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 Their new faces are functioning - in terms of movement control - at
about 60 percent of what a normal face would, and the patients are
seeing "significant improvement" in the ability to feel hot, cold
and pressure on the skin.
"For some of them, you would not be able to tell (they had a
transplant)," Dr. Bohdan "Bo" Pomahac, director of plastic surgery
transplantation at the hospital told Reuters Health in a telephone
interview. "Some of them don't look normal, but they look human. But
if you look at them before and after, it's night and day. And there
are still ways we're trying to improve the outcomes, both
aesthetically and functionally."
Before the surgery, all had at least one area of severe damage, such
as the loss of an upper lip or nose, in addition to having 25
percent of the face damaged by an injury such as burn or trauma.
The team reports on the progress of six patients - four men and two
women - in a letter in the New England Journal of Medicine. Two of
the six had partial transplants.
The Brigham and Women's group has given transplants to an additional
man and woman, making it the largest collection of living face
transplant patients in the world.
All but one patient reports a better quality of life, Pomahac said.
Their depression scores have not changed and they have been able to
sense touch on their face in addition to being able to move facial
muscles where, otherwise, they had no viable alternative. "They can
speak better, eat better and breath better," he said.
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Getting back 60 percent of the ability to move the facial muscles is
"what one would expect with any nerve injury if you cut it or repair
it," Pomahac noted. The improvement tends to wane after two years.
"After two years the muscles that are working are working, and the
muscles that are not are essentially atrophic and won't work," he
added.
"Imagine your widest smile. They do about 60 percent of that. Some
subtle facial movements you may not be able to detect on them, but
the sadness, the happiness, they can express," he said.
And while they once had minimal or no feeling in the face after the
transplant, "now they may feel that it's like it was prior to the
accident," he said. "They do feel close to normal."
All the recipients must continue to take medicine to prevent immune
rejection, and doctors have had to deal with between two and seven
episodes of rejection per patient.
"If you look at the types of infections they're getting (while
taking anti-rejection drugs) they're not particularly concerning and
they mirror what you find in the organ transplant literature,"
Pomahac said. Six months after surgery, the infections tend to
reflect what non-transplant patients experience.
SOURCE: https://bit.ly/2GM2xra The New England Journal of Medicine,
online May 29, 2019.
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