FACIAL TRANSPLANT
THE
FACIAL TRANSPLANT SURGERY:
Surgery was performed following the strict rules for the experimental surgery in animals, in a veterinary operating room (Clínica de Pequeños Animales Fundación Universitaria San Martín) under general anesthesia. We obtained the dogs from the municipality 10 days prior to surgery and they were wormed and received nutritional support, to improve their general condition for the surgery.
The
recipient dog received immunosuppressive therapy with cyclosporine 4 mg/ kg /
day and prednisone 1 mg/kg/day, to avoid the hyper acute rejection of the
transplant.
Picture 3: animal model for facial transplant.
Donor
Dog:
We
started the surgery with the donor dog.
Under
general anesthesia.
Dissecting
a skin-muscle flap under the SMAS.
Cutting
around the eyelashes.
Including
the eyelids in the flap.
|
Picture 4a: Donor dog. |
Picture 4b: Flap incisions. |
Picture 4c: Flap raised based in the facial vessels. |
Recipient
Dog:
When
we finished the dissection of the hemi face in the donor dog we anesthesiated
the recipient dog.
Picture 5: Operating room setting, donor and recipient dogs
under general anesthesia, and the interdisciplinary team.
In
this dog we started the procedure looking for the recipient vessels (the lingual
artery and the external jugular vein).
As
soon as we isolate the vessels in the recipient dog we cut the vessels of the
face in the donor dog and then we transferred the face.
The
donor dog was destroyed by lethal injection under general anesthesia.
Then
we perform under magnification the microvascular anastomoses between the
arteries and veins.
After 30
minutes of normal flow in the anastomoses we drew the resection of skin in the
recipient dog according to the size of the transplanted hemi face.
Then
we proceeded to resect the skin of the face in the recipient dog, and insert the
flap stitching everything in place.
|
Picture 6a: Recipient dog |
Picture 6b: Transplanted face. |
Picture 6c: Done. |
RESULT:
The dog was kept alive during 5 days with the flap perfusing normally. The dog received cyclosporine , prednisone, antibiotics and analgesics.
Picture 7: Postoperative picture at the 5th day.
Following this period, the flap developed inflamatory changes and necrosis.
The dog was destroyed by lethal injection and biopsies were taken from
the transplanted tissue. The histology showed vascular necrosis and a severe
acute inflamatory response.
Picture 8: Acute rejection of the flap.
Our hypothesis was correct: Facial transplantation can be safely accomplished by using the facial artery and the external jugular vein as pedicles.
Some words about the ethics of this experiment.
The ethical issues about animal experimentation have been some of our major concerns. For someone who has never seen one person fighting to gain a normal appearance and a normal life, or who has never felt the suffering of a wounded soldier, it is not easy to understand how important would be for many desperate people to find the perfect procedure for some not life threatening conditions. Because I have been exposed to the human suffering and to the concerns of deformed people, I decided to proceed. I took under consideration the ethical aspects of animal experimentation.
There was only one way to replace the use of animals to test this hypothesis, it was testing the surgery in a volunteering needed human being; and this would not be ethical at all ( please see the page other way to test a novel procedure ).
We got those dogs from the Zoonosis Center of the local municipality, they were already condemned to die by electric shock. We treated them with consideration, all the surgery was performed following the same rules we would use in human beings.There was not any commercial interest. Animals were treated with respect and consideration. Pain and distress cannot be evaluated easily in animals and therefore the animals were treated following the same rules and techniques used in humans. An experienced anesthesiologist and a veterinarian managed the anesthesia and pain during the experiment. You can see how this surgery was performed and in what conditions was performed. If you want to see the video of this surgery click here
Alleviation of pain or distress took precedence over completing the project. As soon the first signs of rejection were noticed the animal was euthanased without delay.
We are really interested
about the ethical aspects of the present study please let me know what do you
think.
Postoperative care Dr.
Diego Calderón MV, and the staff of the San Martín University Veterinary
Clinic directed by Dr. Londoño.
The Director of the
complete project Dr. Luis Bermúdez.
MD.
Professor of Plastic Surgery. Military Hospital. Bogota.
