Face Transplant Operation is 'Most Extensive in History'

A 37-year-old Virginia man severely disfigured by a 1997 gun accident has received the most extensive full-face transplant in medical history, according to University of Maryland Medical Center surgeons.

Hospital officials report that Richard Lee Norris, of Hillsville, Va., is recovering well after an amazing, medically unprecedented 36-hour surgery that not only gave him a new face—from the hairline to the neck--but also teeth, a tongue, and upper and lower jaws. (See before/after photo above, right.)
A week after the full-face operation, Norris’ improvement has exceeded his doctors’ expectations. He can open and close his mouth and is already brushing his new teeth and shaving the whiskers growing on the transplanted face. He’s miraculously regained his sense of smell, which he’d lost after the accident.

15 Years Hiding Behind a Mask

After the gun accident destroyed his face—robbing him of his lips, nose and teeth and limiting use of his mouth—Norris underwent many lifesaving and reconstructive surgeries. He remained so disfigured that he became a recluse, hiding in his home by day and only venturing out at night to shop, wearing a mask to conceal his face, according to a report by MSNBC.
"It's a surreal experience to look at him. It's hard not to stare. Before, people used to stare at Richard because he wore a mask and they wanted to see the deformity," said lead surgeon Dr. Eduardo Rodriguez, associate professor of surgery at the University of Maryland Medical Center. "Now, they have another reason to stare at him, and it's really amazing."

A Groundbreaking Medical First

Norris’ doctors say that the two-day operation is the world’s first full-face transplant performed by a team of plastic and reconstructive surgeons with specialized training and expertise in craniofacial surgery and reconstructive microsurgery.
In all, more than 150 doctors, nurses, and medical staffers were involved in the groundbreaking procedure, which used innovative surgical and computerized techniques to “precisely transplant the mid-face, maxilla and mandible including teeth, and a portion of the tongue,” as well as underlying muscles and nerves, said Dr. Rodriquez in a news release.
“Our goal is to restore function as well as have aesthetically pleasing results.”

A Rare Operation

Norris is only the 23rd person in medical history to receive a face transplant since surgeons began doing the operation seven years ago. The first full-face transplant was performed in France, on a woman whose face was severely mauled by her dog. The first US partial face transplant was done at the Cleveland Clinic in 2008, while the first U.S. full-face procedures were performed last year at Brigham and Women’s Hospital (BWH) in Boston.
Recipients include Dallas Wiens, a 26-year-old Texan who accidentally struck a power line while painting a church; Mitch Hunter, 30, of Indiana, disfigured by a car crash, and Charla Nash, who was famously attacked and mauled by a neighbor’s pet chimpanzee, Travis. The three patients’ results were described in a recent New England Journal of Medicine study.

What’s Involved in a Full-Face Transplant?

"Unlike conventional reconstruction, facial transplantation seeks to transform severely deformed features to a near-normal appearance and function that conventional reconstructive plastic surgical techniques cannot match," NEJM study author Dr. Bohdan Pomahac, director of the plastic surgery transplantation program at BWH, reported last year. "It truly is a life-giving procedure."
Before a full-face transplant, patients must undergo rigorous medical and psychological exams to determine if the person is physically and mentally ready for the grueling and life-altering surgery and its potential risks, which including infections, anesthesia reactions, severe bleeding, and the possibility that the transplant may fail.

How risky are full-face transplants?

In the NEJM study, Hunter and Nash had “single episodes of rejection,” which were successfully treated with immunosuppressant drugs so their bodies wouldn’t reject the new faces. All three patients in the study got infections, with Nash developing both pneumonia and kidney failure after the operation.
Nash’s doctors also tried to give her new hands (from the same donor) to replace those lost in the chimp attack, a procedure only attempted once before, in France. In Nash’s case, the hand procedure failed and the new hands had to be amputated. However, the full-face transplant took and she has regained sensation, but not movement, in her face, according to CBS.

What might be ahead for Richard Lee Norris?

