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Regaining an essence of humanity

At Brigham and Women’s, Texas man disfigured in accident receives nation’s first full face transplant

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By Kay Lazar
Globe Staff / March 22, 2011

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One of the things Dallas Wiens has missed most is kissing his 3-year-old daughter, Scarlette.

The 25-year-old Texas man suffered horrific burns in a 2008 electrical accident that obliterated his lips and most of his other features, but last week he received the nation’s first full face transplant — a feat performed at Brigham and Women’s Hospital and announced yesterday.

A Brigham team of more than 30 specialists worked for about 15 hours to replace Wiens’s lips, nose, facial skin, the muscles that animate his face, and the nerves that power them and provide sensation.

“Dallas is looking forward to giving his daughter a kiss again,’’ Dr. Bohdan Pomahac, director of the Brigham’s burn unit and the plastic surgeon who led the transplant team, said in an interview after yesterday’s announcement. “It’s such a simple human function that we take for granted.’’

Pomahac said Wiens is doing so well that he has been chatting with his family on the phone, walking around, and has had most of the tubes removed that connected him to machines. Also gone is the incision into his windpipe that helped him breathe after losing his nose in the accident. He now is able to breathe through the transplanted nose. No date has been set for his release from the hospital and return to his home in Fort Worth.

The surgery will be paid for by a Department of Defense grant given to the Brigham to refine the operation and perform the procedure on disfigured soldiers and others. The hospital was unable to provide a cost estimate for Wiens’s surgery.

While his case is the nation’s first full face transplant — the new face extends from his mid-scalp to his neck — it is the 14th full or partial facial transplant in the world. The Cleveland Clinic in 2008 performed the first surgery in the United States, replacing about 80 percent of the face of Connie Culp, who was injured by a shotgun blast. The Brigham team performed the country’s second, completing a partial transplant in 2009.

Wiens was painting the second floor of a church and was burned when a cherry picker he was standing in brushed against a high voltage power line. When Pomahac first met Wiens about a year ago, he said he initially worried that there was not much he could do to help the former day laborer. His wounds were so extensive that there was little left of his face besides the bones.

By then, Wiens had had at least 22 surgeries, according to a June 2009 blog posting by his grandmother, Sue, who said that he had “the burned tissues on his face and head removed down to the bone,’’ and had lost all of his facial features, except for a small portion of his chin. She wrote that his teeth and left eye have been removed, and that he was blind as a result.

Yet Pomahac found there were enough underlying nerves left in his face to make the transplant viable. The surgeon said he was also moved by Wiens’s spirit and determination to persevere. As Wiens’s grandfather, Del Peterson, put it during yesterday’s packed press conference, “Dallas always said after the injury that he now had a choice. He could choose to get bitter or he could choose to get better. His choice was better.’’

It will take months for the nerves in his face to recover, Pomahac said, but Wiens will once again be able to feel the kisses from his daughter because his new lips will likely have near-normal sensation in 75 percent of the circumference and some sensation in the rest.

The Brigham team already has two more patients on a waiting list for a face transplant, including Charla Nash, the Connecticut woman mauled by a chimpanzee in 2009.

In April 2009, a team at the Brigham performed the country’s second face transplant on James Maki, who had fallen on the electrified third rail at the Ruggles subway station and severely burned much of his face, though his injuries were not nearly as severe as Wiens’s.

Maki received a nose, upper lip, part of the mouth, and surrounding facial tissue from his donor, Joseph Helfgot of Brookline. Since then, Helfgot’s widow, Susan Whitman Helfgot, has championed the urgent need for more organ donation. On average, 18 people in this country die every day — more than 6,000 each year — waiting for an organ transplant, according to the United Network for Organ Sharing.

Two years after his surgery, Maki is doing so well that the amount of medications he takes to make sure his body does not reject the face transplant is the lowest level among the 13 other patients worldwide who have had a face transplant, said Dr. Elof Eriksson, chief of the Brigham’s plastic surgery division. The level is akin to that taken by a patient who has had a kidney transplant, he said.

Wiens, too, is taking medicine to prevent rejection, one of the main concerns after a transplant.

The Brigham is not releasing the precise date of Wiens’s transplant surgery or the name of the donor, whose family asked to remain anonymous, but said the match was made based on gender, race, approximate age, and blood type. Consent for donating a face requires more than signing the back of a driver’s license. The families of patients who match the recipient and have indicated a willingness to donate organs are approached and asked to give specific permission for a face transplant.

Since his operation, Wiens has been eagerly running his hands over his new face, his grandfather said, asking questions about his appearance.

The next step, Peterson said, is dental surgery to provide Wiens with teeth, which he also lost in the accident.

“When I first saw him after the injury I had no idea what would follow,’’ Peterson said. “This is beyond anything I had imagined.’’

Liz Kowalczyk of the Globe staff contributed to this report. Kay Lazar can be reached at klazar@globe.com.

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