Face Transplantation: Principles, Techniques and Artistry

156 Pages·2015·6.52 MB·English

by  Juan P. Barret

Face Transplantation

Juan P. Barret (cid:129) Veronica Tomasello
Face Transplantation
Principles, Techniques and Artistry
Juan P. Barret, MD, PhD Veronica Tomasello, MD
Department of Plastic Surgery Cannizzaro Hospital
and Burns Catania
University Hospital Vall d´Hebron Italy
Barcelona
Spain
ISBN 978-3-662-45443-5 ISBN 978-3-662-45444-2 (eBook)
DOI 10.1007/978-3-662-45444-2
Springer Berlin Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014960147
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To my wife Esther and my daughter Júlia, who made all this
possible.
Sóu poesia per a la meva vida, amor fi ns l’infi nit. Gràcies per
existir
Juan P. Barret, MD, PhD
To Dr. Barret. With all my gratitude for believing in this
project.
Non avrei potuto desiderare niente di più e niente di meglio per
la mia carriera
Veronica Tomasello, MD

Pref ace
R econstructive allotransplantation has emerged as the ultimate restorative
technique for treating face deformity, hand amputations and others. In particu-
lar, a real revolution in face reconstruction has occurred. The not-so-old dream
of restorative surgery, namely the replacement of damaged parts of the body
by new, unharmed preformed tissues, has become a reality. The development
of techniques aimed towards the transplantation of vascularised composite tis-
sues has provided clinicians with a new, robust tool for the reconstruction of
deformities that were, not so long ago, impossible to achieve. The results of
face transplantation in humans demonstrate that face transplantation is no lon-
ger an abstraction but a clinical reality. It has been implemented in the recent
years with increasing interest and great success. The limits of indications are
still, though, desperate catastrophic face disfi gurement. Similarly to that learnt
in many other transplant and plastic surgery disciplines, the development of
face transplantation programmes calls for a strong team approach. Building a
multidisciplinary team involves joining together all essential and diverse spe-
cialists to make a robust protocol and an experienced team that warrants excel-
lency in outcomes. The general objective of our intense efforts in basic, clinical
research and implementation in the human clinic is the standardisation and
introduction of a new treatment for patients suffering from severe face defor-
mities and destructions caused by burns, trauma, congenital defects and the
extirpation of malignant tumours. It introduces technical aspects; immuno-
logical, psychological, ethical and legal methodologies; and the necessary sur-
gical profi ciency for the performance of face transplantation. With the
development of novel, more effective, immunosuppressant regimens, which
shall decrease the advent of toxic side effects, the indications for this new
technique may widen. In fact, the achievement of such a regimen that mini-
mised side effects and counterbalanced the ethical issues in reconstructive
allotransplantation would allow for the transplantation and restoration of any
anatomical and functional unit of the human body. Cell therapy, tissue engi-
neering and new synthetic polymers will help in the development of a true
restorative surgery in the future, combining the knowledge and expertise of
transplantation medicine specialists with the advent and development of bio-
logical and synthetic tissue engineering.
Barcelona , Spain Juan P. Barret , MD, PhD
Catania , Italy Veronica Tomasello , MD
vii

Contents
1 Introduction and General Background . . . . . . . . . . . . . . . . . . . 1
1.1 General Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.2 Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2 History of Face Transplantation and Objectives. . . . . . . . . . . . 11
2.1 Vascularised Composite Tissue Allotransplantation. . . . . . . 13
2.2 Objectives in Face Transplantation. . . . . . . . . . . . . . . . . . . . 14
3 Indications for Face Transplantation. . . . . . . . . . . . . . . . . . . . . 15
3.1 Indications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.1.1 Contraindications for Face Transplantation . . . . . . . 19
3.1.2 The Timing for Face Transplantation . . . . . . . . . . . . 19
4 Psychological, Social and Ethical Issues . . . . . . . . . . . . . . . . . . 21
4.1 Psychosocial and Ethical Considerations
of Face Transplantation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.2 Psychological and Social Aspects of Transplantation . . . . . 22
4.2.1 The Psychological Response. . . . . . . . . . . . . . . . . . . 22
4.2.2 Identity and Communication. . . . . . . . . . . . . . . . . . . 22
4.2.3 Psychological Adaptation to Deformity . . . . . . . . . . 23
4.2.4 Psychological Support for Face
Transplant Patients . . . . . . . . . . . . . . . . . . . . . . . . . . 23
4.3 Protocol Adhesion, Preoperative and Postoperative
Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4.4 Life Following Hospital Discharge. . . . . . . . . . . . . . . . . . . . 25
4.4.1 Living with a New Appearance. . . . . . . . . . . . . . . . . 25
4.4.2 Adhesion to Medical Treatment . . . . . . . . . . . . . . . . 26
4.4.3 The Risk of Rejection and Transplant Failure. . . . . . 26
4.4.4 Effect on Family Members . . . . . . . . . . . . . . . . . . . . 27
4.4.5 Ethical and Legal Issues in Face
Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4.5 The Role of Ethics Committee in Patient’s Protection. . . . . 30
4.6 Appendix 4.1: The Helsinki Declaration . . . . . . . . . . . . . . . 31
4.6.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4.6.2 Principles for All Medical Research. . . . . . . . . . . . . 32
4.6.3 Additional Principles for Medical
Research Combined with Medical Care . . . . . . . . . . 34
4.7 Appendix 4.2: The Code of Nuremberg . . . . . . . . . . . . . . . . 35
ix