This is a classic article from New 杏吧原创鈥檚 archive, republished as part of our 50th anniversary celebrations
THE race to conduct the first face transplant, albeit only partial, has been won by a French team, ahead of rivals in the US and the UK. But were the surgeons right to give 38-year-old Isabelle Dinoire a triangular flap of facial tissue containing the nose, lips and chin of a dead woman?
Dinoire, who had been savaged by her dog, thanked the surgeons after waking from the 4-hour operation at a hospital in Amiens on 27 November. But some doctors and medical ethicists have questioned whether the team, led by Bernard Devauchelle and Jean-Michel Dubernard, should have delayed the procedure until they had first tried repairing the wounds using conventional surgery. The French team has the support of its rivals, however. The key justification, they say, is that the transplant offered the only hope of giving the woman a functioning 鈥� and cosmetically normal 鈥� pair of lips.
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鈥淚f there is total amputation of both lips, I would dispute that there鈥檚 any conventional surgery that could correct that,鈥� says Gordon Tobin of the University of Louisville in Kentucky, whose team also plans to perform face transplants. 鈥淪o I would agree with the French team doing the procedure.鈥� Peter Barker, who heads another rival team at London鈥檚 Royal Free Hospital, echoed this view.
The dog had bitten off Dinoire鈥檚 lips, chin and the tip of her nose after she had taken sleeping pills following a family argument. Since then, she had been unable to speak or eat properly. The difficulty with lips is that they are virtually useless unless they move. 鈥淵ou could have rebuilt a nice nose,鈥� says Tobin. 鈥淏ut with the lips, the only option would have been to put up flaps of tissue from the chest. She would have had a poor cosmetic result, and virtually no functional capabilities.鈥�
Dubernard and Devauchelle tackled this problem using a triangular graft taken from a brain-dead donor in Lille who was still on a life-support machine. As well as skin and fat, the graft contained a multitude of nerves, muscles, arteries and veins.
During the operation, the surgeons stitched the arteries and veins to the corresponding vessels in the patient鈥檚 face, restoring blood flow to the graft. They then joined the networks of facial nerves and muscles needed to restore lip movement. Dinoire will now be given rehabilitation therapy to relearn how to speak and eat 鈥� she has reportedly already eaten strawberries and chocolate 鈥� but she will have to wait to see if full movement returns.
This article was originally published in New 杏吧原创 on 10 December 2005
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