FACE-TRANSPLANT PATIENT 'SATISFIED'

A French woman who two years ago became the first person to receive a face transplant has recovered with remarkably good aesthetic results and has gradually regained normal skin sensation and control of her facial muscles, doctors reported yesterday in the first detailed account of her progress.
Isabelle Dinoire, who at age 38 lost her lips, cheeks, chin and most of her nose when she was mauled by her dog, now blends into crowds and attends parties comfortably with the face she got from a 46-year-old brain-dead donor. Surgeons attached the face like a mask in a landmark 15-hour surgery.
Her recovery, however, has at times been harrowing, her surgeon, Jean-Michel Dubernard, acknowledged. Twice her immune system has mounted violent reactions against the new tissue, one of several anticipated risks that had led some experts to question the wisdom of the surgery. The immune-suppressing drugs she must take for the rest of her life have also wreaked havoc, causing infections and, at one point, kidney failure.
But Dinoire is "very satisfied" with the outcome, the medical team reports in today's issue of the New England Journal of Medicine. And although some experts remain uncomfortable with the experiment, including its lack of psychological follow-up, some who were initially critical of the attempt said they are impressed.
"They proved me wrong," said Peter Butler of the Royal Free Hospital in London, who has been organizing a slower-paced effort to transplant faces in England. "Her neuromuscular recovery looks good. She's done extremely well."
The circumstances of Dinoire's injury remain mysterious. She was unconscious when her dog chewed off much of her face on May 28, 2005. Some have suggested she had tried to take her own life, though Dubernard, of Lyon University, has said she merely took a sleeping pill and may have stumbled and startled the animal.
Whatever the cause, the injury was devastating. Lipless and lacking key muscles, Dinoire could not speak and was fed through a tube.
At the time, teams in several countries were developing controversial plans to transplant faces, raising concerns among ethicists and others that a race to be first was underway. Critics said the risks -- including the possibility of total rejection, leaving the person worse off than before -- were not justified to fix a non-life-threatening injury. Others wondered about the psychological impact of wearing another's visage, given the personal and cultural import of the face as a core element of identity.
But with Dinoire's consent, much of the donor's face -- a triangular swatch of skin, including lips, muscles, nerves and blood vessels -- was microsurgically attached on Nov. 27, 2005. The new report covers the first 18 months of recovery.
In one clear failure, an experimental infusion of bone marrow stem cells from the donor failed to make Dinoire's immune system tolerant of the graft. Despite immune-suppressing drugs, rejection reactions developed 18 days after transplant and again six months later. That necessitated use of more potent suppressant drugs, which led to herpes and pox virus infections.
The infections responded to medications, but the drugs led to blood problems and kidney failure, which required other treatment changes. She is now getting an experimental therapy in the hope of preventing further rejection.
Meanwhile, Dinoire learned to make expressions, eat and drink and enunciate. A video shows her progress, and photos show that with makeup, there is virtually no evidence of the trauma.

source---------http://www.washingtonpost.com/wp-dyn/content/article/2007/12/12/AR2007121202012.html?hpid=moreheadlines

by---------Dermatologist London