Hospital leads the way in pioneering facial transplant method(2)

To date more than 10 burn victims have been given new faces using this technique. Xie said more burn victims are learning about the skin flap technique and approaching the hospital for the treatment. It takes about a year for treatment to be completed but the hospital has limited resources.

"The surgery involved in this is very time-consuming and physically exhausting. We began surgery on the last patient we had in the afternoon and didn't finish the operation until 20 hours later, the following morning," Xie said.

There is now a queue of facially deformed people wanting this surgery and it has a high success rate.

Range of techniques

Historically patients with severe facial burns have had a limited range of techniques to try. Skin grafting has been known for hundreds of years (Sushrutha, an Indian doctor in the fifth century AD, carried out many skin grafts and is often hailed as the father of skin grafting). But the success rate was never high.

Another technique, allogeneic facial transplants - where the skin is not genetically identical to the recipient's skin - has not been successful in China. "Allogeneic facial transplants have a lot of problems including ethical issues, a shortage of donors, immunological or psychological rejection, infection and a high cost. Allogeneic facial transplants have not been very successful in China," Liu told the Global Times.

About seven or eight years ago, the Department of Plastic and Reconstructive Surgery at the Shanghai Ninth People's Hospital began to research other techniques to help patients suffering serious facial burns and began working on a method to create a "new" face using skin from the patients themselves. Li Qingfeng pointed out that the tissues used to create a new face should have similar color, texture, dimension and depth as the skin on a patient's face.

Eventually the technique was perfected at the hospital. "The face is a huge piece of skin. We can't take one piece of skin the same size from any part of the body without creating a huge wound. Also a face is round. To create a circular shape that could be transplanted to a face we needed to do something else. Thus we began to use the dilating instrument," Xie said.

The dilating instrument is like a ball and is inserted under the patient's skin, letting the skin grow as it would if it was on the head. In the major operation surgeons take the newly grown skin from the dilator and place it on the face. For women undergoing this treatment the dilator is placed in the side of the waist.

The technique is now considered proven and effective and the hospital is promoting this but not all institutions can replicate this. There is a fear that smaller medical centers could try to adopt this method without the skills or resources needed.

Another problem is the one Kang Xinwang faces. Looking the way he does he cannot get a job and earn money. But the cost of the operations will be between 100,000 yuan ($16,342) and 200,000 yuan. Kang's uncle has raised about 20,000 yuan and although the hospital has agreed to waive some of the cost there is still a lot owing.

Kang is lucky - the Shanghai German Club and the charity Fire Phoenix have each donated 20,000 yuan for his treatment.

Special charity

Fire Phoenix was established to help burn victims by Yuan Yuwen, a then medical intern working under the supervision of Li Qingfeng, and a businessman who was once treated by Li. Yuan has been working at the Shanghai Ninth People's Hospital and has dealt with many burn victims.

"Most of the patients have been burned in road accidents or industrial accidents. They don't have a lot of money and they have had little assistance in treatment or advice. Some of them have been operated on but this sort of surgery has not helped and often caused more pain," Yuan told the Global Times.

"Facial reconstruction is a huge project. We not only give money to patients, but also keep track of the whole treatment process. When we learned about Kang Xinwang's difficulties, we decided to provide help," Yuan said.

The Fire Phoenix website will be launched at the end of December and will be designed to help burn victims through every phase of the treatment in collaboration with the Shanghai Ninth People's Hospital, rehabilitation doctors, psychiatrists and other charities.