First words of patient who received partial face transplant: 'Thank you'

LYON, France (AP) _ A woman who underwent the world's first partial face transplant regained consciousness 24 hours after the groundbreaking operation and her first words were ``thank you,''

Wednesday, November 30th 2005, 9:33 am

By: News On 6

LYON, France (AP) _ A woman who underwent the world's first partial face transplant regained consciousness 24 hours after the groundbreaking operation and her first words were ``thank you,'' one of her doctors said Friday.

Dr. Bernard Devauchelle, one of the two surgeons who operated on the woman, said there were no post-surgical problems and the patient was doing fine.

The 38-year-old woman, a divorced mother of two teenage daughters whose name has not been disclosed, was mauled by a Labrador in May, leaving her with severe facial injuries. She underwent the transplant Sunday at a hospital in Amiens, northern France. The donor was a brain dead woman.

Devauchelle told a news conference that after the woman woke up, she put a finger on the tracheotomy tube in her throat and said, ``Merci.'' Behind him were projected images of the portions that were transplanted _ a section of the nose, lips and chin.

The woman's injuries had made it difficult for her to speak and eat, her doctors said. However, since the surgery, she has eaten strawberries and chocolate, and drunk coffee and fruit juice, her doctors said.

Video released by the hospital showed the brown-haired woman from the back, sitting in a chair with a bundle of red knitting and needles on her lap while a doctor examined her injured face. The footage also showed the woman being wheeled out of surgery on a bed, her new lips, chin and nose in place.

Hospital director Philippe Domy said the surgery was required because ``we are in an exceptional situation that required an exceptional response.''

Dr. Jean-Michel Dubernard, her other surgeon, acknowledged that he had initial reservations in the planning stages of the surgery, but he added that when he saw the extent of the woman's disfigurement, ``I no longer hesitated for a second.''

He denied a French media report that the woman was attacked by the dog after she had passed out from having taken pills in a suicide attempt. Instead, he said the woman had taken a pill to try to sleep after a family argument and was bitten by the dog during the night.

``There was no suicide,'' Dubernard said. The woman was examined by several psychiatrists before the surgery and ``all these teams gave the green light.''

Devauchelle said that in terms of matching the skin color and texture of the donor and recipient, the results of the surgery ``surpassed our hopes.''

Carine Camby, director-general of the agency under the French health ministry that coordinates organ procurement said the woman was warned that she risked becoming a center of media attention because the surgery was a world's first.

The operation has set off a debate among scientists over ethics. One surgeon questioned the procedure, saying traditional reconstructive surgery should have been tried first. Others raised concerns over her psychological health.

Dr. Laurent Lantieri, an adviser to the French medical ethics panel, said the surgeons violated the panel's advice because they failed to try reconstructive surgery first.

The panel had previously objected to full face transplants but said partial ones could be considered under strict circumstances, which included first trying normal surgery.

However, surgeon Denys Pellerin, of the National Consultative Ethics Committee advised by Lantieri said, ``as long as the transplant is not total, it is not unethical.''

And Dr. Jean-Pierre Chavoin, secretary general of the French society of plastic surgery, noted that Lantieri had planned to do a face transplant himself but was beaten to it.

Camby said normal reconstructive surgery could not have been used in this case.

``It is precisely because there was no way to restore the functions of this patient by normal plastic surgery that we attempted this transplant,'' Camby said. ``She could no longer eat normally, she had great difficulty speaking and there is no possibility with plastic surgery today to repair the muscles around the mouth which allow people to articulate when they speak and not spit out food when they eat.''

However, a surgeon involved in the advance evaluation of the case suggested traditional techniques may not have been impossible.

``We could have tried (reconstructive surgery). ... The aesthetic result would have been average. ... This was the search for a better functional and aesthetic result,'' said Dr. Guy Magalon, director of plastic and reconstructive surgery at Conception Hospital in the southeastern city of Marseilles. He was the consultant on reconstructive surgery to the French Agency of Health Security and Products for a review panel it convened in June to look at the graft proposal.

Chavoin, who took part in preparatory meetings about the patient's case over the last several months, was one of a few doctors who questioned the woman's psychological health Thursday.

The patient ``seems to have quite a depressive profile,'' he said. It was unclear whether he was referring to the woman's state of mind before the dog bite or afterward.

However, Magalon appeared to defend the patient's psychological suitability for the surgery.

``There was a psychological review indicating that she would be able to withstand this operation. After that, nobody is infallible,'' he said.

Camby also said the patient ``received many psychiatric examinations. The psychiatrists decided that she understood the surgery and that she accepted all of the consequences, including the risk of rejection and of failure, the risk of immune suppression treatments and the need to take them for life.''

Dubernard led teams that performed a hand transplant in 1998 and the world's first double forearm transplant in January 2000.

The hand transplant recipient later had it amputated. Doctors said the man failed to take the required drugs and his body rejected the limb.

Lantieri said he feared this operation could turn out like that first hand transplant if the patient is psychologically unstable.