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Potential for face transplants may be limited by skin matching problems, pioneer surgeon tells BDA conference

The potential of face transplants for burns and injury patients may be limited by the difficulties of finding suitable donors, according to Professor Bernard Devauchelle who carried out the world's first partial face transplant.

Speaking at the BDA hospitals group conference in Cambridge last month, Professor Devauchelle, head of maxillofacial surgery at the University of Picardy, said a successful transplant depended on the donor and recipient having the same shaped face, being of similar age, and having skin of the same colour and consistency.

Since he led the team which carried out the first facial transplant on Isabelle Dinoire, then 38, in Amiens, France in November 2005, after she had been mauled by the family dog, there had been only two further transplants – one in China in 2006 and one in Paris last year, he told the conference.

'The first difficulty is to find the best donor and it's difficult. Then it is necessary to transplant the face in less than six hours,' he said.

Isabelle Dinoire had to wait six months before a suitable donor was found – a 46 year old brain dead woman whose family had agreed to donate all her organs. 'She matched all our morphological criteria, so a team went to Lille to harvest the transplant and we prepared to start the operation,' said Professor Devauchelle.

The 17-hour operation involved two teams and was followed by four months' intensive physiotherapy. Three months after the operation Ms Dinoire said the sensitivity in her face was back to normal and objective tests verified this, Professor Devauchelle told the conference. But rejection was also a consideration. Ms Dinoire suffered two episodes of rejection – one 18 days after the transplant, and another six months afterwards, when it had been necessary to increase immunosuppressant treatment, he said.

A face transplant needed to provide a pleasing aesthetic result, as well as restoring function, something Ms Dinoire alluded to at a press conference in February 2006. 'She said “when you don't have a face you are nothing”,' Devauchelle told the audience at Magdalene College. She was pleased with the result and now went about her normal life without drawing stares.

James Partridge, founder of the charity Changing Faces which supports people with disfigurements, urged dentists to be more sensitive to patients who were coming to terms with a changed appearance.

Mr Partridge, who suffered 40 percent burns when he turned over a Land Rover in 1970 when he was 18, urged maxillofacial surgeons and general dentists to work more closely with psychologists to meet the needs of patients with disfigurements. More than 500,000 people in the UK have significant facial disfigurements, which often affects their ability in socialising and finding work.

Alluding to Humpty Dumpty, Mr Partridge said: 'Very often it feels as though we have been put back together again, but it's still very difficult to go out in the world and meet people. Time is not an automatic healer and we suffer low self-esteem, and self-confidence is seriously challenged.'

Early facial prosthesis to go on show, see page 356.

Courtesy of BDJ
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