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The Long-Term Impact of Face Transplants

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Reported by Tiffany Chao, M.D.

It may be time to take a second look at face transplants.

While 19 people worldwide have undergone successful face transplants, their long-term followup may be under-reported, according to reconstructive surgeons. Their results, presented at the 2012 American College of Surgeons Annual Clinical Congress, evaluate the use of a scoring system called the "FACES score," which helps to assess a patient's ability to resume normal living.

The FACES score was originally developed by Dr. Chad Gordon, who was a plastic surgery fellow on the 2008 Cleveland Clinic surgical team that had performed the nation's first facial transplant on a woman. This score is a five-pronged assessment to predict successful outcomes.

However, Gordon and colleagues found that out of the world's 19 face transplants, only eight patients had postoperative evaluations after their operation that detailed their return to society.

"Plastic surgeons are trained to report form and function, but not necessarily how well patients function in everyday life," said Gordon, now the clinical director of Johns Hopkins' facial transplant program. "Face transplant is a marriage between transplant surgery and reconstructive surgery, so we have to think more like transplant surgeons."

FACES scores evaluate a patient's preoperative functional status, severity of injury, depth of the wound, additional medical problems, and surgical history. The higher the preoperative score, the more a patient would need and benefit from a face transplant. The postoperative score is used to demonstrate how much the transplants improved their lives and functioning.

Gordon argues that surgeons should fully utilize FACES data to look at the patients overall functioning before and after transplants.

"Facial transplantation can make a dramatic impact in the lives if many traumatized civilians and wounded warriors," said Gordon. "But until we can demonstrate its powerful benefits, it is not as widely accepted as it could be."

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