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A team of French surgeons has won the race to perform the world's face transplant, giving a partially new face to a woman who was attacked by a dog.
Doctors from the University Hospital in Amiens, northern France, collaborated with a team from Lyon to give the new face to a 38-year-old woman who lost her nose, lips and chin when she was mauled by a dog in May.
The operation was carried out on Sunday and lasted five hours, according to statements from the hospital and the lead surgeon, Jean-Michel Dubernard, the pioneer of hand transplants.
"The patient is in an excellent state and the transplant looks normal," said Dr Dubernard’s team, adding that the donor was a brain dead woman. Dr Dubernard declined to give further details ahead of a full briefing on the operation on Friday.
Dr Dubernard, head of transplant surgery at the University of Lyon, told the Associated Press that the patient wishes to remain anonymous and that he did not know when she will be well enough to leave hospital. He said the dog attack had left her unable to chew and talk.
But she is understood to have survived the first 48 hours after the operation without any severe reaction to her mouth, nose and chin. The first days after a major transplant operation are seen as the time of greatest risk of rejection.
To perform the operation, the doctors took the donor face and worked through the night to strip it of excess skin, fat and blood vessels before attaching it to the patient and reconnecting the tissues.
Although complex, the operation used techniques from transplant and reconstructive surgery that have been available for years. Facial transplants using a single sheet of skin have not been performed before because of ethical doubts and the unknown consequences of the procedure.
The patient is said to have received extensive counselling before the operation because of the intense psychological implications of a face transplant. As the recipient of a transplant, she will have to take immuno-suppressant drugs for the rest of her life and suffer a significant risk of infection, cancer, and liver and kidney failure.
Dr Dubernard carried out the world's first hand transplant in 1998 and then performed a double hand and forearm transplant in 2000. His team has been one of four around the world, including scientists at the Royal Free Hospital in Hampstead, who have waiting for a patient, and permission, to carry out the world's first face transplant.
In November 2003, the Royal College of Surgeons advised British doctors against performing face replacements because of the lack of research into the psychological and physical consequences of the operation.
Regulatory authorities in the US, Italy and the Netherlands, where surgeons have explored the possibility of face transplants, have also been reluctant to grant permission for the transplant, which, unlike other major organ transplants, is not life-saving.
In France, medical authorities rejected an application by doctors to try the surgery last year, but gave permission for transplants of a triangular patch of skin around the mouth and nose, believed to be the type of operation performed on Sunday.
But reconstructive surgeons argue that carefully selected patients, who have suffered major disfigurement and respond positively to counselling, should be eligible for the operation. The bone structure of the recipient means that they will never resemble their donor too closely.
Three American clinics planning the operation say they have been flooded with applicants for the surgery.
Iain Hutchison, consultant facial surgeon at St Bartholomew’s Hospital, London, and chief executive of The Facial Surgery Research Foundation, celebrated the operation but said that many questions remained unanswered.
"This is the first facial transplant of the modern era. All medical advances are to be celebrated, but this operation throws up many moral and ethical issues," he said.
"This was a ‘quality of life’ operation rather than a life-saving operation and has many implications for the recipient and donor’s families," he added, warning that the patient could suffer a rejection of the new face, and be left "back to square one without a face, needing further reconstruction operations".
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