Details of three face transplants offer a closer understanding

Details of three groundbreaking full facial transplants were released in a research article published Wednesday in the New England Journal of Medicine.

The cases of three patients, from being screened for surgery to recovery, are documented. Although known as Patients 1, 2 and 3 in the article, they are recognizable in their photographs as Dallas Wiens, Charla Nash and Mitch Hunter, whose transplants in 2011 at Brigham and Women’s Hospital in Boston made headlines.

Wiens was burned by an electrical line and lost his sight, Nash was attacked by a friend’s chimpanzee, and Hunter was in a car accident and was burned by a fallen power line.

The surgeries were performed by teams responsible for various stages of the procedure, such as preparing the patient for the transplant and retrieving tissue from the donor. Although the surgery was extensive, requiring copious units of blood and immunosuppresive drugs, recovery of some of the patients’ functions happened fairly quickly after surgery.

Wiens, for example, regained his sense of smell after three days, and after four months sensation and some muscle movement was restored to the right side of his face. After two months, Nash could breathe through her nose and mouth. Four days after surgery, Hunter was able to talk, eat and drink.

There were, however, complications: Nash and Hunter rejected their transplants before receiving anti-inflammatory medications that allowed them to recover. Doctors also had to treat some infections.

“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,” said lead author Dr. Bohdan Pomahac in a news release. Pomahac, director of the plastic surgery transplantation program at Brigham and lead surgeon in all three surgeries, added, “It truly is a life-giving procedure for these patients.”

In the article, the authors wrote, “It is our subjective opinion, as well as that of two of the donor families, that the patients do not look like their donors.” They plan to continue to evaluate the patients’ continued recovery and function.