Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2007, vol. 16, nr 2, March-April, p. 323–328

Publication type: review article

Language: English

Face Transplantation – New Possibilities and Risks

Przeszczep twarzy – nowe zagrożenia i korzyści

Tobiasz Szajerka1,, Jerzy Jabłecki2,, Artur Szajerka3,

1 Student Scientific Circle, Department of Internal Diseases and Allergology, Silesian Piasts University of Medicine in Wrocław, Poland

2 Microsurgery Center for Limb Replantation, Surgery of Hand and General Surgery, Trzebnica, Poland

3 Second Department of General and Oncological Surgery, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

As a new achievement in composite tissue grafting, partial face transplantation needs to be reconsidered from a medical and ethical point of view. The aim of this paper is to present the benefits and risks involved in face transplantation. The crucial facet is the attitude of physicians with regard to augmenting the quality of life at the expense of life−span. The technical aspects include selection of the recipients, the operational approach, immunosuppressive therapy, and the feasibility of alternative reconstructive methods.

Streszczenie

Częściowy przeszczep twarzy, nowe osiągnięcie transplantologii, wymaga rozważenia wielu kwestii zarówno medycznych, jak i etycznych. Celem pracy jest przedstawienie korzyści oraz zagrożeń, na jakie są narażeni biorcy. Podstawowym problemem etycznym jest stanowisko lekarzy wobec polepszenia osobom oszpeconym jakości życia kosztem jego długości. Do technicznych zagadnień związanych z przeszczepem twarzy należą: wybór biorców, sposób operowania, leczenie immunosupresyjne oraz dostępność alternatywnych metod rekonstrukcyjnych.

Key words

face, transplantation, immunosuppression, reconstructive surgery, quality of life

Słowa kluczowe

twarz, przeszczep, immunosupresja, chirurgia rekonstrukcyjna, jakość życia

References (40)

