Managing the risks of facial transplantation.

摘要

The early progress report by Bernard Devauchelle and colleagues1 about the partial face transplant done in France in November, 2005, is encouraging. Sensory recovery occurred quickly, with the whole area of the postoperative graft sensate by the 14th week. Restoration of motor function was slower, as anticipated, but the patient is able to eat andcommunicate, and the appearance of the graft exceeds expectations. As predicted by data from hand transplantation, the gradual recovery of function and good aesthetic appearance have been accompanied by psychological acceptance of the graft and gradual reintegration into social networks by 12 weeks. Commentaries thus far have concentrated on the risks be anticipated, planned, and managed.8 Although the risk of transfer of identity from donor to recipient has been highlighted,11 computer simulation of facial transplantation has shown, as predicted, that the skin envelope reforms over the facial skeleton, donor identity is not transferred, and the result is a new hybrid face. The partial face transplant similarly supports this conclusion. The psychological effect of this change in appearance is an anticipated outcome and its management can be on the basis of practices already in place for facial reconstruction.