Skip to contents
In This Issue:
Stefan Tullius, MD, speaks at the March 21 press conference; Jim Maki in August 2010.
How do you perform a surgery that no one has ever done before?
That was the question Bohdan Pomahac, MD, asked in 2004 when he began researching face transplantation. He had just signed on to join BWHÕs Plastic Surgery division and frequently treated patients with head and neck cancers and devastating facial burns, many of whom had no traditional reconstruction options.
"When the world's first face transplant was performed in France in 2005, it reinforced my decision to pursue the development of a program here," Pomahac said. "Some patients have no acceptable reconstruction options, and I knew we had to serve them better."
Pomahac developed a proposal with input from plastic and transplant surgeons, anesthesiologists, nurses, therapists, psychiatrists, physicians and the New England Organ Bank. He focused on management, logistical operations, organization and the preparation of protocols, which were largely derived from decades of research and understanding gained from solid organ transplant.
"Once we had a candidate in mind, we scrutinized all aspects of the case to create a comprehensive medical work-up, including assurances that the patient would be safe during surgery and a plan to manage care in the long-term," said Stefan G. Tullius, MD, BWH's chief of Transplant Surgery.
Tullius' team coordinated the management of immunosuppressant medication to prevent rejection of the new face.
"We created a protocol for the surgery that was individualized for our patient based on everything we knew from decades of solid organ transplantation," he said. "At the same time, we acknowledged that we were working in a completely new field where there was no experience."
The second part of the preparation involved developing surgical technique, a process unique to each recipient that requires an intense understanding of the anatomy of the face. Pomahac solicited the help of Julian Pribaz, MD, of BWH Plastic Surgery, to conquer this task.
The patient, Jim Maki, underwent imaging tests to identify the facial defect. Pribaz and Pomahac determined how to surgically transplant the parts of the face he needed in an aesthetically-pleasing way. They had to consider not only the facial tissue, but also the nerves that power muscles to create sensation and the vessels that carry blood to the face to keep the tissue alive.
The surgeons tested their technique in an anatomy lab. "We discovered our plan was actually very feasible," said Pomahac, who traveled with Pribaz to Brussels to learn from the experience of the French surgical team that pioneered face transplantation.
Towards the end of his research and preparations, Pomahac spoke with Nobel Prize recipient Joseph Murray, MD, who performed the world's first organ transplant in 1954.
"He reminded me that there will always be obstacles in the path to success, but you must push forward and do the best you can for your patient," said Pomahac.
On April 9, 2009, five years after Pomahac first conceived of a face transplant program at BWH, he led an approximately 30-member team in the first successful, male partial face transplant in the country. Today, Maki is doing very well and his immunosuppressant medications are at the lowest level of all face transplant patients in the world.
This month, Pomahac and his team made history again by performing the nation's first full facial transplant on 25-year-old Dallas Wiens.