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Green Signal given to Full-Face Transplants

Prof Peter Butler, a pioneering plastic and reconstructive surgeon has been given the go-ahead for full face transplantation //by the ethics committee of the Royal Free Hospital, London to select four patients for the first, ground-breaking operations.

However the Royal College of Surgeons has called for caution with leading surgeons voicing their concerns about face transplantation.

The surgery promises to transform the lives of hundreds of people who have been forced to live with severe facial disfigurement, mostly caused by burns and for whom standard reconstructive surgery is of no further benefit.

Prof Butler expressed his relief and delight at having been given permission and stated that he would start "the more important task, the selection of the right patients".

He stressed upon the need for a slow and cautious approach saying that the selection of patients and their preparation would require at least three to four months and it could take a year before the first operation took place.

Sir Peter Morris, chairman of the facial transplantation working party of the Royal College, has written to Prof Sir Liam Donaldson, the chief medical officer for England, calling for "minimum requirements" before any unit or institution contemplates undertaking a face transplant.

The college, in a statement, said, "We would urge the trust [Royal Free] not to allow this surgery to proceed before the review has taken place.We believe that facial transplantation should only take place if all the minimal requirements we will set out can be met."

According to Prof Butler he had met the committee and was "very pleased" with their statement commenting that the Royal Free had agreed to more than meet minimum standards. He said, "You need to be a recognised transplant centre and a recognised plastic surgery centre. We have in addition our own psychological department. It is right that, initially, face transplantation sho uld be limited to centres of excellence."

Isabelle Dinoire, 38, who had been savaged by a dog, received the lips, nose and chin of a donor was the recipient of the first partial face transplant last year. Her surgery was successful and she began to regain sensation within weeks.

Prof Butler's team has already been approached by 34 hopeful patients. He said, "We are looking at people who have lost all their facial tissue and who have had 50 to 70 reconstructive procedures already. Plastic surgery has nothing further to offer them.

"In other words, surgeons cannot work on them any more. They may have problems with eyelid and mouth opening and closure, they may not have any hair, their ears may have gone, been destroyed or damaged.

"Most of them just want to be able to walk down the street without being stared at. The French say their patient says she can walk down the street and no one looks at her. It is actually what she wanted to do. You can't say more than that."

Each operation is expected to cost £20,000 and anti-rejection drugs, another £5,000. The Face Trust, a charity was launched yesterday to raise the necessary money. Each operation will last almost 12 hours and with six surgeons working with the donor and the recipient.

Prof Butler said that if an operation fails, research conducted by them has shown that the patient would be no worse off. The patient could be offered another transplant, treatment with artificial skin or more standard plastic surgery after a waiting period of six months at least. No cases of acute rejection had been reported in 24 hand transplants.

Donors for the transplant would be people on the national donor register. Recipients and donors would be matched for tissue type, as with organ transplants, but also for skin color and tone and gender.

Prof. Butler commented on the changing opinion nowadays after French surgeons reporting that bereaved families offered face s to transplant co-ordinators since Ms Dinoire's surgery.


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