By Michael Smith , MedPage Today

CLEVELAND, Dec. 1 - The world's first partial face transplant -- carried out in France over the weekend -- represents both a surgical tour de force and a fount of troubling ethical questions.

The recipient of the transplant, a 38-year-old woman who was severely mauled by a dog last May, is in good general health and the transplant is doing well so far, according to a statement from the university hospital in Amiens, where the surgery was carried out.

Led by transplant specialist Jean-Michel Dubernard, M.D., surgeons grafted a nose, lips, and chin from a brain-dead multi-organ donor, whose family had given consent.

The surgery has been hailed a major step forward, but it raises several questions:

Was the patient's condition so severe that it justifies a lifetime of immunosuppressive medication?
What attempts, if any, were made to restore the woman's face short of a transplant?
Given that facial structures were transplanted, how successful can the surgery be in terms of restoring function?

Doctors at the Cleveland Clinic here are screening potential patients for a total facial tissue transplant, but the bar is set high, according to a statement. The patient must be "severely disfigured" and have exhausted all other means of conventional medical treatment.

Members of the surgical team, led by Maria Sieminow, M.D., were not commenting directly today on the French procedure, but a hospital spokesperson said their face transplant plan differs from what was done in France.

The goal here is to use the entire facial skin surface from a cadaver to overlay the patient's underlying musculature, said a spokesperson. That would eliminate one of the issues in the French procedure -- the difficulty of ensuring that transplanted lips, for example, would be functional.

The Cleveland team is looking for patients who are so badly disfigured that the lifelong use of immunosuppression will be justified.

The French patient, who has requested anonymity, was left unable to chew or talk after the dog attack. A statement from the hospital said her injuries would be "extremely difficult or even impossible to repair using standard maxillofacial surgical techniques."

MedpageToday.com

ABOUT THE AUTHOR

Russell Wilcox is a retired college professor who spends several months in Florida and several months in Rhode Island each year, and whose interests include boating and sailing, political activism, ballroom dancing and bridge. He has an MBA from Harvard, a Computer Systems CAGS from Bryant and a BS from Northeastern. He has worked in industry for EG&G and Texas Instruments, operated his own business with more than 200 employees, and served as Director of the Computer Information Systems Program for Stonehill College. He is a published author of two technical studies, and is the proud father of four children and the proud grandfather of six grandchildren. A holder of two patents in microchip connections and a true product of the melting pot, his father is the son of a Yankee farmer, and his mother the second generation daughter of Italian immigrants who retained their culture, but strove mightily to become Americans, sending four sons to fight against Hitler and Mussolini.