28 March 2012

Virginia Man Gets A New Face In Baltimore

Story first appeared in The Baltimore Sun.

When the patient opened his eyes after a marathon 36-hour surgery to give him a new face, he immediately wanted a mirror.

A natural reaction for a man who had been practically living as a recluse since a 1997 gun accident took off his nose, chin, lips and teeth, said doctors from the University of Maryland who had just performed the world's most extensive face transplant on the 37-year-old from Hillsville, Va.

There were up to 150 doctors, nurses and other professionals from the Maryland medical system who had a direct hand in caring for the patient.  So many hands in the surgery does leave room for possible error, which could lead to a Baltimore Medical Malpractice Lawyer stepping in.
Just six days after his surgery, he was saying some words, shaving and brushing his teeth. He's also beginning to get some feeling back in his face.

The patient received donor skin from his scalp to his neck, as well as a new jaw, teeth, tongue and the underlying muscle and tissue. In addition to matching his blood type, doctors had to match his skin color and bone structure to a donor.

Unemployed and living with his parents before he came to Maryland in 2005, the patient had undergone a dozen surgeries, but none that could restore him to functioning membership in society.

Maryland had been working for the past decade on face transplant methods, improving the way tissue, muscle, skin and bone are woven onto a recipient and increasing the odds of acceptance by a recipient.

The Department of Defense's Office of Naval Research funded the work with eight grants totaling $13 million. It supports research that could aid returning service members injured by explosives. At some point, injured veterans could undergo transplants at Maryland.

The hospital provided no details about the gun accident, but during Tuesday's news conference at Maryland, doctors and university officials recounted the patient’s transformation through a series of photos.

Doctors showed before and after pictures that included a photo from his high school prom; a post-injury photo where he appeared to have no chin and a mangled nose; and a post-surgery photo that made him appear close to normal, if swollen, after surgery.

The patient’s facial features appear to be a blend of his own and those of his donor, whose family he has not met.  The donor was not named by the Living Legacy Foundation of Maryland, which works in the state to supply recipients with needed organs. The same donor provided five life-saving organs to five other recipients, four of whom also had surgeries at Maryland.

Drivers who check "organ donor "on their licenses do not consent to face transplants. A family must give special permission.

Around the world, 22 people have received face transplants since the first was performed in France seven years ago. While Maryland is a large transplant center, this was its first face transplant.

Doctors there have been working to perfect the protocol to prevent rejection of any transplant.  Normally, patients are given a daily three-drug cocktail for the rest of their lives to keep them from rejecting their transplants.

Starting five years ago, the center's doctors began using two drugs for many kidney and pancreas transplant patients and they're trying them on the patient, the first time for a face-transplant patient, surgeons said. The drugs suppress the immune system and make a patient more vulnerable to infection, so a smaller amount can reduce that side effect. Eventually, doctors hope to reduce the dosage of the two drugs.

Doctors felt confident using the new drug regimen on the patient after years of lab work at Maryland.  The research supported the change as long as they also transplanted high amounts of "vascularized" bone marrow, which came inside the jaw transplanted into his face. The bones and attached vessels give the marrow a ready place to live and steady supply of blood, and that seems to offer some continuous protection from rejection, though researchers aren't entirely sure why.

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