Giatsidis Giorgio, Sinha Indranil, Pomahac Bohdan
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, MA.
Ann Surg. 2017 Apr;265(4):841-846. doi: 10.1097/SLA.0000000000001760.
On November 27, 2005, Isabelle Dinoire underwent the world's first partial face transplant in Amiens (France) after a dog attack had left her face severely disfigured. The abrupt surgical leap found the medical community and society unprepared to deal with the scientific, ethical, and societal implications of a surgical procedure that was striving to transition from sci-fi novels to science. Today, 10 years and over 35 transplants later, public opinion has become accustomed to the concept of "face restoration" through transplantation. However, face transplantation is far from being a safe "routine" surgery and the science behind it is still mostly unknown. Patients and multidisciplinary teams of physicians confront daily medical challenges, life-threatening risks, and personal struggle that only in part come to light. Could (or should) this be the laborious, uncertain, and high-risk trajectory of disruptive medical innovation? Over the last decade, some medical discoveries and surgical advancements in the field have been closely accompanied by partial regulatory frameworks, intense ethical discussions, and meaningful changes in social beliefs across cultures and continents. Yet, a very long way is to come and the questions we still have today greatly outweigh the answers we can offer. Here, we take the chance of the 10-year anniversary of face transplantation to reflect on the path traveled and to look forward to the challenges lying ahead.
2005年11月27日,伊莎贝尔·迪努瓦在法国亚眠接受了世界首例部分面部移植手术,此前她遭狗袭击,面部严重毁容。这一突如其来的外科手术飞跃让医学界和社会措手不及,不知如何应对这样一种正努力从科幻小说走向科学的外科手术所带来的科学、伦理和社会影响。如今,10年过去了,超过35例移植手术完成,公众舆论已逐渐习惯了通过移植进行“面部修复”的概念。然而,面部移植远非一项安全的“常规”手术,其背后的科学原理仍大多不为人知。患者和多学科医生团队每天都面临着医疗挑战、危及生命的风险以及个人挣扎,而这些只是部分地显现出来。这会是颠覆性医学创新所必经的艰难、不确定且高风险的轨迹吗?在过去十年里,该领域的一些医学发现和外科进展一直伴随着部分监管框架、激烈的伦理讨论以及跨文化和各大洲社会观念的重大变化。然而,前路仍漫长,我们如今仍有的问题远远多于所能给出的答案。在此,我们借面部移植十周年之际,反思走过的道路,并展望未来的挑战。