Tuesday, April 10, 2012

The Acid Behind The Scarred Face

A life as full of agonizing pain and gratuitous cruelty as that of Pakistani acid-burn victim Fakhra Younas must be honored and brought to bear upon the souls of nations in many ways. Karachi filmmaker Sharmeen Obaid-Chinoy had begun to do just that, winning Pakistan’s first Academy Award for “Saving Face”, a documentary that followed harrowing acid-attack stories like Ms Younas'. So does Declan Walsh, in a recent New York Times story announcing her suicide, on March 17, 2012.

Here, I want to make a space to understand just that facial disfigurement is a uniquely devastating wound. Not just an irretrievable loss of a multiple-function system, facial disfigurement is profoundly jarring to a fundamental sense of self—which may explain why acid attack is a weapon of choice for some vindictive South Asian men.

Born of a heroin addicted mother into a brutally difficult life, Fakhra Younas had become a dancing girl as a teenager. A photograph of Ms. Younas taken before the crime displays a tough cookie, ebulliently self-aware, self-reliant, even ambitious. After the crime, frighteningly disfigured, she fled her home and her husband, taking her young son with her to Italy, where she was protected under political asylum. She learned to speak Italian, and submitted herself thirty-eight times to facial surgery, paid for by a Milan cosmetics company, just to be able to open one eye and close her lips. Plastic surgeon Dr. Valerio Cervelli found her “so headstrong, so independent.” She knew how to leverage the notoriety of her plight, and spared no energy doing it. She wrote a memoir, “Il Volto Cancellato (The Erased Face)”, published in Italian, French and German, which sold well enough to support herself and her son, now a high school student in Rome. “She ventured outside fearlessly,” writes Walsh, “armed only with a bawdy sense of humor ingrained on the streets of Karachi,” sometimes, for example, brandishing her false ear at the soccer stadium as crowd control. Then the faces of acid-attack victims like herself appeared on the silver screen, winning accolades and a sense of Pakistani national pride, despite the documentary's damning subject matter, for the homeland to which she could never return.

And in the astringent limelight have awakened the stirrings of a national conscience, of political movement, however timorous, toward justice for women. And once-unimaginable miracles of craniofacial innovation have begun to make daily headlines around the world...

But Ms Younas herself, say her son and her closest friends, had never overcome her sense of isolation, and a deep-rooted depression, and an unassuageable sorrow for her lost self. Finally, last month, perhaps in search of that self, Fakhra Younas stepped off a sixth-floor balcony in Rome, and died.

Friday, April 06, 2012

More Miraculous Face Transplants. STAT.

Richard Norris, before and after
Thirty-seven-year-old Richard Lee Norris had lived fifteen years as a recluse, a masked man to all but his closest relatives. His face was a gnarled mass of scarred flesh and useless features, after a close range shooting accident in 1997. Luckily—or not—Norris was not blinded in the accident that blew his face off. He has been able to see clearly the life that was passing him by—and the expressions of horror in the faces of others. And then, one day last month, Norris was able to look in a mirror and see a handsome man looking back.

In a 36-hour operation at the University of Maryland Medical Center in Baltimore, Norris received the “most extensive face transplant ever carried out”, including not only a continuous facial tissue from scalp to clavicle, but also a tongue, both upper and lower jaws, and all their perfectly matched teeth. Faculty surgeon Eduardo Rodriguez, M.D., D.D.S.,
 Dr. Eduardo Rodriguez with transplant team at UMMC
led a team of more than 100 physicians, nurses and professional staff, whose expertise included not only dental and facial reconstruction, but also shock and trauma, for the first time in a face transplant. UMMC houses the R. Adams Cowley Shock Trauma Center, where the critical care concept of the golden hour was coined, and which has long experience in treating just such “high-velocity ballistic facial injuries”. And UMMC’s renowned Division of Transplantation has focused on the anatomic and immunologic challenges to craniofacial transplantation. Research there has found that high amounts of vascularized bone marrow (VBM) may significantly reduce the risk of tissue rejection, reducing the amount of dangerous immunosuppression required over the lifetime of the recipient. The mandible that Norris received is rich in VBM, and expectations, though guarded, are high.

Like the only other full-face transplant in the US, performed by Dr. Bohdan Pomahac and his team at Brigham and Women's Hospital in Boston, Norris’ FFT was paid for by grant funding from the Office of Naval Research (ONR) in the United States Department of Defense. The ONR funds medical research to support military operational medicine and clinical care of returning veterans. In addition to conducting research, the University of Maryland Medical Center trains military medical staff prior to deployment and performs organ transplant surgeries for patients at Walter Reed/Bethesda National Naval Medical Center. At this moment the Department of Defense estimates that as many as 200 wounded soldiers are eligible for an operation like Norris’.

Two hundred. Ready right now. Since 2005, when the first partial face transplant stunned the world, this once unimaginable miracle has already been repeated twenty-three times.

Only twenty three.