Surgeons preparing for UK’s first face and hand transplant

British surgeons are preparing to carry out the UK’s first face and hand transplant.

A team at the Royal Free Hospital in north London is assessing patients for the procedure, which has only been performed once before in France.

Peter Butler, director of surgery and trauma at the Royal Free, has been researching face, and face and hand transplants for much of his career.

In 2006, he received the go-ahead for the UK’s first full face transplant and is now waiting for a suitable donor match.

Several patients are also being assessed for a combined hand and face transplant, and are undergoing rigorous psychological testing.

It comes as surgical experts at the National Institute for Health and Clinical Excellence (Nice) said yesterday there needs to be “more evidence” on the possible risks and benefits of hand transplant surgery.

In new guidance, it said health professionals should explain the uncertainties and possible risks to all patients considering the operation before they give their consent.

Nice had been asked by British surgeons to look at issues surrounding the operation but the organisation has no power to prevent it from happening.

Prof. Butler’s team is working with surgeons in Birmingham, Austria and Pittsburgh in the US to share information on proceeding with the transplant.

The surgeon, who is head of the UK Facial Transplantation Res-earch Team, said face and hand transplants had long been part of his team’s research programme.

“We have a number of patients that we have seen with combined face and hand injuries and a number are potentially going to be done.

“Some 60 hand transplants have been carried out worldwide but more work is needed to ensure the patients are suitable.”

Prof Butler said people frequently put their hands up to their face to protect them, meaning they can end up with combined face and hand injuries.

The patients currently being assessed include burns victims, those who have been in a blast and people who have suffered serious infections.

Prof. Butler said the team had been offered “donors or potential donors but no match as yet for our patients” for those needing a face transplant.

“A combined hand and face transplant adds some complexity to the surgery but has benefits for the patient in that it gives them extra functionality.

“It’s not immunologically different or psychologically different (to carrying out a face transplant only).

“Every patient going through the process has unique matching requirements so if a patient with a face and hand requirement matched the donor, then that patient would be done.”

But he said it was “very difficult to put a timescale on when this will happen”.

Worldwide, there have been fewer than 10 double hand transplants. Some 11 face transplants have been performed, of which one was a combined hand and face operation.

That recipient, a French national, died from a heart attack caused by a heart problem two months after the surgery.

Experts had been trying to tackle an infection that had set in weeks after the transplant.

A statement from Nice’s specialist committee on surgical procedures said it had been asked to look into how safe the operation is and how well it works.

“However, its specialist committee found that there is currently not enough evidence to allow it to draw firm conclusions.”

In its guidance, Nice said patients must be made aware of the possible risks, including limb rejection, blood clots and infection.

They will also need a lifetime of immunosuppressants to stop the new organ being rejected.

The guidance also calls for specialist surgical teams to get appropriate permission from their hospital and review how patients do to ensure more can be learnt about the procedure.

Bruce Campbell, chair of the committee which developed the guidance for Nice, said: “Hand allotransplantation may offer carefully selected patients a hand which looks more natural than a mechanical prosthesis and which restores some sensation and movement.

“People who agree to the procedure must be prepared for prolonged rehabilitation and the need to take medication for the rest of their lives.

“Nice recognises that the procedure should only be carried out in experienced units and that considerable teamwork is required in order to achieve worthwhile results.

“We would welcome the opportunity to review this guidance once further research has been published.”

A hand transplant operation can last eight to 10 hours and involves removing the donor limb below the elbow joint.

The human hand has 27 bones, 28 muscles, three major nerves, two major arteries, multiple tendons, veins and soft tissue.

The surgery involves fixing bones and attaching arteries, veins, tendons and nerves.