Featured Research

from universities, journals, and other organizations

Surgeons develop framework to assess long-term impact of facial transplant operations

Date:
October 1, 2012
Source:
American College of Surgeons
Summary:
According to reconstructive surgeons, a recently developed standard scoring system that measures a patient's ability to return to a normal life predicts facial transplant procedures' long-term impact.

Facial transplant operations are often portrayed as dramatic before-and-after stories but new research shows that the procedures' real long-term impact may sometimes be underreported, explained researchers from The Johns Hopkins Hospital, Baltimore, MD. An analysis of patient outcomes data found that a recently developed standard scoring system called "the FACES score" -- which measures a patient's ability to return to a normal life -- has not been fully utilized for some patients who have already undergone facial transplants, according to reconstructive surgeons who presented study results at the 2012 American College of Surgeons Annual Clinical Congress.

Related Articles


"Facial transplants are not just about reconstructive surgery," explained Chad Gordon, DO, assistant professor of surgery at The Johns Hopkins Hospital and clinical director of the hospital's facial transplant program, which launched in August 2012. "The face represents so much to someone's life. It's about taking someone isolated from society and putting him or her back into society. We're spending millions to research and perform face transplants, but we don't know if patients are getting back into society. Are they getting jobs? Are they able to live on their own? Or are they still socially disabled?"

To date, only 19 face transplants have been performed worldwide. When Dr. Gordon's team looked at postsurgical FACES data on all 19 patients, only eight had complete reports -- three from the U.S., three from France, and two from Spain. "Surprisingly, we found that many of the reports were incomplete," Dr. Gordon said. "We have no idea if these patients found a job, got married, or are living on their own." With the lack of reporting, patient outcomes of face transplant procedures cannot be properly assessed and patients may not be receiving the best postoperative followup and care. Better return-to-society reporting, could help surgeons understand and improve upon the procedure's success, he said. Furthermore, better reporting can help us to reassess the reconstructive surgeon's role in patient care -- from the time the operation is performed -- to the patient's return to normal life, he explained.

In December 2008, Dr. Gordon was on the Cleveland Clinic surgical team that performed the nation's first facial transplant on a woman who had been shot in the face by her husband. After that operation proved successful, Dr. Gordon developed a five-pronged assessment tool called the FACES score to screen future patients. The FACES assessment was also designed to measure postsurgical clinical and social outcomes based on five criteria: functional status, aesthetic deformity, comorbidities, exposed tissue, and surgical history.

Functional status measures how well the person performs in society, as well as whether the person leads a functional life, such as being self-sufficient and maintaining relationships. While comorbidity criterion considers how well vital organs work, particularly the liver and kidneys, aesthetic deformity looks at the severity of the facial injury and the patient's other health conditions, along with lifestyle habits that could lead to health conditions (for example, smoking or excessive drinking). The final two measures look at exposed tissue -- or how deep the facial wound is -- and surgical history. Patients who have already had numerous operations usually have accumulated a lot of scar tissue, which makes the facial transplant more complex. On a scale of 10-60, an overall score of 45 or higher indicates an ideal face transplant candidate. "Patient selection is a key to success," Dr. Gordon explained.

The mean presurgical FACES score for the eight patients who had complete reports was 29.3. Following the operation, the score dropped to 16.4. "The purpose for the screening tool is to identify patients with higher FACES scores, meaning those who needed surgical treatment the most," Dr. Gordon explained. "By their scores going down, it tells you that the scoring system is working, and the transplant was successful." Among the five subcriteria, aesthetic deformity and exposed tissue proved to be statistically significant. Mean scores dropped from 9.33 and 7.77 to 1.13 and 0, respectively. Dr. Gordon said the other three criteria that proved to not be statistically significant are likely due to the small number of patients included in the study.

The dearth of long-term outcomes data signals a need for surgeons to rethink their role in patient care for this patient population. "Surgeons are taught to talk about what the problem was and how we fixed it," Dr. Gordon explained. "But we're not taught to look at the functional effects, the psychosocial benefits. I know it sounds clichι, but we need to look at the whole person. As reconstructive surgeons, we need to evaluate more critically the psychosocial and functional benefits of face transplantation, in addition to the obvious reconstructive benefits," he said.

Considering outcomes beyond clinical measures could mean that surgical societies, medical care centers, and donor registries have to make a deliberate, joint effort to track facial transplant patients, Dr. Gordon said. "Then, when there are doubts about taking these extra steps, we can show there are huge benefits to following these patients long after their operations are completed," he concluded.

Other participants in the study included Karan Chopra MD; Seenu M. Susarla, MD, DMD, MPH; and Danielle Goodrich, BS.


Story Source:

The above story is based on materials provided by American College of Surgeons. Note: Materials may be edited for content and length.


Cite This Page:

American College of Surgeons. "Surgeons develop framework to assess long-term impact of facial transplant operations." ScienceDaily. ScienceDaily, 1 October 2012. <www.sciencedaily.com/releases/2012/10/121001141435.htm>.
American College of Surgeons. (2012, October 1). Surgeons develop framework to assess long-term impact of facial transplant operations. ScienceDaily. Retrieved October 24, 2014 from www.sciencedaily.com/releases/2012/10/121001141435.htm
American College of Surgeons. "Surgeons develop framework to assess long-term impact of facial transplant operations." ScienceDaily. www.sciencedaily.com/releases/2012/10/121001141435.htm (accessed October 24, 2014).

Share This



More Health & Medicine News

Friday, October 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

IKEA Desk Converts From Standing to Sitting With One Button

IKEA Desk Converts From Standing to Sitting With One Button

Buzz60 (Oct. 24, 2014) — IKEA is out with a new convertible desk that can convert from a sitting desk to a standing one with just the push of a button. Jen Markham explains. Video provided by Buzz60
Powered by NewsLook.com
Ebola Protective Suits Being Made in China

Ebola Protective Suits Being Made in China

AFP (Oct. 24, 2014) — A factory in China is busy making Ebola protective suits for healthcare workers and others fighting the spread of the virus. Duration: 00:38 Video provided by AFP
Powered by NewsLook.com
WHO: Millions of Ebola Vaccine Doses by 2015

WHO: Millions of Ebola Vaccine Doses by 2015

AP (Oct. 24, 2014) — The World Health Organization said on Friday that millions of doses of two experimental Ebola vaccines could be ready for use in 2015 and five more experimental vaccines would start being tested in March. (Oct. 24) Video provided by AP
Powered by NewsLook.com
Doctor in NYC Quarantined With Ebola

Doctor in NYC Quarantined With Ebola

AP (Oct. 24, 2014) — An emergency room doctor who recently returned to the city after treating Ebola patients in West Africa has tested positive for the virus. He's quarantined in a hospital. (Oct. 24) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins