Face Transplant Patient Can Smell, Taste, Breathe Normally

Nearly a year after groundbreaking surgery, gunshot victim continues to show improvement 

Connie Culp, the Ohio woman who underwent the first facial transplant in the United States can now smell, taste what she eats and breathe through her nose, according to a report from her surgeons.

Nearly a year after the surgery, blood vessels from the transplanted tissue have integrated with existing tissue, she has had no significant complications and her sensory and motor abilities, including the ability to speak, continue to improve, according to the surgeons update report in a facial and reconstructive surgery journal this month.

The researchers and doctors are excited about the prospects of new frontiers both for transplanting more of the face and for offering it to individuals with previous reconstructive failures.

Culp, a mother and grandmother from Unionport, Ohio, was shot by her husband in a failed murder-suicide attempt in 2004. The shotgun blast destroyed the middle part of her face, including her nose and nasal passage, upper jaw and cheeks, and she lost her sight.

Though there were three face transplants performed worldwide before Culp's -- and a total of about seven to date -- Culp's "near-total" face transplant was among the most extensive ever performed. The surgery replaced much of the soft tissue of her face, the bony structure of the palate (roof of the mouth) and her upper jaw.

What made the surgery even more challenging was the fact that Culp had previously endured 23 failed attempts at reconstructive surgery.  Hers was considered a "salvage operation," as the earlier operations caused extensive scarring and destroyed blood vessels, further complicating an already difficult task.

On Dec. 9, 2008 eight surgeons from the Cleveland Clinic replaced 80 percent of Culp's face and jaw during a 22-hour operation. The donor was a woman who had been pronounced brain dead and was a match for Culp's age, race and skin complexion. The new face included the nose, upper lip, lower eyelids, upper jaw, incisor teeth, palate and various glands, as well as bones and ligaments. Culp, then 46, was given immunosuppressant drugs to prevent rejection.

The big question before the operation was whether the donor tissue could graft succesfully and accept blood supply from the facial arteries.  They were encouraged during the surgery when they saw bleeding coming from the donor tissue; this indicated that Culp's existing facial arteries would suffice.

Obviously surgeons are excited by the success of the surgery, however are cautious about future applications of such a procedure as ethics guidelines have yet to be developed for the procedure. 

Meanwhile, Culp will likely have another surgery later this year to remove extra glandular tissue around her lower jaw. If surgeons get their wish, the final outcome will look remarkably like a normal face.

In a year that has been rather tumultuous in the US, and seemingly moreso in Ohio, it's nice to report on something that is looking positive.