Soldiers who have been severely disfigured in Iraq and Afghanistan may benefit from a $3.4 million contract granted by the Pentagon to Brigham and Women’s Hospital to perform face transplants. To qualify, soldiers must be missing at least one-quarter of their face and be unable to get significant help from conventional plastic surgery techniques.
A 35-member medical team at Brigham and Women’s Hospital performed the second face transplant in the United States in April 2009. The recipient was James Maki, who had been severely disfigured in a subway accident. The first face transplant performed in the United States occurred in December 2008 at Cleveland Clinic. The patient was Connie Culp, who underwent the 22-hour surgery over two days. Ms. Culp’s husband shot her in the face in 2004 during a murder-suicide attempt, shattering her nose, cheek, and jaw.
The contract awarded to Brigham is the first time money has been given out under a Department of Defense initiative to rapidly introduce innovative medical techniques into mainstream practice. A smaller award was given to the University of Pittsburgh for facial reconstruction surgery.
The need for face transplants and facial reconstruction have become more necessary since the starts of the Iraqi and Afghanistan wars. Compared with previous conflicts in which there were three wounded soldiers for every death, today there are nine wounded for every fatality, Dr. Joseph Rosen, a plastic surgery at Dartmouth-Hitchcock Medical Center in New Hampshire told the Boston Globe. Along with the increasing numbers of wounded veterans are more severe injuries, many of them caused by improvised explosive devices.
Doctors at Brigham are developing the face transplant program, including recruitment information for veterans. The plan is to make the information available on websites for veterans and to also contact soldiers through a government registry of the wounded. Face transplant surgery costs approximately $250,000 to $300,000 and is not covered by insurance.
In addition to performing the face transplants, the Department of Defense is also interested in learning more about the use of immunosuppressant drugs, which transplant patients need to take to prevent rejection of the donor tissue. Transplant recipients need to take these drugs and manage their side effects for the rest of their lives.
Over the next 18 months, the Department of Defense hopes Brigham physicians will complete face transplants on six to eight soldiers. This represents a small percentage of the estimated 200 veterans that may qualify for the procedure.
Dr. Rosen told the Boston Globe that “It’s not enough just to keep soldiers alive.” Face transplants for those who have been severely disfigured “would be a big step toward them leading more useful and productive lives.”
ABC News, May 5, 2009
Boston Globe, Dec. 21, 2009
Fox News, Dec. 21, 2009