(U.S. Defense Department graphic illustration by Jessica L. Tozer/Released)
The Defense Department’s unrivaled investment in face transplant research has produced extraordinary results that have the potential to transform modern medicine.
Nearly a decade ago, the Defense Department began collaborating with civilian clinics to research and advance face transplant surgery to eventually help service members with devastating combat injuries from fighting in Iraq and Afghanistan.
“We want to get them as close to how they were before they got injured,” said Dr. Michael Given, program officer at the Office of Naval Research in Arlington, Va.
Face transplant surgery, first performed in France in 2005, offers a promising solution. The surgery goes far beyond the traditional techniques of facial reconstruction. The entire face of a deceased donor – skin, muscle, fat, nerves, blood vessels, bone and even teeth - is removed and then used to restore the patient’s disfigured face.
The difference in patients before and after the surgery is night and day, said Dr. Bohdan Pomahac, who has led five face transplant surgeries at Brigham and Women’s Hospital in Boston, Mass. With these surgeries, doctors can “replace the central part of the face in one operation to an extent I could never dream about,” he said. “Patients who had no solution before now have something.”
“The face is the mirror to our souls, not only because we show expressions on our face … but also because most of our senses are harbored in the facial area,” he added. “I always say these are not life-saving, but life-giving surgeries.”
Successful face transplant operations are only the beginning for what the Defense Department officials and their civilian counterparts hope to achieve. Their continued research into face transplants could potentially solve even bigger medical problems.
“We are onto something that is remarkably interesting, remarkably novel and truly cutting edge,” Pomahac said.
Changing Lives
Just 24 face transplant surgeries have been performed worldwide, with seven occurring in the United States, primarily on civilian patients.
The U.S. surgeries, largely funded by the Defense Department, were performed at Cleveland Clinic in Ohio, Brigham and Women’s Hospital and the University of Maryland Medical Center in Baltimore, Md.
“None of this would have been possible without the vision and leadership of the Defense Department,” Pomahac said. “The military has absolutely played a critical role. “There are no other [funding] sources available for clinical research on face transplant surgery other than them.”
In 2008, the Cleveland Clinic performed the largest and most complex face transplant at the time, replacing 80 percent of a woman’s face. The Armed Forced Institute of Regenerative Medicine funded the 22-hour procedure. The clinic continues to receive funding from the institute and is currently evaluating potential candidates for the surgery.
The Brigham and Women’s Hospital has completed the lion’s share of face transplant surgeries, with Pomahac leading the first partial face transplant in 2009 on Jim Maki, who had suffered electrical burns on his face. Pomahac also performed the first three full face transplants in the United States in 2011.
Dallas Wiens of Dallas, Texas, underwent the first full face transplant in the U.S. in 2011. The surgical team at Brigham and Women’s Hospital in Boston worked for more than 15 hours, replacing his nose, lips, facial skin, and facial animation muscles and nerves. (Photo courtesy of Brigham and Women’s Hospital)
The patients were Dallas Wiens, who lost his face in an accident, Army veteran Mitch Hunter, who sustained facial damage from electrical wire, and Charla Nash, whose face and hands were mauled by a chimpanzee. He completed a fifth face transplant earlier this year on Carmen Tarleton, who was severely burned after an attack by her estranged husband.
Pomahac said that all of his patients have done “remarkably well” and have experienced “a lot of positive social outcomes.” These include reconnecting with family, getting married and pursuing new hobbies that integrate them back into society.
While the first facial surgery Pomahac performed was covered by the hospital, the last four surgeries at $250,000 apiece have been paid for by a $3.4 million grant from the Armed Forces Institute of Regenerative Medicine. The Biomedical Translational Initiative provided funding to support the hospital’s research efforts. The hospital has received additional funding from the institute for six more surgeries.
Three patients have already been chosen but are on a waiting list for suitable donors.
With $13 million in funding from the Office of Naval Research over seven years, doctors at University of Maryland Medical Center were able to devise the most extensive face transplant to date, which they performed last year on Richard Lee Norris, a 36-year-old man who was injured in a 1997 gun accident.
