Face Transplant Takes Leave of Science Fiction

In an emergency room at a Finnish hospital, a man lay unconscious on an operating table as surgeons labored to reattach the hand he had lost hours earlier while chopping wood.

Medical miracles take many forms, but few are as vivid and immediate as this: As the tiny blood vessels were sutured back together, the patient's hand flushed from porcelain to pink. The delicate tendons of the palm revived, and the skin's granite glaze began to soften.

The man's fortunes had taken a remarkable turn. So, too, had those of Dr. Maria Siemionow, a surgical resident assisting in the operation.

"That you could restore to people a part of themselves that had been lost, and actually see it become vital again, was miraculous to me," said Siemionow, a native of Poland who trained in Finland and the United States. "I have never forgotten that day."

Thirty years later, microsurgery is a commonplace marvel, and as director of plastic surgery research at the Cleveland Clinic, Siemionow, 55, is a leading practitioner.

But the career that began in a Helsinki hospital has brought her, and her profession, to an extraordinary place. A team led by Siemionow is planning to undertake what may be the most shocking medical procedure to occur in decades: a face transplant.

After years of heated scientific debate over ethics and technical feasibility, the Cleveland Clinic, in Ohio, last autumn became the first institution to approve this novel surgery. Already Siemionow's group is searching for its first patient.

Siemionow, an amateur photographer she makes portraits of faces, mostly with a talkative, almost merry demeanor, is not the sort that one expects to find at center stage in a medical danse macabre. But this is no ordinary procedure, and she is no ordinary scientist.

"This is the single most important area of reconstructive research, and she is carrying the torch," said Dr. L. Scott Levin, chief of plastic and reconstructive surgery at Duke University Medical Center, in North Carolina.

Siemionow was raised in Poznan, Poland, a city midway between Warsaw and Berlin. She graduated from the medical university there in 1974.
"Even in my high school you were taught that medicine is a humanistic practice," she said. "Physicians are a part of their patients' lives, and there must be an intimate bond."

There are few areas of medicine in greater need of a humanistic perspective. No one knows exactly how many people live with facial disfigurement caused by burns, trauma, disease or birth defects. But Siemionow has seen too many cases already the woman whose fiance left after she was burned in a car accident, the lonely shut-in whose face was lost to cancer. For these patients, there is little doctors can do to restore normal appearance.

Plastic surgeons usually "resurface" the damaged face with skin from the victim's back, buttocks or thighs. Patients may need as many as 50 operations to regain even limited function, and the results are mixed at best.