  1. Ye EM: Psychological morbidity in patients with facial and neck burns. Burns 1998, 24, 646−648.
  2. Lefebvre A, Barclay S: Psychosocial impact of craniofacial deformities before and after reconstructive surgery. Can J Psychiatry 1982, 27, 579−583.
  3. Macgregor FC: Facial Disfigurement: Problems and management of social interaction and implications for mental health. Aesthetic Plast Surg 1990, 14, 249−257.
  4. Devauchelle B, Badet L, Lengele B, Morelon E, Testelin S, Michallet M, D’Hauthuille C, Dubernard JM: First human face allograft: early report. Lancet 2006, 368, 9531, 203−209.
  5. Morris P, Bradley A, Doyal L, Earley M, Milling M, Rumsey N, RCS Working Party: Facial Transplantation: Working Party – Report. London, Royal College of Surgeons of England, 2003, 1–24.
  6. Working Group – Comitè Consultatif National d’Ethique (CCNE). Composite Tissue Allotransplantation of the Face (Full or Partial Face Transplant). 2004, 1-20.
  7. Petit F, Minns A, Dubernard J, Hettiaratchy S, Lee WP: Composite tissue allotransplantation and reconstructive surgery: First clinical applications. Ann Surg 2003, 237, 19.
  8. Dubernard JM, Owen E, Herzberg G et al: Human hand allograft: Report on first 6 months. Lancet 1999, 353, 1315.
  9. Walton RL, Levin SL: Face Transplantation: The view from Duke University and the University of Chicago. South Med J 2006, 99, 4, 417−418.
  10. O’Neill F: Face transplantation: Is it should we, or how should we, proceed? Bioeth Today, December 2003, 1−3.
  11. Lee WP, Mathes DW: Hand transplantation: Pertinent data and future outlook. J Hand Surg 1999, 24, 906−913.
  12. Concar D: Hand today, faces tomorrow. New Sci 1998, 160, 13.
  13. Siebert C: Making new faces. New York Times Magazine, 9 March 2003.
  14. Clarke A, Butler PEM: Patient Selection for Facial Transplantation II: Psychological Considerations. Int J Surg 2004, 2, 116–118.
  15. Renshaw A, Diver A, Clarke A, Butler PEM: Facial transplantation: A real option in facial reconstruction? Int J Surg 2006, 4, 94−96.
  16. “El segundo trasplantado de rostro ya sonríe y habla mandarin”. Informativos CanalSur WEB, 29/07/06; http://www.rtva.es/Informativos/−ArchivoNoticias/2006/07.Julio/29/290706−mr−019−SOC.htm
  17. Naughton P: French transplant woman says: ‘Now I have a face’. Times Online, February 06, 2006; http://www.timesonline.co.uk/article/0,,13509−2027554,00.html
  18. Hettiaratchy S, Butler PE, Lee WPA: Lessons from hand transplantations. Lancet 2001, 357, 494–495.
  19. Thomas A et al: Total face and scalp replantation. Plast Reconstr Surgery 1998, 102, 2085−2087.
  20. Pribaz JJ, Fine NA: Prefabricated and prelaminated flaps for head and neck reconstruction. Clin Plast Surg 2001, 28, 261−272.
  21. Beumer J et al: Advances in osseointegrated implants for dental and facial rehabilitation following major head and neck surgery. Semin Surg Oncol 1992, 11, 200−207.
  22. Wilson C: The boldest cut. New Sci 2004, 229, 182, 132.
  23. Vranckx JJ, Vermeulen P, Dickens S, Massage P: Smart autologous skin engineering: Science and fiction. ECSAPS 2005, S7.
  24. Buncke HJ: Microsurgical replantation o f the avulsed scalp: report of 20 cases [discussion]. Plast Reconstr Surg 1996, 97, 1107−1108.
  25. Petit F, Paraskevas A et al.: Face transplantation: where do we stand? Plast Reconstr Surg 2004, 113, 1429−1433.
  26. Siemionow M, Agaoglu G, Unal S: A cadaver study in preparation for facial allograft transplantation in humans: part II. Mock facial transplantation. Am Soc Plast Surg 2006, 117, 3, 876−885.
  27. Chun YS, Pribaz JJ: A cadaver study in preparation for facial allograft transplantation in humans: part II. Mock facial transplantation – Discussion. Am Soc Plast Surg 2006, 117, 3, 886−886.
  28. Usturner E et al.: Long−term composite tissue allograft survival in a porcine model with cyclosporine/mycophenolate mofetil therapy. Transplantation 1998, 66, 1581−1587.
  29. Bermudez L, Santamaria LE, Romero T et al.: Experimental model of facial transplant. Plast Reconstr Surg 2002, 110, 1374.
  30. Siemionow M, Gozel−Ulusal B et al.: Functional tolerance following face transplantation in the rat. Transplantation (US) 2003, 75, 1607−1609.
  31. Fansa et al.: The effect of the immunosuppressant FK506 on peripheral nerve regeneration following nerve grafting. J Hand Surg 1999, 24, 38−42.
  32. Barker JH, Vossen M, Joseph C, Banis Jr JC: Technical, Immunological and Ethical Feasibility of Face Transplantation. J Sur 2004, 2, 1, 8−12.
  33. Butler PEM, Hettiaratchy S, Clarke A: Managing the risks of facial transplantation. Lancet 2006, 368, 561−563.
  34. Petruzzo P, Revillard JP, Kanitakis J, Lanzetta M, Hakim NS, Lefrancois N et al.: First human double hand transplantation: efficacy of a conventional immunosuppressive protocol. Clin Transpl 2003, 17(5), 455−460.
  35. Jones NF: Concerns about human hand transplantation in the 21st century. J Hand Surg 2002, 27, 771.
  36. Clarke A, Butler PE: Facial transplantation: adding to the reconstructive options after severe facial injury and disease. Exp Opin Biol Ther 2005, 5 (12), 1539−1546.
  37. Sage A: Face transplant woman to profit from picture sales. The Times, December 08, 2005; http://www.timesonline.co.uk/article/0,,13509−1915330,00.html
  38. AK Lawrence: French, in First, Use a Transplant to Repair a Face. The New York Times, December 1, 2005.
  39. Butler P: Unpublished data presented to Facial Reconstruction Working Party. Royal College of Surgeons of England, September 17, 2003.
  40. Butler PEM, Hettiaratchy S, Clarke A: Facial transplantation: A new gold standard in facial reconstruction? J Plast Reconstr Aesthetic Surg 2006, 59, 211–212.
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