Meet the surgeon who has managed a facial transplant | Technology and science | science

"It exceeded all my expectations". Andy Sandness still can not speak, he wrote these words after seeing his new face in a mirror. For about 11 years, this young American lived with a severe deformation of the face because of a bullet in the face, with which he tried to commit suicide. However, in 2016 Samir Mardini, a plastic surgeon at Mayo Clinic (USA) and a team of more than 40 experts, offered him a new opportunity thanks to a facial transplant. Mardini is currently in Peru as part of a collaborative project with the National Institute of Child Health of San Borja aimed at treating children with cleft lip and palate.

– Since the first facial transplant performed in 2005 You think that's an appropriate figure?

The main reason why this number is not 500, is that it is not easy to be an ideal candidate for a face transplant. It must be very serious facial malformations. In addition, this is a procedure that involves a large number of specialists and resources. Andy was almost missing all his face. With the transplant, we restored everything that was before his eyes. It was a six-year process where we discussed the risks with him, he informed us, we put together the necessary team and discussed with the Mayo Clinic Board of Directors. The simple planning of the operation itself took three and a half years.

– Is this procedure a last option?

Not necessarily. At some point, you must decide as a doctor the way forward. Conventional facial reconstruction involves the use of parts of different parts of the patient's body, such as using a part of the leg to rebuild the jawbone. In addition, in these types of procedures, several blood transfusions may be necessary, which may result in greater rejection of the transplanted organs. If you have a patient who has undergone 50 operations, more implants, more transfusions, the transplant will be very complicated. This is why you must decide very early if you want to continue with conventional methods or if you are considering a facial transplant.

– What makes this operation so complex?

Each face transplant is unique. I think that's the definite individualized medicine. In the case of Andy, the challenge was to connect the good nerves between his face and the donor's. To do this, before the operation, we had to locate, isolate and determine the function of each nerve. Keep in mind that a nerve branch can, for example, participate in 80% of the eyelid movement and 20% of the smile. We connect eight nerve branches on each side of the face.

– It should also be noted that the body does not reject the new face …

Exactly. Patients who undergo a facial transplant will have to go through the same medication as those who have received a heart, kidney or pancreas, among other organs. It's a diet for life. This is another reason why there are so few cases of face transplants.

– Waking up and seeing yourself with someone else's face can be shocking. How is the psychological aspect treated?

This is essential to the success of the operation. We have a team of psychiatrists who helped us choose Andy as a transplant candidate and also helped him to be ready and to be aware of all the risks. For example, although he has a new face, he will always attract attention, he must learn to manage it. The emotional support he needs from specialists will always be available to him.

– Can technology increase the number of such procedures?

When we talk about face transplant, it is very important to use the latest technological advances. optimize results, be more efficient. To treat Andy, we train using virtual systems, which allows us to determine where to make the cuts, which position to adopt and which angle to adopt. We also have 3D printed guides that are placed on the bones of the face and allow us to make more precise cuts, so that the graft adapts without problems. New technologies will continue to be implemented in this type of treatment, but I think that which will increase the number of facial transplants will improve the methods of immunosuppression, thus reducing the need this type of medicine.

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