The face is integral to what makes us human. When the face has been destroyed through trauma or disease, surgeons must consider both form (how the skin and the underlying musculature looks) and function of remaining tissue - are all of the major components, such as lips, jaws, eyelids, nose, etc intact?
While there are many excellent plastic and reconstructive techniques to address any one of these deficits, a patient who is missing more than one facial component may not have enough of his or her own tissues to rebuild all of the intricate structures of the face. In these cases, the patient may have better outcomes using transplanted tissues from a deceased donor.
Face transplants are completed in parallel surgeries, involving two teams of surgeons: one to remove the tissue from the donor, and another to re-implant the tissues in the recipient. Because the tissues being used are from the same source as their destination, the fit of bones, skin and muscles is much better than when using tissues (such as skin from the back or bone from the fibula) from elsewhere in the patient’s own body. In the face transplants done to date, patients have regained their ability to eat, have been freed from extensive scars that made it impossible to move their faces, and have regained their sense of smell and the ability to close their eyes without help.
Transplants are not, however, without risk. Face transplant patients need to take medications to suppress their immune systems, to keep from rejecting their grafts. Some of these medications have side effects that are difficult to live with. The medications can have a significant cost associated with them that may not be reimbursed by insurance. The choice of whether to repair facial tissues using more traditional techniques or to consider reconstructive transplant of the face is a decision to be made by the patient and his or her surgeons.
Sometimes injuries from motor vehicle accidents, fires, explosions or gun violence are so severe that the limb must be removed (amputated) to avoid further injury or infection. Typically, patients who have had amputations are fitted with a prosthetic (artificial) limb. While newer prosthetic limbs offer a greater range of motion, better fine motor regulation and the capacity to handle more weight, they cannot offer the full functionality of a natural limb. Patients fitted with prosthetic arms miss the sense of touch and the feedback that touch provides. They lack the natural sense of where the limb is in space. As a result, many upper extremity amputees stop wearing their prosthetic arms after just a few years.
Since 1999, nearly 60 hand transplant have been completed worldwide, including transplant of both arms (bilateral upper-extremity) in the United States and Germany. The recipients of these transplants have experienced excellent return of functionality, including the ability to write, work and hold hands with loved ones.
While these outcomes are very encouraging, transplant is not without risk: All transplant patients need to take medications to suppress their immune systems, to keep from rejecting their grafts. Some of these medications have side effects that are difficult to live with. The medications can have a significant cost associated with them that may not be reimbursed by insurance.
The wall of the abdomen does more than contain our internal organs. It stabilizes our core, supporting the muscles of the back, which are critical to our walking and lifting. Of all of the muscle groups in the human body, the muscles of the abdomen are among the most used and least appreciated.
Sometimes, after a traumatic event or a major surgery (such as a kidney or intestinal transplant) the abdominal wall develops a dangerous swelling called a compartment syndrome. Compartment syndrome can cut off the supply of blood to the muscle, causing it to die. While many patches have been developed to re-close the abdomen after compartment syndrome, the only completely effective and functional method of re-closing the abdomen is to transplant the abdominal wall and muscles from a deceased donor.
The first abdominal wall transplants were performed in 1994. Today, this procedure is life-saving for patients who have suffered a catastrophic abdominal compartment syndrome. Abdominal wall transplant is not considered an elective procedure.
As with any transplant, patients who undergo reconstructive transplant of the abdominal wall need to take medications to suppress their immune systems, to keep from rejecting their grafts.
Am I a Candidate
Cleveland Clinic is committed to providing life-renewing reconstructive transplants to patients under the strictest guidelines for patient safety, patient health, and the protection of rights for both the patient and the donor.
Decisions about care after a traumatic accident or illness are influenced by many factors and should be undertaken by patients with the help and guidance of their family, friends and physicians.
Because reconstructive transplant requires the use of immunosuppression drugs for the lifetime of the patient, it is a treatment option that should be discussed only after it is clear that all traditional treatment options, including surgery, prosthesis and use of the patient’s own tissues, will not restore the patient’s function. These important treatments are not cosmetic procedures; they are intended to restore normal function to our patients.
If you have suffered a traumatic injury or illness and are interested in exploring reconstructive transplant as an option, please contact us for more information or to schedule an appointment.
Becoming a Patient
Is reconstructive transplantation an option?
Reconstructive transplantation is reserved for those patients in whom conventional plastic and reconstructive surgery is insufficient to produce acceptable results. Potential patients are those who have suffered massive loss of complex tissue, including hands, faces, abdominal walls and larynx, where prosthesis is either unavailable or insufficient to restore physical integrity and function. Reconstructive transplantation offers the possibility of restoring natural function to these patients, allowing them to regain daily living independence.
Becoming a Reconstructive Transplantation patient
Patients interested in being considered for reconstructive transplantation at Cleveland Clinic are carefully screened for psychological health, family support, understanding of complications and medication compliance.
- Patients must be healthy enough to tolerate surgery and the extensive immunosuppression therapy required after surgery to prevent rejection.
- Patients must undergo extensive psychiatric evaluation to ensure their mental stability and ability to handle the treatment and recovery from transplantation.
- Patients are required to show a sufficient social support network to cope with the stress and possible complications of transplantation.
- Patients with a previous history of cardiovascular disease or cancer may not be eligible due to an increased risk of complications and recurrence from immunosuppression therapy.
- For more information or to schedule an appointment, please contact us.