A team of French surgeons has broken an ethical and surgical barrier by carrying out the world's first face transplant, on a woman who had been savaged by a dog.
The 38-year-old patient had severe injuries to her nose, lips and chin. This part of her face was replaced by a "triangle" of the same features taken from a recently deceased donor.
The operation was carried out at Amiens' university hospital on Sunday night by a team of French doctors led by Professor Jean-Michel Dubernard, who pioneered the first hand transplant in 1998.
Disclosure of the procedure seemed to have caught the team off guard after details were leaked yesterday. It is thought they wanted to wait until they could say the operation was a success before making a formal announcement. A spokes-woman for the hospital said the woman was recovering well. "The patient is in excellent general condition and the graft is normal," she said.
Doctors said the first few days would be crucial, with a high risk of technical failure of the transplant. There will then be a risk of rejection and the patient could expect a lifetime on immunosuppressant drugs.
British specialists oscillated yesterday between admiration for the French team's courage in trying the difficult procedure and warnings of the dire consequences for the woman if things went wrong.
The Royal College of Surgeons said that , if successful, it would be "a major breakthrough in facial reconstruction". But there were technical, psychological and immunosuppression challenges. The charity Saving Faces, which campaigns for the facially disfigured, said all advances were to be celebrated but the transplant threw up "moral and ethical issues".
Iain Hutchison, a consultant facial surgeon at St Bartholomew's Hospital, London, and chief executive of the charity, said: "The recipient chose to take the risk of the operation failing if the blood vessels become blocked. There's a medium-term risk of the immuno-suppressant drugs failing to control rejection of the donor tissue, and a long-term risk of the drugs causing cancers. She could be back to square one without a face, needing further reconstruction operations."
No details of the woman were available last night but it is understood she was attacked by the dog last summer. After surgeons carried out immediate repairs to the damaged tissues, the woman and her doctors waited for a suitable donor.
When one became available on Sunday, after apparently dying in an accident, the operation went ahead late the same night and lasted into Monday morning. She had only a partial transplant, of the central portion of the face, so issues of the similarity in appearance of the donor and recipient are "unlikely to be a problem", the RCS said.
However, doctors also said the partial transplant posed greater difficulties because of the complex musculature around the mouth. They warned that the woman could have very limited facial expression.
At least a dozen groups around the world have been preparing to carry out face transplants and a team in Cincinnati, Ohio, led by a plastic surgeon, Maria Siemionow, obtained ethical approval for the surgery last year. They have been pipped to the post by the French team.
In Britain, plans for the first face transplant were led by Peter Butler, of the Royal Free Hospital, London, but they were put on hold in 2003 when the RCS imposed a moratorium, citing the medical and psychological risks, until more research had been done.
Professor Butler said yesterday: "This is a step forward for European science. It takes the 'face race' out of the equation and makes it easier to progress." He added that the level of "functional recovery" achieved by the woman would not become clear for six months.Reuse content