Hands today, faces tomorrow

By David Concar THE controversial hand transplant operation that took place in a French hospital last week raises the prospect of something even more macabre—a human face transplant. While doctors in Lyon continue to closely monitor Clint Hallam and his hand for signs of rejection, a rival American team is gearing up for many similar operations. “We’ll do at least 10 of these in the coming year,” says John Barker, a plastic surgeon at the University of Louisville in Kentucky. Whereas most transplants involve grafting only single organs or tissues, a hand transplant requires skin, muscles, nerves and bone all to be grafted at once. This makes hand transplants a good way of testing drug combinations that might stop the body rejecting multiple tissue grafts, especially ones involving skin, the most immunogenic tissue. Ultimately, Barker predicts that the greatest demand for such transplants will come from patients who lose their faces in a fire, or through disease, shotgun wounds or dog attacks. Surgeons currently rebuild faces using flaps of skin and muscle taken from elsewhere on the patient’s body. Barker says they could get a much better-looking result by transplanting the facial skin, muscles, nerves and lips of a dead donor the same age. However, John Williams, vice-president of the Royal College of Surgeons in London,
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