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Surgeons discuss landmark face transplant

Dr. Maria Siemionow had been preparing for 20 years to make the phone call.

“We have a donor,” she told Dr. Frank Papay, the chief of dermatology and plastic surgery at the Cleveland Clinic, late one night.

Then she headed to the hospital to give a woman who had no upper jaw, nose, cheeks or lower eyelids -- who was unable to eat, talk, smile, smell or breathe on her own -- a new face.

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In a Wednesday news conference, the Cleveland Clinic doctors who conducted the world’s most extensive facial transplant described the 22-hour surgery they said took place at the clinic within the last two weeks. The patient is doing well, they said.

It was the first facial transplant to be done in the U.S. and the fourth in the world.

At the patient’s request, the clinic did not release her name, age or details about what caused her disfigurement -- only that it was severe.

“Children were afraid of her,” Siemionow said. “It became very difficult for her just to go outside of her house.”

The day after Siemionow’s phone call unfolded like the countdown to a rocket launch, Papay said.

First came the wait while the laboratory determined that the deceased donor matched the patient’s blood type, gender, race and approximate age.

The marathon operation involved eight surgeons. One group began removing the donor’s facial skin; all of the muscles in the mid-face; the upper lip; all of the nose; most of the sinuses around the nose; the upper jaw, including some teeth; and the facial nerve. That took nine hours.

Another group spent almost three hours sewing the patient’s blood vessels to the vessels of the donor face to restore blood circulation. The skin turned pink, signaling that the graft was taking.

Surgeons rotated in and out of the operating room, taking turns fitting together layers of bone, muscle and skin like so many pieces of a jigsaw puzzle.

Siemionow spent decades preparing for the surgery, practicing on animals and doing trial runs on cadavers. In 2004, the Cleveland Clinic gave her permission to perform the experimental transplant on humans, and she began assembling a team.

A French physician performed a partial transplant in 2005. Two more followed before the one performed by Siemionow’s team.

Because the surgery is experimental, the Cleveland Clinic paid for it and will pay for follow-up care, a spokesman said. No cost estimate was given.

When the patient awoke from surgery, she explored her still-swollen face with her hands and gave a thumbs up, doctors said.

The hope is that with physical therapy, she will be able to smile, talk, blink and breathe without a breathing tube.

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mary.engel@latimes.com


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