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Wednesday, September 30, 1998 Published at 18:06 GMT 19:06 UK


From hand to face

Hand transplants have arrived. Will face transplants be far behind?

President of the British Association of Plastic Surgeon Brian Sommerlad discusses the possibilities
First there were hand transplants. Now US plastic surgeons say it will not be long before they will be able to transplant faces.

The surgeons from Kentucky are preparing to carry out a hand transplant similar to the operation performed in France last week.

They say the techniques now being developed could eventually lead to face transplants.

A team from Kentucky will start looking for a hand donor in the next few weeks, confident that advances in anti-rejection drug technology will allow them to successfully complete the procedure.

The drug technology, which was cited as essential before the French transplant went ahead, permits surgeons to use foreign skin - the part of the body most likely to be rejected by the patient.

John Barker, who is part of the hand transplant team at the University of Louisville, believes these new techniques will eventually revolutionise reconstructive surgery done on the disfigured faces of accident and cancer victims.

Reconstructive surgery

"A face is just like a hand," he says.

"Let's say for a shot gun wound or a car accident where the jaw, the tongue, the muscle around the jaw, the lips are gone - in that case it's exactly the same as the hand. It is several different tissues, and again the most rejectable is the skin."

Current reconstructive surgery involves taking bone and skin from another part of a patient's body and moulding them to look like the features they must replace.

John Barker says the surgeons do a "fabulous" job, but they still leave patients looking like "monsters".

If all the facial features which needed replacing were taken from a donor, "not only would you have perfect function and fit, you'd also have a cosmetically beautiful result."

John Barker says his work has already attracted the interest of other plastic surgeons wanting to know if the new hand technology could be applied to facial reconstruction.

Only recently, he was approached by a Texan doctor keen to help a young child who had lost part of the face after a dog attack.

Ethical issues

John Barker recognises that the very personal nature of the face means getting donors may prove more problematic than for other types of transplantation.

However, he says most or all of the bone structure would have to be transplanted as well for any of the donor's features to be recognisable on the reconstructed face.

An editorial in New Scientist Magazine, which also carries this story, says the prospect of facial transplants is bound to raise a number of new ethical issues and make some people squeamish.

"But fears that this could lead to people queuing up for the face of their favourite movie star or celebrity should they die young are groundless," it says.

Conventional techniques

The Magazine does, however, question whether such drastic surgery is really that necessary.

"Some surgeons believe advances in conventional reconstructive surgery will mean ethics committees need never weigh up the pros and cons of a face transplant.

And optimists predict that genetically engineered tissue cultures will give us all the 'spare parts' we need for surgery."

John Barker's team have permission from the regulatory authorities to carry out 20 hand transplants.

They will start work on their first patient towards the end of October.

However, it may take several months after that before a suitable donor hand becomes available.

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