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Face transplantation
 
Composite tissue transplant and face transplant

The department  of plastic and reconstructive surgery at the hospital Henri Mondor regularly applies the most advanced techniques of facial reconstruction in order to provide patients with facial mutilation optimal functional and aesthetic recovery.

However, we are faced with in special cases for which we can not consider a satisfactory outcome in terms of quality of life, with conventional reconstruction using the patient's own tissues. This concerns mainly patients who have a total destruction of muscles ensuring continence facial cavities (mouth and eyes), ie orbiculaires muscles of the eyelids and mouth. This may be related to trauma (3rd degree burns, accident firearm, bite), genetic defects or damage tumor. The destruction of these muscles leads to a major functional impairment which results in difficulty feeding, breathing, language, eye damage can lead to blindness and disfigurement source of social exclusion.

In the absence of conventionnal techniques reliable, it is apparent that the only possible solution is to transplant of healthy facial tissue from a brain dead donor in a state, thus achieving a face transplant. It includes different types of tissues like skin, cartilage, nerves, mucous membranes…
This is called composite tissue allotransplantation (CTA).

As it is foreign tissue, these transplant cause a systematic rejection by the body without treatment. It is therefore necessary to take a life of drugs weakening the immune system. These  immunosuppressive treatments that are responsible for complications such as greater susceptibility to infection and cancer.

In the dynamics of the first hand transplantation (CTA) performed in Lyon and Louisville, Dr. Lantieri has been in place since 1999 a research program to assess the feasibility of such procedure. After extensive anatomical studies validating the surgical technique, he proposed a clinical research protocol to include 5 patients. It is promoted by the Assistance Publique-Hopitaux de Paris.
The first patient enrolled in this protocol has been grafted on January 21, 2007. He was carrying a genetic disease, type I Neurofibromatosis, with great deformation of his face.

The functional results collected at 1 year are extremely favorable. In addition to the obvious aesthetic benefits, the patient can now eat a liquid without straw, having a telephone conversation intelligible and express emotions through its new face. He goes out on the street without being bothered and could get a job full time.

The immunosuppressive treatment has not caused serious side effects, apart from a cytomegalovirus infection healed for 6 months.

Following this promising result we have pushed for the expansion of indications of a total face transplant, previously limited to lower face. Thus, other patients were included in the protocol for transplants from other parts of the face.

Besides, we are working in collaboration with the departments of surgery at the hands of the APHP for further CTA, including transplants of bilateral hands.

If you think you might be a potential candidate for a transplant of face or hands, and wish to participate in clinical research program, you can contact the secretariat of service 00 33 1 49 81 25 31
An initial consultation with a plastic surgeon will specify in detail the risks involved and determine whether your case can beneficiate of a CTA.

If so, you will then be assessed by a multidisciplinary team including psychiatrists, psychologists, immunologists, radiologists, neurologists and dermatologists.

The final decision to participate in the protocol is taken by the patient after agreement of the multidisciplinary team.


 
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