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The next step in face transplants being planned

Story Highlights

• First partial face transplant was performed in 2006
• Siemionow has clearance from The Cleveland Clinic to perform a full transplant
• Candidates for the face transplant would be burn or accident victims
By Miriam Falco
CNN
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For more on face transplants and some other medical predictions for the next year, tune into a special edition of "House Call with Dr. Sanjay Gupta: Prognosis '07" on Saturday & Sunday at 8 am ET.

(CNN) -- After a partial face transplant was performed in 2005, it seems a full face transplant will be the next breakthrough.

One surgeon likely to be the first to conduct the reconstructive procedure is Dr. Maria Siemionow, from the Cleveland Clinic.

Trained in Poland, Siemionow's first microsurgical operation was reconnecting someone's hand.

She said it was a very powerful experience that "led me to think that technically we can do so much and you can make patients that are disabled one day ... come back to society the next day."

With the development of better microscopes and instruments and a lot of practice using them, connecting the tiniest blood vessels and nerves is now possible.

Siemionow said the idea of a face transplant evolved from her interest in reconstructive surgery.

"As a hand surgeon I would think, 'We can really make hands functional but there is so little we can do for ... faces.'"

The Cleveland Clinic gave Siemionow the medical and ethical clearance for a full face transplant in 2004, making her the first in the world to receive the greenlight for this experimental procedure.

Yet, two years later, Siemionow has yet to do the surgery.

That's because she hasn't found the perfect candidate.

"I think that is a very important statement that the selection criteria is taking time," Siemionow said.

Appropriate candidates would be burn or accident victims who have exhausted all other reconstructive possibilities. For the transplant, the entire skin flap of a patient's face and possibly parts of the scalp, ears and neck would be replaced.

Patients have to fulfil a lot of criteria. They would have to take immune-suppressing drugs for the rest of their lives to prevent tissue rejection. They would require a built-in escape clause.

"One of the most important things is that the patient who is a candidate for facial transplantation requires enough skin in their own body, where we can actually rescue them or have an exit procedure in case the face transplant would be rejected," Siemionow said.

So the search for the perfect patient continues -- as does the race to see who will be first to conduct the transplant.

French and Chinese surgeons have already reached the partial transplant milestone and a British surgeon announced he's ready to do the first full face procedure.

But he's only received permission to find a suitable candidate, not to perform the operation. Siemionow strongly believes it's important to explain to the public what a full face transplant is about and what it's not about.

For one, she said, it's not about vanity. "I got a phone call from someone very young who said, 'I have this terrible acne, and I heard at Cleveland Clinic, you have this new thing going on -- face transplant -- would I be a candidate?'"

"It should be considered a medical procedure. This is something we want for the wellbeing of our patients and only those who cannot be treated by conventional ways."

Siemionow is looking even further into the future -- transplanting facial tissue and bones too.

She's just published research doing just that on mice, which the American Society of Plastic Surgeons describes as a "step closer to making the reconstructive process easier for patients with extensive skull and facial deformities."


vert.face.transplant2.jpg

This rat had a full face transplant 150 days before this photo was taken.

HEALTH LIBRARY

In association with MayoClinic.com

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