Face, hand transplants soon options for injured Soldiers?
WASHINGTON — Army researchers are developing advanced treatment options, including face and hand transplants, for severely injured service members.
Some face and hand transplants have already been performed, mostly on civilians, said Lt. Col. Luis Alvarez, deputy director for the Armed Forces Institute of Regenerative Medicine at Fort Detrick, Md. AFIRM is managed through the U.S. Army Medical Research and Materiel Command, which helps to fund this research.
The treatment is so new that it is still considered to still be in the experimental stage, he said, adding that "it's not for everyone. Investigators try to be very clear (to the patients) about what they're facing" with the transplant procedure.
The risks have to be weighed with the benefits, said Dr. Wendy Dean, medical consultant for AFIRM.
The benefits can be enormous, she said, particularly for face transplants, which can return basic functionality such as breathing through the nose, chewing, swallowing and eyelid movement.
"If you don't have eyelids, the eyes will dry out and you'll eventually go blind if you can't keep your eyes moist, so that could be a sight-saving procedure," Dean said.
It goes without saying that the person's appearance will also be significantly improved by the transplant, she added.
Hand transplants also improve appearance. But, researchers have not yet found a way for patients to re-establish sensation in their hands like they have with face transplants, she said. They are working on that, however, so someday they may find a way to add the sense of touch, which is controlled by signals from the brain.
While the benefits are great for both procedures, there are some drawbacks.
First, the donor's family needs to be receptive, said Dean. As in heart, liver and kidney transplants, the donor is deceased, so surviving family members are contacted.
Once a donor is found, the antigen must match. If they don't, then antibodies can compromise the immune system, she said.
Fortunately, however, if the transplant is rejected, the effects will be clearly visible on the skin, so treatment can be administered much more quickly, than, say in the case of a kidney or liver, she said.
Another difference between a hand and face transplant over a kidney transplant is that the donor must be the right gender and approximate the recipient in terms of size, skin color and age, she said.
On the plus side, the patient has the ability to wait much longer for a match than someone needing a liver or kidney, which is usually a more immediate life-threatening event, she added.
Once a match is found, surgeons cut away one tissue block, she said, explaining that the entire portion -- or whatever portion of the jaw, nose, skin and muscles is needed -- is removed in one piece and transplanted all at once.
The portion of the face or hands that is required will have first been determined by computerized tomography or CT scan, by magnetic resonance imagining know as MRI or both, she said.
Once the procedure is completed, the hard work begins for the patient.
He or she may need to spend months and sometimes years going through occupational and physical therapy, which may be at times painful and frustrating, she said.
This therapy is essential to getting the muscles to move again and to keep the joints flexible, Dean explained.
Also, the patients will need to take immunosuppression drugs for the rest of their lives, she said. "For some, this is a non-starter."
Dean said Army researchers are working on ways to minimize the impact so that life-long immunosuppressant drugs can be reduced in dosage levels or not required at all.
Lastly, hand and face transplants won't save patients' lives like kidney, heart or liver transplants. Rather, the transplant will improve their lives by bringing back some functionality and improved appearance.
Soldiers wounded or injured in Iraq or Afghanistan might elect these procedures in the future, Dean said. One of the reasons there are not many Soldiers getting these types of transplants is that often years elapse between the injury and when the surgery is performed.
The most important thing is for the injured to first get life-saving treatment and post-operative care, she said. Then, the patient may elect to receive a prosthetics or plastic surgery.
"It may take months or even years before they've plateaued with the use of their prosthesis and decided it's not worth it or it's not satisfying enough for them," she said. At that point, they can consider the face or hand transplant option.
Army researchers are continuing to make advances and investments in regenerative medicine like transplants and tissue engineering, said Alvarez. "This is just one of many options available for our warfighters."