Face transplant patient due for revision surgery

January 1, 2010

The first U.S. face transplant recipient continues to regain sensory and motor capabilities, with future revision procedures planned.

Key Points

Meanwhile, James Maki, who received a partial face transplant in Boston in April 2009, has overcome rosacea-like episodes in his transplanted tissue and underwent a successful revision procedure in October, his surgeon says.

Ms. Culp underwent a near-total face transplant on Dec. 9, 2008, at the Cleveland Clinic to repair damage caused by a shotgun blast to the mid-face.

A recent publication by Ms. Culp's surgical team says the patient, now age 47, is recovering uneventfully, with no surgical complications to date (Alam DS, Papay F, Djohan R et al. Arch Facial Plast Surg. 2009;11(6):369-377).

However, extensive soft tissue loss and fibrosis prevented surgeons from identifying the proximal ends of Ms. Culp's infraorbital nerve, the article says, so they did not perform sensory nerve reinnervation. Nevertheless, this decision probably won't have major ramifications because surgeons designed the new tissue to sit atop Ms. Culp's old face, says Daniel Alam, M.D., a Cleveland Clinic facial plastic surgeon who performed Ms. Culp's microvascular surgery and tissue-harvesting procedure.

"Although the new facial tissue doesn't have innate sensation on its own, if you touch her face, she feels the sensation transmitted through it," he says. Surgeons connected all of Ms. Culp's motor nerves, he adds.

"At this stage, she has a little asymmetry between the two sides. We're probably going to check that at the time of her debulking procedure," to remove redundant glandular tissue that surgeons transplanted to the lateral face.

Ms. Culp has nearly normal movement on the left side of her face. After a couple more months' recovery, Dr. Alam says her ability to smile and make expressions "should presumably be normal, because the nerve anastomosis was done in a way that the specific nerves to those specific muscles are attached" as they would normally be.

Monthly follow-up

Dr. Alam says Ms. Culp returns to the Cleveland Clinic every three to four weeks for routine follow-up, and he sees her every two to three weeks to monitor surgical results and check her sinuses endoscopically.

"This is a unique case where we actually transplanted her sinuses, as well as facial tissues," he says. Although he expected her to develop sinus problems postsurgery, "So far, she hasn't had any - not even a minor sinus infection."

The fact that the transplant included most of the maxilla, palate and cheekbones also makes Ms. Culp's case unique, Dr. Alam says. "We went through a lot of planning, preparation and study in cadavers and in the lab," he says.

One year post-surgery, "It's been rewarding that the integration of (tissues) has been seamless and hasn't presented an issue," he adds.