First UK face transplants get go-ahead

London surgeons expected to win approval from ethics experts to carry out operations on four patients

Although the first UK patients are yet to be selected, the ethical committee of north London's Royal Free Hospital is expected on Wednesday to give its approval for a full face transplant.

A team of medics at the hospital, led by plastic surgeon Peter Butler, has been working towards such a result for more than a decade.

The extraordinary operation became a reality last year when a team based in France won the race to carry out such extensive surgery. Their studies show the operation is not only feasible, but would have psychological benefits for those left terribly disfigured by extensive burns or accidents. Until last year, such operations were deemed to be in the realms of science fiction fantasies. The idea was famously explored in the movie Face/Off where a special agent played by John Travolta and master criminal played by Nicolas Cage have their faces swapped.

Mr Butler aims to find four or five patients for the surgery. A number of candidates have so far been seen by the doctors - including a 22-year-old whose face was badly scarred during a fire.

In 2003, Mr Butler planned to perform a face transplant on a 14-year-old girl, but was warned against attempting the procedure by the Royal College of Surgeons.

Two years later, the team was given approval by a hospital ethics committee to find a suitable patient for the first British operation - a task that was this weekend nearing its completion,

Mr Butler said last night: "I feel the time is right to move on. You can do more and more research but at some point the leap has to be made, and people have to say 'OK, we've done our preparation, let's get behind this'."

The ethics committee may ask for a further delay, but if it is given the green light, the first operation will take place as soon as the a patient was ready.

During the procedure, eight blood vessels which provide the supply to the face have to be removed from the donor, who must be brain dead. Both faces need to have a match of skin colour and texture, and there needs to a physical similarity.

Another team of surgeons prepare the recipient by removing the facial muscles, skin and subcutaneous fat from the recipient.

Once in place the nerves have to be reattached to allow movement and feeling in the new face. If the nerves do not regenerate, the operation would be useless.

In the French operation Isabelle Dinoire, 39, underwent a 15-hour procedure carried out by a team of eight surgeons to replace her chin, lips and nose last November in the northern town of Amiens. She had been savaged by a dog.

It provoked global debate about whether it was ethically appropriate to carry out such an extensive operation. The psychological consequences of the rejection of any skin grafts have been said by experts to be immense.

Last month she revealed that she had complete feeling in the tissue just five months after the op to rebuild her disfigured face.

Prior to that, her lipless gums had been exposed and much of her nose missing from an attack by her labrador as she lay unconscious following an overdose of sleeping tablets.

To ensure the success of the surgery, Ms Dinoire takes ten pills a day and is given anti-rejection treatment once a week.

Mr Butler added: "People have seen a woman with severe facial deformity change to what looks like a perfectly normal face. It's not now a case of how, in this country, but when."

SAVING FACE

* Tissue type, age, sex, and skin colour of the donor face must be compatible.

* Rotating teams of specialists carry out a 14-hour procedure. One team will remove the patient's face, including underlying fat, nerves and blood vessels, while a second team remove the donor's face.

* Surgeons graft donor nerves and vessels to the patient's muscle and underlying bone structure.

* Ten to 14 days in hospital is followed by a lifetime on drugs to suppress the patient's immune system and prevent it from rejecting the transplant.

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