Hand and face transplants becoming more common says surgeon

Hand and face transplants becoming more common says Kiwi surgeon

Boston-based New Zealand reconstructive plastic surgeon Simon Talbot says hand and face transplants are now becoming more common and most patients do very well.

Dr Talbot, Director of Brigham and Women’s Hospital’s Upper Extremity Transplant Program and Assistant Professor of Surgery at Harvard Medical School, is back in New Zealand to speak at the New Zealand Association of Plastic Surgeons’ Annual Scientific Meeting.

He has been involved in a number of double hand transplants and seven face transplants and says they make an extraordinary difference to recipients.

“Many people who lose a limb experience challenging psychological issues. If you can’t reach your face, it’s very hard to feed yourself or take care of personal hygiene. Our hands also play a very important role in our emotional expression and interaction with others.

“It makes such a difference to recipients to be able to use their hands and eat independently or walk around with a face that doesn’t attract a lot of attention.”

Dr Talbot says it wasn’t just members of the public who were uncomfortable about hand and face transplants in the beginning.

“We surgeons had a level of discomfort as well because we were transplanting something that was highly visible, very personal and recognisable. “But that’s changed as we’ve seen how these transplants really improve the lives of recipients.

“It’s also made families far more comfortable with the idea of donating their loved ones’ hands and faces. They can see this isn’t a Frankenstein-type experiment, it’s real life.”

He says immunosuppressant drugs used in transplants are now far less toxic. Patients only need to take them once a day and can be on them for long periods without complications.

“There are many downsides to immunosuppressants, so we work hard to make sure patients have enough to stop rejection but not so much to cause negative side effects, such as impaired kidneys, diabetes and bone loss.

“Less immunosuppression also means a more successful transplant, so we’re doing a lot of work on how to modify the immune system so we need less of them, including mixing the recipient’s and donor’s immune systems and using markers in the blood.”

Another area of Dr Talbot’s research is nerve regeneration – getting nerves to grow faster and the junctions between nerves and muscles to last longer. “These junctions fade away in time so you want that nerve to reach a muscle that is still fresh and able to work.”

He says while 85 percent of his transplant patients have experienced rejection within a year, all have been resolved by boosting immunosuppressive treatment. “Rejection doesn’t mean failure of the transplant. Loss of the transplanted limb is very unusual and is almost exclusively due to the patient not complying with medication and other therapy.”

While the operating team spends months meticulously planning every transplant, Dr Talbot says the psychosocial aspects of the surgery are more important than anything he does in the operating theatre.

“We spend a lot of time predicting the likely outcome of a patient’s transplant to ensure we manage issues like poor family support to maximise transplant success.”

Dr Talbot trained at the Auckland School of Medicine and began residency in New Zealand before moving to Boston to complete his training in plastic and reconstructive surgery fourteen years ago.

He became interested in hand surgery because it combines working with bones, microvascular surgery, nerves and soft tissue with the hand’s functional and cosmetic elements. “Extremity transplantation is also a very academic area of surgery because you have to understand anatomy and surgery as well as rejection and pathology, and combine this with the psychosocial aspects.”

“It’s all about teamwork and absolute trust. Even with a lot of people in the operating theatre, you can only fit two or three people around the patient at one time. We tag team it so that we can all do what we’re best at while we’re fresh and make the most of the operating time.”

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