Successful face, arm transplants signal wider potential
A CLOSER LOOK: COMPOSITE TISSUE ALLOTRANSPLANTATION
Doctors express hope that the encouraging results from such surgeries could benefit patients worldwide. Other types of potential CTAs include scalp and ear procedures.
Several types of so-called composite tissue allotransplantation (or CTA) are now being done or are considered good candidates to be done in the future.
In a 16-hour procedure in July, a 30-member team at the Technical University of Munich performed the world's first total-arm transplant. This was also a double-arm transplant. The world's only forearm transplant -- also a double -- was performed in Austria in 2003.
Three successful partial face transplants have been performed so far -- two in France, including the world's first in 2005, and one in China -- and Dr. Maria Siemionow of the Cleveland Clinic in Ohio is ready to start doing face transplants in the U.S. as soon as she can find an appropriate recipient.
Recipients of face transplants do not look exactly like they used to look, but neither do they look exactly like the donor, because the donor's skin and muscles are stretched over the recipient's bone structure.
Siemionow, professor of surgery and director of plastic surgery research and head of microsurgery training at the Cleveland Clinic, believes face transplants are especially important because facial deformities, injuries, tumors, etc. are such a limiting factor in just about every social interaction. "You can put your hand in your pocket, and no one will care," she says, "but you can't hide your face."
The three face transplants done so far were all very different, she says, but overall, "The results are encouraging." Siemionow would like to do the world's first total face transplant should she find a patient with that need.
One rather different type of CTA is being performed successfully by surgeons at the University of Miami: partial abdominal wall transplants -- nearly a dozen have been done since 2003. These are generally only needed in conjunction with small bowel transplants.
Other CTA possibilities include the scalp, ears, genitalia -- an unsuccessfula penis transplant was performed in China about three years ago -- and body wounds. Most, if not all, of these would only seem appropriate when risks from taking immunosuppressive drugs have been significantly reduced.
Dr. Stefan Schneeberger, director of the CTA Program at the University of Pittsburgh, believes that day will come, and when it does, it will be a great boon to many people, perhaps more so in other countries than here.
"The pioneers in the field are in privileged countries," he says, "but millions of patients in other countries could profit from this. . . . Some countries have 10 times more amputees than we do."
Although CTA recipients have all been adults so far, Schneeberger believes that eventually it might be especially useful in treating birth defects.
Dr. Warren Breidenbach III of the Kleinert Kutz Hand Care Center in Louisville, Ky., is equally optimistic about the potential for CTA. "I believe it could have applications I can't even imagine," he says.
