Face transplant extends the boundaries of surgery

Two teams of surgeons spent 25 hours replacing the face, scalp and one ear of the woman. Professor Morrison, who led the surgery at the renowned St Vincent's Hospital in Melbourne, Australia, said that the day might come when major trauma victims left hospital with someone else's face.

"This is a dry run for actually transplanting faces. This is what we could only dream we could do," the professor said.

The 28-year-old woman's appalling injuries, described by Professor Morrison as the worst he had seen, were sustained after the skin of her face and scalp were ripped off like a glove after her hair became caught in a milking machine on a dairy farm in the state of Victoria, leaving only her chin and one ear intact.

She was found by a friend, who would have been confronted by a sight like an anatomical dissection, Professor Morrison said. The woman's face and scalp were packed in ice and taken with her to the hospital which has pioneered the use of microsurgery. There, surgeons using microscopes reattached blood vessels and nerves using tiny stitches finer than a human hair.

The surgeons worked from 10pm last Tuesday - hours after the accident happened - until 11pm the following day. Yesterday, six days after the accident, the woman was still in intensive care under heavy sedation, but Professor Morrison said he was "fairly confident" that all the face would survive. He said he knew of only one comparable operation performed before, several years ago in China.

Describing the case to reporters, Professor Morrison compared it to the movie Face/Off now playing in Australia and due to open in Britain. Face/Off is a violent action thriller starring John Travolta and Nicholas Cage as enemies whose faces are swapped by surgeons. However, he admitted that there were still formidable problems of rejection to be overcome. The skin is the most immunologically resistant organ in the body - it provokes a more violent response than a heart or kidney when transplanted into another body. Although immunosuppressant drugs could be given to prevent rejection, their long-term effects are thought too risky except in cases such as heart and kidney transplants where death is likely without a transplant.

Stewart Watson, consultant plastic surgeon at Withington Hospital, Manchester, and an expert on the care of accident victims, has treated war wounded in Bosnia and earthquake survivors in Armenia and Iran. He said the woman's injuries suffered were unique. "The scalp is vulnerable to 'de-gloving' where the skin comes off but I have never heard of a case like this involving the face as well."

Once the graft had taken and the blood supply had been re-established the biggest problem facing the surgeons would be to restore feeling to the face and to ensure the proper functioning of the eyelids and mouth. "They will need to take extreme care to protect the eyes, probably by sewing the eyelids together initially. Getting good eyelid function will be one of the major challenges as well as dealing with the junction of the skin at the nose and mouth so that it is not overstretched," he said.

Surgeons at St Vincent's hospital said the woman may be able to go home within two weeks. Professor Morrison said she would have scars around her eyelids and chin but would be recognisably the same person. "She will have animation of her face and the essential characteristics will be there," he said.