“For the past 15 years I lived as a recluse hiding behind a surgical mask,” Norris said in a press release seven months after his surgery. “My friends have moved on with their lives, starting families and careers. I can now start working on the new life given back to me.”
The successful surgeries have been life-changing for the patients, but they have even more far-reaching effects that could transform modern medicine as well. The Defense Department officials and their civilian counterparts are using the surgeries to help solve other medical problems, including one major roadblock, immunosuppression.
Only the Beginning: “No Boundaries”
All types of transplant surgeries require patients to go on lifelong immunosuppression medications to keep their bodies from rejecting the donated organ, or in the case of face transplants, the donated bone, muscle and skin.
These medications reduce the patients’ ability to fight off foreign tissue, lessening the likelihood of rejection, but they also reduce their ability to fight life-threatening infections. Pomahac estimated that immunosuppression drugs cost $10,000 per patient per year.
Transplant surgery may not be worth it when weighed against the need for immunosuppression medications. Patients are forced to balance the risks and benefits before undergoing the surgery.
The real science and big advances happen when we figure out how to make patients’ immune systems more tolerant of donated organs and tissues, said Army Col. Barry Martin, chief plastic surgeon at Walter Reed National Military Medical Center in Bethesda, Md.
“A lot of things are possible once you crack that nut,” Given said.
Face transplant surgery provides an opportunity to solve the immunosuppression puzzle since it includes the transplantation of skin, which is the tissue most likely to be rejected by patients and requires high doses of immunosuppression drugs.
The Defense Department is working toward finding ways to fool the body into accepting donated tissue as its own in order to eliminate the need for immunosuppression medications.
“The overall goal is to get to the point where you don’t have to use immunosuppression medications after transplant surgery,” Given said. “We are not there yet, but we are making strides in this direction.”
The Defense Department officials and their civilian counterparts have already succeeded in reducing the amount of immunosuppression drugs needed and are getting closer to eliminating the need for them all together.
“We have progressed to the point where patients do well for longer periods of time, and organs aren’t rejected as frequently, but there are still side effects,” Pomahac said. Research is getting closer to the point where immunosuppression drugs will no longer be needed, he said.
Pomahac shared that his hospital has recently gotten a new drug approved by the Food and Drug Administration to minimize the need for immunosuppression medications or even eliminate it. Recruitment for transplantation studies at the hospital is starting soon.
If the need for immunosuppression medications is eliminated, the door is left wide open for other medical advancements.“I see no boundaries,” Pomahac said. “Every part of the human body would be virtually replaceable by transplantation. This will revolutionize surgery as we know it.”
The achievement could have far-reaching effects not only on transplants, but on other immune-related diseases, including allergies, cancer and blood disorders, according to Pomahac.
“This would never have happened without the Defense Department,” he said. “They have been tremendous partners in research and tremendous in their vision. They deserve huge credit for being able to step up to the plate and allow us to carry [the] research forward.”
If Interested in Face Transplant Surgery
The Defense Department intends to continue funding immunosuppression research and collaborating with civilian medical centers to perform more face transplant surgeries.
“We want to keep making gains and take care of injured folks who do not have real good conventional options,” Martin said. “We are actively involved in research and science that will help out not only injured service members, but other folks who are victims of trauma.”
Service members interested in face transplant surgery should contact Walter Reed National Military Medical Center to get evaluated as potential candidates. Inactive duty and retired service members are also encouraged to call.
Written by Dana Crudo, from www.health.mil
Follow Armed with Science on Facebook and Twitter!
———-
Disclaimer: The appearance of hyperlinks does not constitute endorsement by the Department of Defense of this website or the information, products or services contained therein. For other than authorized activities such as military exchanges and Morale, Welfare and Recreation sites, the Department of Defense does not exercise any editorial control over the information you may find at these locations. Such links are provided consistent with the stated purpose of this DOD website.