In mid-September, experienced plastic surgeons, medical students and members of the public were given a rare opportunity at the Faculty of Medicine to observe one of the most complex transplant procedures. Bohdan Pomahač, a surgeon who has performed ten face transplants and hundreds of other procedures to help people with very serious injuries since 2009, came for a visit lasting several days.
Bohdan Pomahač accepted the invitation of Libor Streit, head of the Clinic of Burns and Reconstructive Surgery at the University Hospital Brno. Streit organises the Brno Flap Dissection Course in cooperation with the Department of Anatomy at the Faculty of Medicine, a meeting of experts focusing on demonstrating various reconstruction techniques.
“It is a fairly prestigious meeting, bringing together people from all over the world. They share their experiences of working with skin flaps – pieces of tissue used in plastic and reconstructive surgery. I came here to demonstrate the harvesting of tissue for facial transplants,” said Professor Pomahač, explaining why he came to Brno.
New faces
The Czech surgeon became renowned for performing a full face transplant, which he and his team carried out in 2011 as the first in the United States and one of the first in the world. This procedure is rarely performed: to date, Pomahač has performed ten such operations, one of which was a re-transplant. “One of our patients lost her transplanted face due to chronic rejection. We were debating whether to try again with a new transplant, but in the end, it was the patient herself who convinced us, as the operation had significantly improved her quality of life. She is now in her fifth year since the retransplantation and is doing well.”
The quality of life that face transplants bring to patients is an important factor. Thanks to the operation, not only do they often regain their human appearance, but they can also breathe through their nose, speak, smell and eat normally again. According to Pomahač, this procedure offers an alternative treatment option for individuals who have lost parts or all of their face.
Such injuries are usually treated by covering them with tissue taken from the patient’s body. The advantage of this method is that the tissue is not rejected. However, the disadvantage is that it is impossible to find tissue on the human body that is similar to facial tissue in terms of softness, texture and skin colour. Often, the result does not look natural. The only way to achieve a convincing human-like appearance this is to transplant facial tissue from another donor.
“However, suitable patients for face transplants are hard to find, as are teams capable of performing them. Many people are reluctant to accept the fact they will need to take immunosuppressants – drugs that suppress the body’s immune response to foreign tissue – for the rest of their lives, and the procedure is also very demanding in terms of time and, of course, money. Until now, these procedures have mainly been funded by grants, but we are now trying to persuade insurance companies to cover them,” noted Pomahač.
Face transplants typically take around 12 hours to complete, and are performed by teams of several dozen people, about eight of whom need to be surgeons. “Of course, others want to be there, too – to watch and practice some tasks,” said Pomahač, explaining why the number of doctors involved in these procedures tends to grow. He added that while most of the procedures involved in face transplantation are common in microsurgery and plastic surgery, the harvesting of donor tissue is special, and he demonstrated this in Brno.
Dexterity and chess-player thinking
Not everyone can perform major transplant surgery. According to Pomahač, an innate talent for the delicate manipulation of instruments and good coordination are a requirement for microsurgery. Having experienced colleagues or mentors at the beginning of one’s career who can provide a sense of security and confidence is also helpful. “While experienced microsurgeons can handle many things, procedures such as face transplants require you to think many steps ahead and anticipate what might happen while operating. Not everyone has this ability, and it can prolong the time needed for the procedure.”
All-day surgeries can also be physically demanding. However, Bohdan Pomahač does not feel ready to retire from surgery yet. “I still enjoy my work. On average, I perform one microsurgery per week, each lasting eight to twelve hours. But I have my routines that help me manage. Most importantly, I still feel I’m getting better with each passing year,” he added with a smile.
Professor Pomahač also delivered a lecture at the Faculty of Medicine in Brno, where he showed students and doctors the details of face transplants, explained how these operations work, and shared some behind-the-scenes information. “We are giving our patients their lives back, and it is an honour to be a part of that,” he concluded.