U.S. Face Transplant Patient Is Reportedly Doing Fine

TUESDAY, July 14 (HealthDay News) -- Seven months after receiving a near-total face transplant, Connie Culp is doing well, according to one of her surgeons, Dr. Maria Siemionow, from the Cleveland Clinic.

Culp had been shot in the face with a shotgun by her husband in 2004. The shooting left her with most of the middle part of her face missing, including her nose. In addition, there was mouth, nerve, skin and other structural damage. She could not drink from a cup, her speech was slurred and she lost her sense of smell.

"We are now seven months post-transplant, and the patient is doing very well," Siemionow said. "She is back in her community. She is walking a dog. She is happy to be home and is going back to her life. She really adjusted very well, and is really a positive and happy patient."

The doctor said the transplant changed her life. "Before, when she was walking her dog, people were calling her names," Siemionow said. "People were calling her a monster when she was in a shopping mall or grocery."

Culp, the mother two, had had 23 operations since the shooting, but she remained disfigured and had said she felt humiliated in public. That fueled the decision that a face transplant was the only way to restore her facial function, as well as her appearance.

Culp's case is reviewed in an article in the July 15 online edition of The Lancet.

Her new face came from a woman who had been declared brain dead and who was a match for Culp's age, race and skin complexion. In a 22-hour operation in December, Siemionow's team used the donated face to cover 80% of Culp's face.

The new face included the nose, upper lip, lower eyelids, upper jaw, incisor teeth, palate and various glands. After bone portions of the transplant were secure, surgeons connected the arteries and veins. About an hour and a half later, the donor tissue began to "pink up," confirming that the graft was viable, they reported. Finally, surgeons connected the facial nerves.

Immediately after the procedure, Culp was given immunosuppressant drugs to prevent rejection -- drugs she will have to take for the rest of her life, Siemionow noted. One episode of rejection 47 days after surgery was reversed, according to the report.

With the help of physiotherapy, speech therapy and psychological support, as well as the passage of time, Culp can now smell, eat solid foods and drink from a cup, her speech is intelligible and she continues to regain the use of her facial muscles and nerves, Siemionow said.

She said that Culp will probably need additional surgery to remove some extra skin that was left to be sure there was enough tissue. "We are planning to do that one year after surgery," she said. "We see now that as her facial expressions are returning and she is using her face on a daily basis -- smiling and talking -- and the swelling is going down, we are very happy that we reserved this procedure for later."

That surgery, Siemionow said, should improve what she called Culp's "aesthetic" outcome.

"We have not only restored her functions like breathing through the nose, drinking from the cup of tea, but we have also restored her function in the society as a normal human being," she said.

Siemionow said the key to a successful face transplant is choosing the right patient.

"We choose a very motivated patient, a patient who has a strong personality and is willing to go through the process," she said. "With such a patient, the outcome was really excellent, in terms of her compliance, her adaptation back to society."

Others who have been disfigured by accidents or burns could benefit from the procedure as well, Siemionow said.

"This shows that for a patient who underwent a very severe trauma, we can perform in one major surgical procedure a very functional and excellent reconstruction," she said. "In the future, we will be able to change the lives of many patients."

Dr. Jeffrey C. Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine, said that "the actual performance of such surgery is a quantum leap up the reconstructive ladder for such tragic disfigurements."

"The actual performance of the surgery and the required aftercare is, however, a tour de force of management and monitoring," Salomon said. "Make no mistake about it: The benefit to the patient is both in appearance and in function. A tremendous feat indeed."

The ability to perform face transplants has been enabled by a decrease in the trade-offs related to immunosuppressive medications, Salomon added. "Lifelong risks of immunosuppression include infection and malignancies," he said. "Both of those risks are reduced with the latest evolution of the combination of immunosuppression medications used in the face transplants."

SOURCES: Maria Siemionow, M.D., Ph.D., plastic surgeon, Cleveland Clinic, Ohio; Jeffrey C. Salomon, M.D., assistant clinical professor, Yale University School of Medicine, New Haven, Conn.; July 15, 2009, The Lancet, online

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