A Face Transplant First, A Milestone in Care Equity

Robert Chelsea Pomahac
Photo credit: Lightchaser Photography / J. Kiely Jr.

At Mass General Brigham, we support health equity and innovation. 布里格姆妇女医院最近的一项手术扩大了我们在促进和为不同人群进行面部移植方面的全球领导地位.

When plastic surgeon Bohdan Pomahac of Brigham and Women’s Hospital first met Robert Chelsea, 他看到的是严重的面部损伤,影响了他的生活质量.

“A patient is a patient. 我从来都不关心他们的背景。. 布里格姆健康中心韦纳外科特聘主席和整形外科移植主任. “我觉得无论谁来找我,我都会以同样的方式对待他们.”

Chelsea, a 68-year-old Los Angeles resident, 2013年,他的车被一名酒后驾车的司机撞到,他的身体和脸部有60%以上的烧伤. 他昏迷了六个月,住院一年半, undergoing more than 30 surgeries. 加州的整形外科医生无法重建他的嘴唇、部分鼻子和左耳.

In 2019, as a result of a 16-hour operation at Brigham and Women’s Hospital, involving a team of 45 surgeons, nurses, anesthesiologists, residents, and research fellows, 切尔西成为第一个接受完整面部移植手术的非裔美国人. (A Black patient in Paris received a partial face transplant in 2007.)

这是布里格姆医院第九次成功的面部移植手术,也是全国第十五次. Chelsea is among approximately 100 people referred to the Brigham program, which performed its first successful facial transplant in 2009. About half were self-referred, 在经过包括手术在内的广泛筛选后,只有大约15人被认为是可行的候选人, medical, social, economic, and other evaluations.

[Call out text] 16-hour operation involving a team of 45 surgeons, nurses, anesthesiologists, residents and research fellows, 他成为第一个接受完整面部移植的非裔美国人.

我们从不排斥任何人,这与肤色、种族、语言等有关.

Bohdan Pomahac, MD
Director of Plastic Surgery Transplantation
Brigham and Women's Hospital
Robert Chelsea Pomahac
Photo credit: Lightchaser Photography / J. Kiely Jr.

“我们从不排斥任何人,这与肤色、种族、语言等有关,” said Pomahac, a soft-spoken Czech Republic native known simply as Bo, who has been at the Brigham since 1996.

一名队员对切尔西的社会支持提出了一些初步的担忧, 谁和他的妹妹住在一起,有一个成年的女儿独自生活.

“他从自己的教会网络中动员了相当广泛和大量的朋友,” says Pomahac. “He literally had a letter from, I think, 25, 30 people that just said, ‘We are here to support him; we’re here to help him. We’re going to make it work for him.’"

[提示文本:2015年,等待器官移植的黑人患者中只有17%获得了器官移植,而白人患者的这一比例为30%.

“It was amazing to see that he had an entire community behind him. 我想这是我们在其他病人身上从未见过的.”

然而,在2018年3月切尔西被列入移植名单后,一个问题出现了. 最初的治疗计划是局部移植,这样会花更少的时间,也不会造成潜在的并发症.

“我们项目的理念一直是:让我们不要破坏任何正在发挥作用的东西,” Pomahac says. “Let’s just implement or integrate what’s missing.”

But Chelsea’s face resembled a mosaic, 刚愈合的伤口基本上没有色素,早期手术的地方有棕色的雀斑. A full facial transplant seemed a more aesthetic alternative. 当研究小组得知可能的捐赠者——肤色较浅的人——的消息时,审美问题得到了解决. Chelsea opted to wait.

“我们没有意识到的是,非裔美国人肤色的差异如此之大. 他会得到这个功能,但他不会真正看起来像他自己,”波马哈克说. “事实上,罗伯特拒绝了这个提议,在我看来是个好迹象,因为他并不只是急于完成某件事, but he really was thoughtful about it.去年7月,新泽西州的一位捐赠者给了他一个合适的机会. 切尔西搭乘了从加州飞来的第一架飞机,与此同时,该团队与LifeNet Health合作,迅速将捐赠者的脸送往波士顿.

虽然现在评价切尔西手术的最终成功还为时尚早, 面部移植患者的随访研究数据提供了一些指导. A recently published correspondence in the New England Journal of Medicine 发现第一批布里格姆面部移植患者的面部运动和感觉功能强劲恢复, in addition to functionality, 这让他们能够以一种在移植之前不可能的方式重新融入社会.

这些数据表明,切尔西很可能在一年内达到接近正常的感觉和大约60%的面部运动功能恢复, including the ability to eat, smile, and speak normally.

面部移植手术的成功使这一选择成为可能的手术之一, 尽管它仍然与更传统的器官捐赠分开管理.

A more significant challenge is the cost, 到目前为止,哪些已经获得了资助,但在获得保险报销方面进展缓慢.

Pomahac trained as a surgeon and stays away from non-medical discussions. 但是他承认,非洲裔美国人历来普遍不信任太阳成系统. 这种不信任影响了非裔美国人不去美国注册器官捐献者.S. 在2015年等待器官移植的黑人患者中,只有17%的人接受了器官移植,而白人患者的比例为30%.

“Absolutely, I think we should really ask the hard questions,” he says. “Why are we not seeing more African American patients? Why are they disproportionately less common donors? 所有这些问题都是非常相关的,可能可以追溯到历史上.

“Coming from a Central European country, it never was anything that I would experience or be exposed to. 但有些东西是来自于过去的我们必须一点一点地打破它.”

Teaser Content

这个鼓舞人心的手术让人们意识到黑人社区的障碍.

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