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Members of the surgical team gather after the face transplant is complete.
Life changed for Dallas Wiens in 2008, when a cherry-picker he was working in maneuvered into a high voltage wire. Wiens, who is now 25 years old, lost all of his facial features.
Last week, life changed for Wiens once again when he became the recipient of the first full face transplant in the country. It was the second face transplant procedure to be performed at BWH.
"Dallas always said after the injury that he now had a choice," said Wiens' grandfather, Del Peterson. "He could choose to get bitter, or he could choose to get better. His choice was to get better. Thank God today he's better."
Peterson told media and the public at a press conference March 21 that his grandson was excited to undergo the procedure at BWH, led by plastic surgeon Bohdan Pomahac, MD, director of the Plastic Surgery Transplantation Program and BWHÕs Burn Center, and he also thanked the New England Oregon Bank for their role in identifying a donor. The team of more than 30 physicians, nurses, anesthesiologists, residents, surgical techs and others worked for more than 15 hours to replace WiensÕ facial area, including his nose, lips, facial skin, muscles of facial animation and the nerves that power them and provide sensation.
"Dallas told me that Dr. Pomahac inspired confidence from the very first meeting and that he knew he was in the right place here at the Brigham," Peterson said. "Our experience over the past several days has certainly confirmed Dallas' instincts."
Dallas Wiens and his grandfather, Del Peterson, arrive at Logan Airport.
From Dallas to Boston
Weins and his grandfather, who both live in Fort Worth, Texas, boarded a Boston-bound plane almost immediately after being notified that there was a donor available.
"Dallas was so excited. He kept saying "Is this really happening? Is this really the day?'" Peterson said. It was a pivotal step in a journey that was the result of more than a yearÕs worth of consults between Wiens, Pomahac and Jeffrey Janis, MD, Wiens' plastic surgeon at Parkland, the Dallas, Texas, hospital where he received care immediately following his accident.
"Dallas sustained a devastating injury leaving him with a bare skull instead of a face. Thanks to his treating physicians at Parkland, he survived," Pomahac said.
Pomahac and Janis met at a medical symposium in 2009, after Janis had already performed a number of surgeries on Wiens. Recognizing that his patient might be a future face transplant candidate, Janis introduced himself to Pomahac and the two exchanged information. Nearly two years later, Janis joined Wiens and Pomahac in Boston just hours before the transplant was set to occur.
"It meant a lot to me to be here. I promised Dallas that I would be here for this part of his journey," Janis said.
Wiens and Peterson arrived at BWH soon after their flight landed in Boston and began to prepare for surgery.
"We had no idea how long the surgery might last, but we were completely confident. Dallas was ready," Peterson said.
Bohdan Pomahac, MD, enters the OR with the donor tissue.
Teamwork in the Operating Room
As Wiens was en route to Boston, teams at BWH were hard at work coordinating the logistics of the surgery. During the 15-hour procedure, they would first remove the skin grafts that covered what was left of WiensÕ bone, muscles and soft tissue. They then planned to attach the donorÕs face, reconnecting the nerves so Wiens would be able to feel and move his new features.
"The night of the surgery, Bo sat down with the whole team and laid out the surgical plan,Ó said plastic surgeon Matthew J. Carty, MD, noting that the team, who had already met several times to discuss WiensÕ case, leveraged much of its experience with patient Jim Maki, who received a partial face transplant at BWH in 2009, in terms of set up and planning (see related story, page 4).
"There was an early morning team, who was the "starter team," and then a late morning team came in later to provide relief," said Carty, who was part of the late morning team.
The careful planning paid off during surgery.
"An operation like this requires a large team working together, and there truly was no ego in that room. We were all focused on Dallas," Carty said. "Our group works seamlessly together. As each of us finished a component of the case or started to get fatigued, we would tap one another and give someone a rest."
Anesthesiologist Tom Edrich, MD, agrees that collaboration and teamwork were essential for the surgery's successful outcome.
"This surgery would not have been possible without the nearly four years of collaboration among many disciplines," he said.
"We're a team as it is, but this type of experience brings us closer," said scrub tech Natasha Amaro, ST. "We'll all remember this patient and experience."
Wiens' surgery will be paid for by the U.S. Department of Defense, who in 2009 awarded BWH a $3.4 million research contract to refine the operation to help disfigured soldiers.
In the days after the operation, Pomahac said Wiens was meeting all of his post-transplant milestones. He spoke to family and friends in Texas via phone, and was also walking around. But what Wiens is looking forward to most, his grandfather says, is to once again feel the kisses of his four-year-old daughter, Scarlette.
"When I first saw him after the injury, I had no idea what was going to follow," Peterson said. "He is determined to get well, to move on with his life and to make something of his life. This is beyond anything that I even thought would happen when he first received the injuries.ÓDel Peterson shakes hands with anesthesiologist Gyorgy Frendl, MD, PhD, before the March 21 press conference, while Stefan Tullius, MD, left, looks on; Dallas Wiens leaves Logan Airport, heading to BWH.
Del Peterson shakes hands with anesthesiologist Gyorgy Frendl, MD, PhD, before the March 21 press conference, while Stefan Tullius, MD, left, looks on; Dallas Wiens leaves Logan Airport, heading to BWH.
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