Connie Culp:: First Woman To Receive Face Transplant
Connie Culp- Before (left) After (right)
An Ohio woman, 46 years-old, uncovered on Tuesday that she is the first U.S. recipient of a face transplant, a procedure that requires both the promise of major medical technology and the ethical and economic challenges they can pose for society.
Connie Culp went through a 22-hour procedure at the Cleveland Clinic in December to restore the function to her face that was destroyed by a shotgun blast in 2004. The wound left her with no nose, lower eyelids, upper jaw, palate and other features, and she had been unable to breathe on her own, eat solid food, smell or smile. Ms. Culp had been unable to leave her home without being isolated by others and teased by kids.
At a news briefing on Tuesday, a team of eight doctors that performed the operation, reported that the surgery will allow her to drink from a cup, eat solid food, smell and breathe through her nose. The surgeons removed most of the face of a dead donor and placed it onto Ms. Culp like a mask, incorporating portions of her own face. About 80% of her face was replaced.
“We think this…procedure has changed her life dramatically,” said Maria Siemionow, director of plastic-surgery research at the clinic and the leader of the surgical team.
The operation shows how doctors are advancing the frontiers of transplant surgery, devising increasingly complex procedures and using them to help peoples lives, not just to save them. French surgeons performed the first partial face transplant in 2005.
Unlike, heart or kidney transplants, which are focused on one main type of tissue, the face involves skin, muscle, nerves, glands and other structures.
Patients receiving any tissue from a donor need to take an anti rejection drug that carries risk of infection, posing an ethical problem when the transplants aren’t done to save or save a life. Doctors said that concern has lately been more of an impediment than the technical ability to perform such procedures.
Expense is a whole other story. While the clinic didn’t provide data on what Ms. Culp’s procedure expense, doctors estimated it would be $300,000 to $400,000. That’s pretty steep for a procedure that isn’t life-saving, and that doesn’t include the extended care associated with transplant surgery.
It is hard to say how many people in the U.S. might be suitable for such a procedure, clinic officials believe it could possibly be in the thousands. For example, many soldiers in the Iraq war suffered major facial injuries.
The ethical concerns that had to do with the procedure help explain why doctors emphasized that Ms. Culp’s face transplant wasn’t done for aesthetic reasons. “The fact that there has been some recovery of function is important,” said Eric Kodish, chairman of bioethics at the clinic. “This is not cosmetic surgery in any sense of the word.”
The circumstances surrounding Ms. Culp’s injury weren’t addressed on Tuesday, but news reports before her surgery say she was shot by her husband in an apparent murder-suicide attempt in 2004. He also survived and he is serving a seven-years in prison. In the previous years before the transplant, Ms. Culp had 30 different reconstructive surgeries, but none effectively restored her lost functionality.
Ms. Culp was chosen for a transplant for both reasons, the seriousness of her injury and what doctors described as a positive attitude, making it more likely she would stick to a medication regimen.
The first concern among doctors was that whether blood vessels needed to be attached to vessels in the donated tissue would be too scarred from previous surgeries, said Frank Papay, chairman of the dermatology and plastic-surgery institute at the Cleveland Clinic and a member of Ms. Culp’s surgical team. But it turned out her vessels were okay.
Dr. Papay remembered that when doctors were ready to remove clamps that would enable blood to flow into the donated tissue, “It was a cadaver face, it was pale and white. We released the clamps, it turned rosy pink.” There was a “collective sigh” of relief in the room.
Ms. Culp’s appearance is different from before the shooting but she has a near-normal-looking face. She does have excess skin, but it will be removed in about 12- 18 months.
At the briefing, she stood in front of the cameras and reporters to thank the family that allowed facial tissue to be donated and the doctors and nurses who cared for her. She urged people not to judge others by their looks, and reflected on the difficulty she has had feeling shunned since the shooting, she said, “Five years later, I got me my nose.”
Leave a Reply