In the NEJM study, the three patients who received full-face transplants all regained partial sensation in their new faces in a few months. The researchers also reported promising results in 18 patients who received face transplants since 2005, but most were to repair partial disfigurement.
Based on these cases, Norris’ appearance is likely to gradually transform over time to look like a combination of his new and original face, and he may regain at least partial sensation. Dr. Rodriquez is hopeful that Norris, who is unemployed and has lived with his parents since the accident, will now be able to have a full life.
"This accidental injury just destroyed everything,” Dr. Rodriguez told Associated Press. “The rest of his friends and colleagues went on to start getting married, having children, owning homes.” After 15 years behind a mask, “he wants to make up for all of that.”

source : http://health.yahoo.net

Breast Reconstruction for Cancer Patients

Almost 200,000 women are diagnosed with breast cancer each year, with over 40,000 dying from the disease annually. Many of the survivors undergo mastectomies—the removal of one or both breasts—a procedure which can be devastating to a woman’s self-image and self-esteem.

one procedure which helps to minimize the psychosocial aspect of such a surgery is breast reconstruction, sometimes performed at the time of the mastectomy. A study to evaluate the psychosocial outcomes and body image of mastectomy reconstruction patients has shown ongoing benefits to women in self-esteem, body image and general well-being two years after undergoing the procedure. However, not everyone is made aware of the option for reconstruction.
A study by Dr. Caprice Greenberg from Brigham and Women's Hospital in Boston found that many women who have had a mastectomy failed to receive information about breast reconstruction. He found that younger women, more educated women, and women who were Caucasian were most likely to receive discussion about breast reconstruction. Doctors apparently unconsciously discriminated against older women, less educated patients, and women of minority races.
According to a recent report published by the American Society of Plastic Surgeons, a staggering 7 out of 10 women facing breast cancer are never told of their options. An additional study released at the 2010 American Society of Breast Surgeons (ASPS) Annual Meeting reported that 4 of 5 women do not receive breast reconstruction after mastectomy despite legislation passed more than 10 years ago requiring insurance companies to cover the cost. The results of these studies indicate how important it is for women to get as much information as possible prior to treatment.
Some of the more common breast reconstruction options being used today are:
Nipple-Sparing Mastectomy: In this instance, all visible breast tissue is removed beneath the nipple, which is spared. This type of surgery is normally available if the cancer is located at least 2-4 cm away from the nipple, which decreases the likelihood that the nipple is involved.  This means there are strict criteria to qualify for the procedure, but it is being performed with more regularity.
DIEP Flap: This employs both skin and the fatty tissue from the patient’s abdomen, resulting in a bit of a tummy tuck along with the breast reconstruction. Without interfering with the abdominal muscles, the patient’s own tissue and skin is removed and used to reconstruct a more natural-feeling, soft  breast.
SIEA Flap: Similar to the DIEP Flap, but utilizes a different blood flow to reconstruct the breast.
SGAP Flap: This procedure employs both skin and the fatty tissue from the patient’s gluteal area. When a patient does not have excess abdominal fat to do a DIEP Flap, they can perform the same type of surgery utilizing tissue from the buttocks/upper hip area.
IGAP Flap: Same as the SGAP but utilizing skin and tissue from the lower hip and buttocks.
TUG Flap: The tissue and skin for reconstruction comes from the inner portion of the thigh, near the groin crease. Helps to avoid abdominal scars, but can only be used for small to medium-sized breasts due to the amount of flesh available in the area.
There are additional reconstruction options, utilizing other methods, available. You should discuss all options with your oncologist and surgeon before making any final decisions.
“Health is increasingly a shared responsibility between the physician and the patient,” says Dr. Cary Presant, HealthNews columnist. He recommends that as a patient you must ask important questions and take control of your future health. Asking not only the physician or surgeon, but also the nurse, nurse practitioner or physician's assistant who is helping the doctor, is extremely important. In addition, it is important to research the treatment or surgical procedure which has been suggested. Good sources are websites which can be reviewed to provide advice and further questions for your physician and the medical staff, and non-profits such as the American Cancer Society and Susan G. Komen Breast Cancer Foundation.