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Face graft

post #1 of 19
11/30/05 at 10:44am
Thread Starter 
The first face graft surgery have been performed three days ago.

Pr Dubernard (the man who grafter hands) performed this surgery with Professor Devauchelle (I followed some teaching coming from him). It was performed on a woman who suffer serious dog bitting, who resulted on the loss of her nose, terribles scars on her lips and chin. With conventionnal surgery process, it was impossible to cure it. Worse, she had problems to swallow, and it was very difficult to understand what she said while speaking.
After hours of discussions with psychologists and physicians, the woman accepted to have this surgery.
A face was choosen among other brain dead woman, who presented the biggest level of physical similarities. The graft consisted on the skin, muscles, grease, vessel and nerves.

Today the graft is alive.

One year ago, there was a huge ethic discussion in France, to know if this kind of surgery should be allowed or not.
The plus is the only ability for some people to have a normal face (read do not look anymore like a monster)
the cons, is the psychological problems when you are looking in a mirror : you see an other person.

Personnaly, I think that it's a good thing. If my face was entirely destroyed, that I have problems to speak, and look like a monster, I would consider this option, even if I will change of face. I prefer the face of someone else, rather a monster face.

link here : BBC
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post #2 of 19
11/30/05 at 11:41am
I haven't looked at any of the articles yet, but the term "face graft" or "face transplant" seems misleading to me. The face isn't just the skin on the top, the underlying bone structure gives you the look of your face.
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post #3 of 19
11/30/05 at 11:45am
Thread Starter 
Quote:
Originally posted by BRussell
I haven't looked at any of the articles yet, but the term "face graft" or "face transplant" seems misleading to me. The face isn't just the skin on the top, the underlying bone structure gives you the look of your face.

There is no better wording avalaible right now. Of course the underlying structure is important, but in the lip aera, the soft tissues are the predominant factor that give the look to a face.
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post #4 of 19
11/30/05 at 11:52am
Yes...I thought the term 'reconstructive surgery' or 'cosmetic surgery' applied in this case.

It's always a wonder to see how great medical advances are put forward too, although I'd venture that internal multi-systems organ transplantation is much more challenging (in terms of consequences) than facial skin reconstruction. It's great to see that the skill of the French team has been put to use.

The French ethical debate isn't as inane as "shall we do this or not" - the consequences of such procedures are so hard to foresee. For instance, most rationale people (excluding particular cults) accept organ transplantation on the basis of quality of life for humans. When a dead person's organs are used for a living person's gain, where does it stop? Like the third world trade in live relatives for organ transplants - will someone with economic clout and lesser morals decide that someone's particular face would be nice to wear, and arrange for the quick death of a person for their own gain. Frightening thought. Think how hard it would be to trace criminals who change faces, or what older richer and uglier people with no morals might get up to.

Is it helpful to consider whether or not what advantage a surgical procedure could have its use put to...and to consider the same question in a corrupt social-political system, where abuse takes place? It's heartening to seethe French are more thoughtful in some respects about the potential consequences.....
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post #5 of 19
11/30/05 at 12:35pm
Thread Starter 
Thanks for your comments Justin.

Speaking of the challenging I don't know, but I am sure that we will have a lot of info during the next year congress of plastic surgery . I guess, that in a reanimation point of vue, compared to a liver transplant it's a cakewalk. For the surgical procedure, I think it's more complicated, because you have to do many microvascular anastomosis, and you have also to connect the facial nerves, or many branchs of the facial nerves, and this alone is real challenge : without nerves the face of this woman will look like a mask.

I expect that this procedure will be a success, because it will give hope for people that we canno't cure sucessfully today.
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post #6 of 19
11/30/05 at 12:50pm
It should be noted that this wasn't a "complete" face. Only the nose and mouth.
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post #7 of 19
11/30/05 at 12:54pm
Hey Powerdoc -

there's so much about the body I still don't know about. How do they join the live person's nerves to the dead person's facial nerves? It must be million times harder than trying to get an Apple to talk to a Windows PC. Do they have some kind of nerve growth stimulant, like tree plant stimulants to get the process started?

There's so much technical wonder in all of this.

What happened to the dog btw?
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post #8 of 19
11/30/05 at 12:58pm
Quote:
Originally posted by Justin
How do they join the live person's nerves to the dead person's facial nerves?

