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Authors: M.D. Kevin Fong
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skin grafts taken from donors related to the recipient survived longer than those taken from unrelated individuals. Precisely why this should be the case was unknown, but it gave cause for thought. Archie McIndoe himself had observed that grafts could be exchanged between identical twins without fear of rejection. Today donor and recipient are matched as closely as possible with respect to specific marker proteins expressed by their cells. The closer your genetic code, the more likely these proteins are to match. These proteins are like flags on the mast of a ship at war, announcing its sovereignty and distinguishing it from the naval vessels of a hostile foreign power. For the cells of the human body, exhibiting the wrong surface-marker proteins is akin to flying hostile flags and provokes attack.
Matching surface proteins as closely as possible provides a degree of protection, but ultimately it only delays the onset of rejection. To ensure graft survival, the recipientâs immune system must be suppressed, risking overwhelming and potentially fatal infection. PomahaÄâs many appeals to the IRB at Brigham and Womenâs Hospital had opened the door, but each case would still have to be decided on its individual merits. PomahaÄ began a search that would lead him to Dallas Wiens.
PomahaÄ first heard of Dallas at a meeting of the American Society of Plastic Surgeons in 2009. The surgeon was due to present case reports of successes that he had had with partial face transplants. But speaking before him was Dr. Jeff Janis, a surgeon from Texas, who told the story of a man who had suffered the nearly total destruction of his face by high-voltage electric current. Dallas Wiens had been helping to paint a church in his hometown. He had climbed into a cherry picker in order to reach the roof. What happened next remains unclear. As the basket containing Dallas rose from the ground, he appears to have gotten close enough to a high-voltage power line for it to discharge through his body for many seconds, nearly long enough to kill Dallas and more than long enough to burn and almost completely destroy his face.
Dallas was resuscitated in the emergency room of the Parkland Memorial Hospital in Dallas, Texas. The scenes would have been distressing even for seasoned health-care professionals. Electrical burns are caused by the heating effect of the current as it passes through tissues. The resultant burns run deep, and electrical involvement of the heart can lead to immediate cardiac arrest. The power line had discharged through his head, heating and then burning the full thickness of skin over his entire face. The charge running through his body cauterized his face, reducing it to a coagulated mass.
Dallas was close to death when he arrived at Parkland. The resuscitating surgeons wondered how hard a fight for life they should mount. Seeing how completely his appearance had been destroyed, they initially wondered if anyone would want to survive in such a disfigured form.
A face fulfills a role that goes well beyond appearance. Its orifices form the conduits through which air is conducted into our lungs and through which food begins its journey down into our digestive tract. It is the sole seat of three of our five senses: sight, smell, and taste. From what the resuscitating team could see, much of that had been utterly obliterated. Even if Dallas could be resuscitated, what quality of life could this man possibly hope for?
Nevertheless, they continued, and later Jeff Janisâs plastic-surgery team would cover Dallasâs head by raising large, free flaps of tissue from his back and moving them up onto his face. But Janis was open about the fact that this effort was a lifesaving measure whose goal was to cover and manage the wound left by the electrical burn. Even after this work had fully healed, it was clear that Dallas would need a more radical solution if any meaningful reconstruction were to be realized.
In
Matching surface proteins as closely as possible provides a degree of protection, but ultimately it only delays the onset of rejection. To ensure graft survival, the recipientâs immune system must be suppressed, risking overwhelming and potentially fatal infection. PomahaÄâs many appeals to the IRB at Brigham and Womenâs Hospital had opened the door, but each case would still have to be decided on its individual merits. PomahaÄ began a search that would lead him to Dallas Wiens.
PomahaÄ first heard of Dallas at a meeting of the American Society of Plastic Surgeons in 2009. The surgeon was due to present case reports of successes that he had had with partial face transplants. But speaking before him was Dr. Jeff Janis, a surgeon from Texas, who told the story of a man who had suffered the nearly total destruction of his face by high-voltage electric current. Dallas Wiens had been helping to paint a church in his hometown. He had climbed into a cherry picker in order to reach the roof. What happened next remains unclear. As the basket containing Dallas rose from the ground, he appears to have gotten close enough to a high-voltage power line for it to discharge through his body for many seconds, nearly long enough to kill Dallas and more than long enough to burn and almost completely destroy his face.
Dallas was resuscitated in the emergency room of the Parkland Memorial Hospital in Dallas, Texas. The scenes would have been distressing even for seasoned health-care professionals. Electrical burns are caused by the heating effect of the current as it passes through tissues. The resultant burns run deep, and electrical involvement of the heart can lead to immediate cardiac arrest. The power line had discharged through his head, heating and then burning the full thickness of skin over his entire face. The charge running through his body cauterized his face, reducing it to a coagulated mass.
Dallas was close to death when he arrived at Parkland. The resuscitating surgeons wondered how hard a fight for life they should mount. Seeing how completely his appearance had been destroyed, they initially wondered if anyone would want to survive in such a disfigured form.
A face fulfills a role that goes well beyond appearance. Its orifices form the conduits through which air is conducted into our lungs and through which food begins its journey down into our digestive tract. It is the sole seat of three of our five senses: sight, smell, and taste. From what the resuscitating team could see, much of that had been utterly obliterated. Even if Dallas could be resuscitated, what quality of life could this man possibly hope for?
Nevertheless, they continued, and later Jeff Janisâs plastic-surgery team would cover Dallasâs head by raising large, free flaps of tissue from his back and moving them up onto his face. But Janis was open about the fact that this effort was a lifesaving measure whose goal was to cover and manage the wound left by the electrical burn. Even after this work had fully healed, it was clear that Dallas would need a more radical solution if any meaningful reconstruction were to be realized.
In
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