- Surgeons are preparing to cross a new medical frontier
with the transplant of a whole human face from a dead to a living person.
-
- Advances in understanding of the processes of biological
rejection and perfection of the skills necessary to carry out the surgery
would make the operation technically possible within the next year, specialists
said yesterday. The first candidates for the surgery could be children
under six, disfigured by disease or accident, who are too young to have
become familiar with their own appearance. Doctors said an adult acquiring
a new face would have to cope with a major psychological and emotional
challenge.
-
- But the main barrier was likely to be public squeamishness
about an operation that people associate with science fiction rather than
surgical fact, specialists said. Peter Butler, a consultant plastic surgeon
at the Royal Free Hospital, London and the Massachusetts General Hospital
in Boston, US, said a public debate was needed to determine society's views
in advance of the surgery becoming possible.
-
- Speaking before a conference organised by the British
Association of Plastic Surgeons, at which latest research on face transplants
was to be presented, Mr Butler said he expected to complete a study of
the anatomical and technical difficulties involved in the next six months.
-
- Transplant of a whole face with underlying muscle would
have advantages over current treatment methods that rely on skin grafts
taken from other parts of the body. They do not allow movement - essential
to convey feeling and expression - and create a mask-like appearance.
-
- Mr Butler, who has researched new techniques of transplantation
and tissue engineering for eight years and was part of the American research
team that grew a "human ear" on the back of a mouse, said there
were three options for the surgery. The first, the subcutaneous option,
involved taking the skin, fatty tissue and blood supply. The second, the
sub-periosteal option, would include facial muscle and nerves while the
third option would take bone as well and involve partial reconstruction
of the skull.
-
- For the first transplant, if approved, surgeons would
take the simplest and safest sub-cutaneous option, to minimise the risks.
"On that basis we should be able to carry out a face transplant in
the next six to nine months," he said.
-
- A bigger challenge was to overcome rejection of the transplanted
tissue. The skin is the most antigenic organ in the body triggering a powerful
immune response which requires high doses of anti-rejection drugs be taken
for life.
-
- The anti-rejection drugs, such as cyclosporin, have nasty
side-effects and increase the incidence of cancer but this is considered
an acceptable risk for a life-saving transplant involving a kidney, heart
or liver.
-
- Where the transplant is about improving the quality of
life, as with face transplants, the risks and benefits are more finely
balanced. Mr Butler said research to be presented to the conference opened
up the prospect of drug-free immunosuppression, meaning transplants of
faces and limbs could be done without the need for lifelong prescription
of medicines.
-
- The technique of immunosuppression, called a tolerance
induction regime, had been successfully achieved in pigs by the Transplant
Research Biology Centre in Massachusetts and trials on humans will start
next year,
-
- "If this comes to clinical reality in the next year
or so it is going to open widely our ability to transplant the face,"
Mr Butler said. "I am told that the age at which children first recognise
themselves is between five and six. Children might be the first group to
use this technique on."
-
- However, public squeamishness is a factor. A study of
attitudes to "face donation" among 120 people, including doctors,
nurses and lay people, found widespread resistance.
-
-
-
-
- http://news.independent.co.uk/uk/health/story.jsp?story=356476
|