WEDNESDAY, March 17, 2021 (HealthDay News) – Robert Chelsea needed a new face, having lost most of his in a horrific car crash in Los Angeles years ago.
But Chelsea is black, and the process of giving her the very first face transplant ended up posing new challenges for her doctors, according to a new report.
It took four times longer to find Chelsea a suitable donor than for white patients, doctors said, due to the lack of donors and the greater variability in skin tone among black Americans.
“It’s so rare to find a black face [for transplant]”Chelsea said in an interview with the BBC. “We didn’t know how rare this was.”
Additionally, tracking Chelsea’s postoperative progress has been found to be more complex due to her darker complexion, with doctors less able to see the redness that serves as an early warning sign for rejection, the surgeon said in chief, Dr. Bohdan Pomahac, director of plastic surgery transplant. at Brigham and Women’s Hospital in Boston.
“On a white patient, you can see redness as a sign of infection or a sign of rejection. In African American patients, you can’t really tell,” Pomahac said. “The redness is very subtle, if possible to notice.”
In August 2013, Chelsea’s disabled car was struck by a drunk driver on a Los Angeles freeway with such force that the vehicle exploded on impact.
Chelsea suffered burns to more than 60% of her body and face. He lost his lips, part of his nose and part of an ear, and required more than 40 surgeries to regain his health.
Doctors recommended a face transplant to Chelsea and put him on the transplant list.
“Being able to address a person without intimidating them would be a major relief,” Chelsea told the BBC before his operation.
However, finding a suitable donor has not been easy.
Chelsea spent nine months on the list before receiving the first offer from a donor and remained on the list for a total of 17 months before her operation, medics reported on March 18 in the New England Journal of Medicine. The average time to find a donor for a listed white patient is four months.
The lack of donors was a problem. “There is a really remarkably low number of African American donors,” Pomahac said.
An appropriate skin tone assortment
Another problem was finding a good match with the skin tone, which in a black patient can range from almost dark blue-black to light cappuccino, Pomahac said.
“There are so many different color ranges that it would seem extremely disturbing” if a transplant were to be done with a mismatched tone, Pomahac said.
Chelsea turned down two donors before finding one they deemed compatible. Pomahac said there were also other donors who weren’t even presented to Chelsea as an option because they were so incompatible from the start.
The skin tone also shaped the final extent of the surgery. Chelsea really only needed a partial face transplant, but “we finally decided to do it full face because I was concerned the face would look abnormal” with two different skin tones, “Pomahac said.
In July 2019, Chelsea, then 68, became the oldest person and the first black American to receive a face transplant, in a 16-hour surgery involving a team of more than 45 healthcare professionals. health at Brigham and Women’s Hospital.
The world’s first partial face transplant took place in 2005 in France, and the first full face transplant was performed in Spain in 2010. Only about forty such surgeries took place, all in white patients before Chelsea .
The operation was successful, but over the next few days Pomahac and his team encountered another problem while trying to see if Chelsea’s body would accept or reject the transplant.
In white patients, the redness of the skin is such a clear signal of rejection that “we feel like we can monitor rejection in real time, pretty much,” Pomahac said.
Such redness is harder to see in a black patient’s skin, so doctors added regular inspection and biopsies of Chelsea’s mucous membranes – the inside of her cheek, the lining of her lips – as a way to follow up. the rejection.
Urgent need for organ donation
Chelsea’s transplant proved successful, but her ordeal illustrated the need to promote organ donation among blacks and other ethnic groups, experts have said.
“It is vitally important for people of all races and ethnicities to consider organ donation, including the donation of external transplants, such as the face and hands,” said Alexandra Glazier, President and CEO General of New England Donor Services, in a press release. “Unlike internal organs, the donor’s skin tone can be important in finding a match.”
“God bless the donor and his family who have chosen to donate this precious gift and give me a second chance,” Chelsea said after her surgery. “Words cannot describe how I feel. I am overwhelmed with gratitude and feel very blessed to receive such an incredible gift.”
Black patients should hope in Chelsea’s case and contact doctors if they need similar operations, Pomahac said.
“It is important for African Americans and people of all skin tone types to be assured that we are there for them regardless of their background, and we are able to help them,” said Pomahac.
Brigham and Women’s Hospital has more on Robert Chelsea face transplant.
SOURCES: Bohdan Pomahac, MD, director, plastic surgery transplantation, Brigham and Women’s Hospital, Boston; New England Journal of Medicine, March 18, 2021; BBC