Thursday, January 19, 2006

Face transplant debacle

Once again, French Surgeons led by Dr. Jean-Michel Dubernard have managed to set back both science and professional ethics in attempting a poorly planned surgery. Recently the world first "partial" face transplant (consisting of the cheek soft tissue on one side) was performed by his team in Northern France.

If you'll remember, Dr. Dubenard also has the claim to fame of the world's first hand transplant. The common denominator in both case is a rush to be "first" to do a radical surgical procedure while ignoring ethical concerns and half-assed patient selections for his human experimentation.

The first hand transplant was placed on a borderline paroled Kiwi con-artist, Clint Hallam. Predictably this fellow abruptly disappeared from follow up, quit taking his immuno-suppression meds (required to keep his body from rejecting the transplant), and showed up some time later with a dead,mummified hand requiring amputation.

This recent face transplant patient was a young women who reportedly tried to commit suicide with tranquilizer and who face was mauled by a pet dog while she lay unconscious. This alone should have disqualified her from consideration, but did that stop Dr. Dubenard? Of course not.

Well today we see an article that the patient is being non-compliant and has begin smoking, a HUGE risk with a recent microsurgical tissue flap, as nicotine will make the nutrient artery spasm with the flap dying shortly thereafter. Also mentioned from the same article is that fact that a number of previously reported successful hand transplants have failed as patients can't afford their required immunospression drugs or have been non-compliant with their regimines.

These failures only highlight the processes setup at the University of Louisville & the affiliated world-famous Kleinert,Kutz, and Associates hand surgery practice(where I trained) and the Cleveland Clinic which have setup extremely rigorous exclusionary criteria involving not only appropriate physical attributes, but also extensive psychological profiling,testing, and counseling to avoid these problems Dr. Dubenard has predictably encountered. In fact, Dr. Dubenard's team essentially high-jacked the immunosuppression model designed and developed in Louisville (of which I had a very small part in some of the related bench research) while abandoning any pretense of careful patient screening.

Rob Oliver


Anonymous said...

Should we not reconstruct others who have had trauma secondary to attempted suicide. I have worked on a number of patients who required facial recon (free fib flaps, radial forearm) after a failed suicide attempt with a shotgun. Should we deny treatment to any patients who have attempted suicide?. I think not! To be critical of this person's tragedy and ignore their desire for a return to normalcy is myopic and ignorant.

Dr. Rob Oliver said...

The question here was not whether to reconstruct her face. Rather the issue here is:
1) was she screened adequately for psychiatric issues?

2) was she an appropriate candidate for an experimental procedure requiring life-long compliance with immunosuppresive medicine?

The answer here is clearly no on both counts. It's already been reported in the media on the shortcuts that were taken with the IRB equivalent in France. The fact that she's smoking less then 2 weeks after this surgery highlights the absolute failure of the system in place to look out for the patients best interests. This is a repeat of the prior hand-transplant scenario by the same surgeon and surgical team.

Make no mistake this was about the surgeon's ego to be first to do a radical procedure. There were alternatives using standard techniques. That being said, the pictures I've seen look fantastic & are cosmetically superior to anything we could normally do. Again however, this was a failure in the screening process to do it on this patient.