A followup question: If they can do this in a face, arm, etc., why not the spinal cord?
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post #9 of 19
11/30/05 at 1:13pm
Quote:
A followup question: If they can do this in a face, arm, etc., why not the spinal cord?


Whhooaaaa!!!

Powerdoc just showed me how complex it was with one nerve (the facial nerve). When I googled it, the facial nerve had three branches, and then many other tiny branches, and then into something called 'anastomoses' which means micro-capillary type nerve-endings to send signals to the skin. There's a lot of complexity in just that nerve.

Just think of the complexity of the spinal cord - many many nerves. Like a massive fileserver exchange - if all the cables were severed between the computer-brain and peripherals, it would be a nightmare trying to figure out which wire connected to which bit in the time-scale of an operation. If bits of nerve joined up to the wrong bit, then the nightmare scenario of the brain impulse to 'move the big toe' could possibly end up causing the person to do one of those crotch manoeuvres which are so topical on the other side of this forum [miswired]. And so on.

I'm guessing (no expert or learning in this field here) that it's potentially possible for a partial spinal cord recovery although far more complicated than the face.....

Anyone?
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post #10 of 19
11/30/05 at 1:15pm
Just a thought in re the "rich people could abuse this" idea: sufficiently powerful people can pretty much do what they want.

"Having someone killed to get their face" doesn't strike me as any less rehensible, or any less likely, than "having someone killed to get their money/property/power". Ditto using one's power to leap frog the less fortunate and helping yourself to whatever's available. Already a fact of life for quite a few medical procedures.

Unjust and deplorable to be sure, but not a compelling reason to not proceed with a medical technology that could ease a great deal of suffering.
They spoke of the sayings and doings of their commander, the grand duke, and told stories of his kindness and irascibility.
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They spoke of the sayings and doings of their commander, the grand duke, and told stories of his kindness and irascibility.
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post #11 of 19
11/30/05 at 1:24pm
Thread Starter 
Quote:
Originally posted by addabox
Just a thought in re the "rich people could abuse this" idea: sufficiently powerful people can pretty much do what they want.

"Having someone killed to get their face" doesn't strike me as any less rehensible, or any less likely, than "having someone killed to get their money/property/power". Ditto using one's power to leap frog the less fortunate and helping yourself to whatever's available. Already a fact of life for quite a few medical procedures.

Unjust and deplorable to be sure, but not a compelling reason to not proceed with a medical technology that could ease a great deal of suffering.

The ethic between those cases are no differents from the ethic for liver lung, heart or kidney transplant. Those transplantation should follow ethical rule : dead people, family OK with it, and the dead person should not have said no to such procedures while she was alive. And last point : no money involved. The gift is free.
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post #12 of 19
11/30/05 at 1:26pm
Thread Starter 
Quote:
Originally posted by CosmoNut
A followup question: If they can do this in a face, arm, etc., why not the spinal cord?

We canno't do this with spinal cord. Only peripherical nerves are able to recover right now. For spinal cords there is some hope in the field of research but it's very complicated.
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post #13 of 19
11/30/05 at 1:28pm
Quote:
Unjust and deplorable to be sure, but not a compelling reason to not proceed with a medical technology that could ease a great deal of suffering.

I happen to share that view, although others might not. The rate of medical progress frightens some I suppose, particularly because its implications are so hard to work through.

For instance, if I believe that my face is just property, and a possession of mine, like my body, then if someone steals it, then that is fine insofar as stealing my money/possessions are as reprehensible.

Yet if I consider that my face is a part of me - a part of my identity - my person - then anyone who steals my face, or kills me to take it, also destroys my identity.

If my identity is stolen, along with my person, then my self is destroyed and then appropriated as someone else's i.e. my identity is stolen and continues to be used: how is that equivalent to being killed for my money/power/possessions? If I was in a difficult position, and asked for either 'my face' or my money, why is it I feel more inclined to surrender my money than my face?

Will we then see a 'wanted faces' posting on ebay.com? Will we then see a return to the 19th century west of American with faces posted up: "Wanted" - either because a face has been appropriated, or because it is wanted for appropriation?

I don't think considering these possibilities harmful to society: maybe not considering these possibilities is more risky. That's why I'm grateful that the French still think about and debate such issues.
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post #14 of 19
11/30/05 at 1:34pm
Thread Starter 
Quote:
Originally posted by Justin
Hey Powerdoc -

there's so much about the body I still don't know about. How do they join the live person's nerves to the dead person's facial nerves? It must be million times harder than trying to get an Apple to talk to a Windows PC. Do they have some kind of nerve growth stimulant, like tree plant stimulants to get the process started?

