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The Warsaw Voice » Society » January 30, 2014
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Pioneering Face Transplant: How We Did It
January 30, 2014   
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Prof. Adam Maciejewski talks to Witold Żygulski about the pioneering face transplant operation he and his surgical team carried out.

What does it take for an operation to be classed as pioneering surgery?
The determining factor is the innovative aspect of the procedure, chiefly in terms of a new technique applied in specific circumstances. It seems that in the case of the two face transplants performed by my team it is possible to say there was such an innovative aspect, in terms of both individual techniques and the procedure as a whole. I think another important factor is the end result.

Why did you decide to perform the operation in the first place? Was it only because the patient needed it, or were there also other factors at work, such as a desire to take science and medicine to a new level?
No, I wasn’t thinking about that, nor were any of my colleagues. We were simply asked for help after a failed procedure outside our institute involving the patient. Our team specializes in facial transplants, even though up to that point we mainly performed less extensive procedures. The most important factor was the need to save the patient’s life.

How long did it take to prepare for the operation?
The operation took place just over two weeks after the patient suffered an accident. The 33-year-old man was in a state where his life was directly in danger—any infection would have meant death. We decided that a transplant would be the only way of saving the patient’s life. For the next two weeks or so we went about looking for a suitable donor with a matching face structure. The donor’s height, skin tone, blood and tissue characteristics and of course sex were important in order to minimize the risk of postoperative graft rejection.

Which part of the operation was the most difficult and posed the biggest challenge for the surgeons?
I think the logistics were the hardest part, the need to ensure the right timing of all the details, all the preparations and the surgery itself. These included the transport of the donor and the recipient, the right division of the team, the allocation of responsibilities among individual people, securing a supply of blood and preparing the immediate postoperative phase.

Can you tell us a bit more about the 25-hour operation?
The donor and the recipient were placed on two parallel operating tables. One of the teams prepared the recipient’s face for the transplant by removing necrotic tissue, exposing the right blood vessels, nerves, facial skeleton structures, bones and so on. The other team collected a specific graft from the donor, comprising the skin, subcutaneous tissue, muscles, bone structures, mucous membrane structures, of course with the appropriate vessels and nerves. The next stage of the operation involved the transfer of the facial structure to where the recipient’s own structure was missing and joining together the vessels, nerves, bone components, mucosal and muscle components, and finally the skin under a microscope.

I must say that technically the operation wasn’t particularly exceptional in the practice of our clinic. In our everyday work, we perform more complex—though, of course, less spectacular in terms of media attention and public reception—reconstructive microsurgery procedures. We have performed several thousand such operations. They have had varying degrees of complexity. I think the operation we are talking about would not be ranked among the most difficult.

A standout feature of a pioneering operation is that it can be repeated in the future and consequently become a standard medical procedure, as in the case of heart transplants, for example. Will this be the case with the operation your team carried out?
The branch of reconstructive surgery we undertook is developing very rapidly, as evidenced by the number of procedures. We are following the obvious route. As a clinic and team we are fully prepared for further operations. Today I do not see any medical limitations. The only barrier to the development of our field is finances.

Has your clinic attracted the attention of foreign specialists interested in learning about your surgery methods?
Yes, we have met with a great deal of interest from the global medical community, especially those centers that have a track record of performing such transplants. We constantly keep in touch with our foreign colleagues. As we talk I’m preparing for a trip to the United States together with a group of experts to attend a conference of the American Society of Reconstructive Surgery, where we will probably all meet up. I see a great deal of interest and, most important, a lot of people wish us well.

Polish Op Voted World’s Best
The face transplant carried out in Poland by a team led by Prof. Adam Maciejewski has been voted the world’s best piece of reconstructive surgery in 2013 by specialists from 16 countries.

The Polish surgeons received over 60 percent of the vote during an annual meeting of the American Society for Reconstructive Microsurgery in Hawaii Jan. 16.

Maciejewski, who is the only Polish member of the organization, said he was pleasantly surprised by the honor and the global medical community’s response to the operation. “Our success has been described as a success of Polish medicine,” Maciejewski said.

The American Society for Reconstructive Microsurgery brings together over 500 top specialists in the field from around the world. Every year, members list an average of 200-300 operations for evaluation by other doctors. The winner is chosen in an online vote during an annual meeting.

The Polish surgeons conducted the transplant to save the life of a man who had lost most of his face in a gruesome accident.
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