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First face transplant performed in U.S.

Skin and muscles removed from cadaver

A woman being treated at the Cleveland Clinic has an almost entirely new face following the most extensive facial transplant ever performed, the medical center said Tuesday. The surgery is the first face transplant in the U.S. and the fourth in the world.

Few details about the patient have been released in advance of a news briefing scheduled for today. About 80 percent of the patient’s face has been replaced with skin and muscles harvested from a cadaver.

The family of the patient has asked that her name and age not be released so that she may remain anonymous, the clinic said.

But Dr. Maria Siemionow, the Cleveland Clinic plastic surgeon who performed the marathon procedure, is well known among microsurgery specialists, and colleagues were quick to praise the achievement.

“We’re on the threshold of a whole new way of correcting defects,” said Dr. Warren C. Breidenbach, of the University of Louisville, who performed the first hand transplant in the United States.

Siemionow and her colleagues at the Cleveland Clinic have spent years preparing for the surgery, practicing on animals and doing trial runs on 20 cadavers, said Dr. James Bradley, a professor of plastic surgery at the University of California, Los Angeles Medical Center who has seen several presentations by Siemionow at research meetings.

“They’ve done their homework,” Bradley said of the transplant team.

Isabelle Dinoire, a 41-year-old mother of two in France, became the first recipient of a partial face transplant in 2005 after the lower part of her face was mauled by her pet Labrador. Two other individuals have received face transplants since then – a male in France who suffered from a genetic condition and a man in China who was attacked by a bear.

The surgery in Cleveland likely lasted between six and 10 hours as surgeons grafted the blood vessels, muscles and skin from the donor onto the patient, Bradley said. It could take months before the nerves have healed enough to gauge the success of the procedure, he added.

After the swelling subsides, the patient won’t look exactly like the woman who donated her face.

“You look more like a cousin,” Bradley said. “The bone structure is your own, but the skin is from another person.”

Transplanting a face isn’t any more of a technical feat than transplanting a hand, surgeons said. But a face transplant has its own complications.

“You have to wait for a donor, and that’s not easy,” Breidenbach said. “A lot of donor families are in shock and grief because their loved one died and they have to donate a very visible part of the person.”

Doctors said face transplants would become routine in the coming years.

“There is always controversy when there is something new,” Breidenbach said. “I do not believe there should be major controversy about reconstructing a face with a face transplant if the defect cannot be constructed in another way.”