There's so much technical wonder in all of this.

What happened to the dog btw?

For the dog, I don't know.
For the nerves surgery, it's a microsurgery procedure. You don't suture one axone to one another, it's not possible and will take thousands of hours. The axones are grouped in beam. And this beam are also grouped in others bigger deam. That those greater beams, that you are suturing. The problem is that you have to manage to anastomose beams of almost the same size. An another problem is to locate the nerves : they are small.

Note that the crucial thing in this procedure is the vascular anastomosis : if it fail the transplant will die quickly, and it will be a disaster.
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post #15 of 19
11/30/05 at 1:37pm
Thread Starter 
Quote:
Originally posted by CosmoNut
It should be noted that this wasn't a "complete" face. Only the nose and mouth.

Right . Notice that for an entire face, the procedure is not much more complicated, but will lead to more physical changes. Here you create an hybrid between the dead woman and the wounded woman. With a full face, you really give someone face. Imagine if the husband of the dead woman, meet one day by hazard the face of the woman who recieved the face : it may be really disturbing.
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post #16 of 19
11/30/05 at 1:57pm
Quote:
Originally posted by Powerdoc
Imagine if the husband of the dead woman, meet one day by hazard the face of the woman who recieved the face : it may be really disturbing.

Yes, but a special on Discovery Health TV about this noted that the bone structure of the recipient would likely change the shape of the skin to look different than the donor. They had a computer-generated simulation of this and it was quite noticable what the difference between the donor's look and recipient's new look would be.
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post #17 of 19
11/30/05 at 1:58pm
Quote:
Originally posted by Justin
I happen to share that view, although others might not. The rate of medical progress frightens some I suppose, particularly because its implications are so hard to work through.

For instance, if I believe that my face is just property, and a possession of mine, like my body, then if someone steals it, then that is fine insofar as stealing my money/possessions are as reprehensible.

Yet if I consider that my face is a part of me - a part of my identity - my person - then anyone who steals my face, or kills me to take it, also destroys my identity.

If my identity is stolen, along with my person, then my self is destroyed and then appropriated as someone else's i.e. my identity is stolen and continues to be used: how is that equivalent to being killed for my money/power/possessions? If I was in a difficult position, and asked for either 'my face' or my money, why is it I feel more inclined to surrender my money than my face?

Will we then see a 'wanted faces' posting on ebay.com? Will we then see a return to the 19th century west of American with faces posted up: "Wanted" - either because a face has been appropriated, or because it is wanted for appropriation?

I don't think considering these possibilities harmful to society: maybe not considering these possibilities is more risky. That's why I'm grateful that the French still think about and debate such issues.

Right, but I'm assuming that "stealing one's face" pretty much equals "murder". Actually, I kind of hope it would.

Given that, dead is dead, and the creepy/weird part of "someone else has my face" is of no matter to the victim, being dead and all. And you're not more dead than if someone killed you for your money.

Plus, as has been noted, facial features have a lot to do with underlying bone structure, so it's not as if some evil bastard is going to be strutting about looking exactly like you and causing your loved ones horror and confusion.
They spoke of the sayings and doings of their commander, the grand duke, and told stories of his kindness and irascibility.
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They spoke of the sayings and doings of their commander, the grand duke, and told stories of his kindness and irascibility.
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post #18 of 19
11/30/05 at 2:02pm
Thread Starter 
Quote:
Originally posted by CosmoNut
Yes, but a special on Discovery Health TV about this noted that the bone structure of the recipient would likely change the shape of the skin to look different than the donor. They had a computer-generated simulation of this and it was quite noticable what the difference between the donor's look and recipient's new look would be.

Right, but I think that you should be able to recocnize the person in a certain extent, especially if you consider, that the face choosed, must belong to someone who has not a skull very different from the reciever.

I have also performed Hannibal's like anatomy study many years ago : read harvesting the soft tissues of the face of cadavers in order to study the vascular anatomy via X rays. The human look of my harvasted pieces of anatomy where really disturbing.
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post #19 of 19
11/30/05 at 6:09pm
NPR reported today that an American hospital is planning to do one soon, as well.
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