

Story in full THE world's first full face transplant could be performed in the UK within months, medics said yesterday.

Consultant surgeon Peter Butler and his team at London's Royal Free Hospital have been given the go-ahead by their ethics committee to carry out the ground-breaking and controversial operation.

The decision means that the transplant will take place within the next year, with patients already queuing up for the life-changing surgery.

Last year in France, Isabelle Dinoire, 38, became the first person to receive a partial face transplant after her nose, lips and chin were torn off in an attack by a family dog.

The UK team faces competition from countries including the US and France to carry out the first full face transplant.

But Mr Butler insisted that it was not a race.

The surgeon has already been approached by 34 patients from all over the world, but will select just four from the UK or Ireland to operate on.

As the decision was announced, it was immediately criticised by the Royal College of Surgeons (RCS), who will release a report with full recommendations about such surgery next month.

The college said it still had "grave concerns" about face transplantation and urged the hospital to wait until its report had been considered in full before going ahead with surgery.

"We believe that facial transplantation should only take place if all of the minimal requirements we will set out can be met," the RCS said.

Mr Butler yesterday said he felt "delighted" his team had been given the go-ahead.

"It's been a long journey, but this is just the beginning, really," he said. "The most important part of the process starts now, which is selection of the patients."

It is expected that potential patients will have a "pan-facial" disfigurement, meaning the whole face has been affected by injury, such as severe burns spreading to the scalp or ears.

These patients are often still seriously affected by their injuries, such as not being able to fully close their mouth or eyelids.

"These patients will have already undergone reconstructive surgery - perhaps they will have had 50 to 70 reconstructive operations," Mr Butler said.

"They have reached the end of the reconstructive ladder and there's nothing more it can offer them."

Mr Butler said some people with severe disfigurement could feel that everybody was staring at them as they walked down the street, and all they wanted was to be "normal".

The transplant would take ten to 12 hours to complete, but a patient would have to take immuno-suppressant drugs for the rest of their lives to stop the new tissue being rejected.

Mr Butler said he hoped face transplants would become the first choice in reconstructive surgery if the operation proved a success.

He said studies had shown that public support for face transplants was high and much had been done to allay people's fears.

But Changing Faces, the national charity for people with facial disfigurement, gave only a cautious welcome to the go-ahead.

The charity said that it would have preferred the hospital's ethics committee to have waited for the recommendations of the RCS.

"Our main concern is to ensure that any patient who is being considered for this procedure has a full understanding of the risks and benefits, especially the risks associated with the immuno-suppressant drug regime," a spokesman said.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons described the transplant development as "very exciting".

How the operation will be done

THE first full face transplant will take a team of highly skilled staff up to 12 hours to complete.

First, a "retrieval team" will remove the facial tissue from the dead donor, taking around two hours.

This will include veins, arteries, skin, subcutaneous fat and the muscles from the lips, cheek and forehead.

While this operation takes place, the patient is prepared, with previous skin grafts removed in preparation.

Micro-surgery is then used to attach the face and vessels to the patient.

Some have been concerned that the patient will end up looking like the donor, but computer modelling has shown that facial characteristics following transplant are mostly those of the recipient.

This is because the skin is pliable and falls across the bone structure of the person receiving the new face.

Four to six surgeons would be involved in the operation, helped by nurses and anaesthetists. Psychologists would work with the patient and the donor's family.

The team will wait about six months after the first transplant before operating on a second patient so they can assess the results.