Face transplantation is the first in Russia
For the first time, a face transplant was performed in Russia
Yuri Gavrilov, Rossiyskaya Gazeta
The doctors told about a unique operation during which a soldier who received a serious electrical injury underwent partial transplantation of facial tissues from a donor. The trouble with the military happened three years ago. Almost all this time, civilian and army doctors were engaged in reconstructive plastic surgery with him. And when her capabilities were exhausted, the doctors decided on a unique operation. Doctors of the Ministry of Defense, the Ministry of Health of the Russian Federation and the Federal Medical and Biological Agency conducted it in May of this year at the Kirov Military Medical Academy (VMA). In total, the operation lasted more than 18 hours.
This story began in August 2012, when Nikolai E. received a severe electric burn to his head, neck and limbs. After the stabilization of Nikolai's condition, he was evacuated by military transport aircraft to the Military Medical Academy named after S.M. Kirov.
In the conditions of the Department of Thermal Lesions of the VMA, military doctors performed more than 30 reconstructive plastic surgeries on the face, upper and lower extremities, as well as operations to restore vision. Despite the efforts of doctors, the possibilities of reconstructive plastic surgery using auto-tissues to close a large facial defect have been exhausted. Moreover, the stay of Private E. in the hospital was complicated by severe depression caused by doubts about the possibility of continuing further normal life in society with existing facial defects.
The only possible method of treatment was partial face transplantation from a cadaver donor. In Russian medicine, there was no relevant experience in transplanting complex facial tissue complexes. The legal side of transplantation was worked out in detail by specialists of the Ministry of Health of Russia. The face transplant operation was preceded by painstaking work related to legal support, experiments on cadaveric material and immunological studies in hemifacial allotransplantation in animals. To avoid mistakes, doctors created digital and material 3–models of the recipient's face, on which "rehearsals" of the upcoming face transplant operation were repeatedly carried out.
The pretransplantation protocol of the recipient's examination was carried out in accordance with international standards for 36 positions.
The search for a potential transplant was organized by specialists of the Ministry of Health and the FMBA of Russia. A medical team was formed, including specialists from the Kirov Academy and the I.I. Mechnikov Northwestern State Medical University, prepared to take a graft - facial tissues with a fragment of the bones of the forehead, nose and soft tissues.
On May 13, 2015, a suitable donor was prepared in the Kursk region, who died as a result of a severe closed craniocerebral injury. The medical team of the Kirov VMA (5 specialist doctors) together with three specialist doctors of the I.I.Mechnikov Northwestern State Medical University immediately flew to the site.
The Federal Biomedical Agency provided identification and conditioning of a potential donor, immunological examination of a potential donor and recipient, infectious and biological safety of donor tissues, removal, preservation, transportation of seized facial soft tissues, documentation and general coordination of all involved services. To implement this type of assistance, donor hospitals located in 28 regions of the Russian Federation (from Murmansk to Vladivostok) were involved, relying on the established three-level system for coordinating the donation of human organs and tissues by the FMBA of Russia using an electronic system for maintaining potential donor cards.
The graft removal operation lasted more than 12 hours – from 14:00 on May 13 to 3:00 on May 14, 2015 and ended with the preservation of the allograft. A military transport aircraft of the Russian Ministry of Defense was allocated for the prompt delivery of the transplant to the Military Medical Academy (St. Petersburg). All stages of transportation were controlled by duty shifts of the National Defense Control Center of the Russian Federation.
On May 14, 2015, at 6:00 a.m., the medical team arrived at the Military Medical Academy and began conducting the first facial tissue transplant operation in Russia to the recipient. The operation for partial allotransplantation of the face with a composite skin-fascial-bone flap from an immunologically compatible donor was performed at the first Department of Surgery of Advanced Medical Training of the VMA. The operations of the surgical team were led by the head of the Department of Surgery Gennady Khubulava and the head of the Department of Plastic and Reconstructive Surgery of the I.I. Mechnikov NWSMU, Associate Professor of the Department of Military Traumatology and Orthopedics of the S.M.Kirov Military Medical Academy Maria Volokh.
During the operation, which lasted more than 18 hours, doctors ensured full blood supply and viability of the transplant, as well as carried out measures to prevent rejection of the transplanted area of the face. Doctors transplanted a "signal" skin flap from a donor into the recipient's forearm area, which allowed monitoring the engraftment of donor tissues. At the moment, the patient's condition is satisfactory, the transplanted graft is viable, complex medical treatment is being carried out, including immunosuppression with modern drugs.
In December of this year, plastic surgeons will perform a small corrective operation to improve the appearance, after which Nikolai will be transferred to outpatient treatment at the Military Medical Academy named after S.M. Kirov.
If we take the world statistics, it was the 32nd successful operation for the transplantation of human facial tissues. Russia has become the eighth country on the planet where such surgical intervention has been carried out with the help of modern medical technologies.
The head of the VMA, Andrei Belskikh, believes that such operations will soon become normal practice for army doctors. "I hope that these sophisticated high-tech methods of treatment for the Military Medical Academy will become an everyday reality in the future," he told reporters at a press conference at the National Defense Control Center of the Russian Federation on Friday.
The patient himself also made a video call with the Center. He thanked the surgeons for the operation, According to him, two years of experiences were crowned with success, and in the future he plans to go to study. "Thanks to the operation, I can now safely go outside, communicate with other people and feel comfortable," he added.
In the meantime, the Ministry of Defense decided to provide all possible assistance to the victim. "Currently, we are solving the issues of this serviceman with housing. We will help him get a higher professional education, – said the state Secretary of the military department Nikolai Pankov. "We have an understanding of which university this patient will study at." In addition, the Deputy Defense Minister promised that the military department will continue to provide the necessary medical care to the operated.
Dossier "RG"Allotransplantation is an operation to transplant organs and tissues from a donor to a patient. The complexity of such operations is due to the lack of a donor bank, the complexity of selecting, removing, storing and transplanting a transplant, as well as social and legal reasons.The first allotransplantation of a complex complex of facial tissues was performed in France in 2005, when doctors transplanted a chin, nose and lips to a patient who was bitten by a dog.In total, more than 40 similar operations have been performed in the world. But only 32 of them are recognized as successful.Russia, following Spain, Belgium, the USA, France, Poland, China and Turkey, has become the eighth country whose medicine allows such operations to be carried out successfully.
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27.11.2015