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First Canadian face transplant performed in Montreal

Posted September 19, 2018

In a Canadian first, a team of surgeons from Hôpital Maisonneuve-Rosemont (CIUSSS de l’Est-de-l’Île-de-Montréal), led by the distinguished plastic surgeon Dr. Daniel Borsuk (also of Université de Montréal), has successfully completed a face transplant. The operation was carried out at the hospital last May in collaboration with Transplant Québec.

The recipient, a 64-year-old man who’d been severely disfigured in a shooting accident, is the world’s oldest person to receive a face transplant. The 30-hour operation required the expertise of multiple specialists and the exceptional collaboration of more than 100 health professionals, including doctors, nurses, and many other personnel.

Seven years ago, the man was severely disfigured by an accidental gun shot. Four months after his transformative surgery, he is now doing well.

Seven years ago, the man was severely disfigured by an accidental gun shot. Four months after his transformative surgery, he is now doing well. Image credit: Hopital Maisonneuve – Rosemont.

The transplant was made possible thanks to an organ donation coordinated by Transplant Québec, with the permission of the donor’s family.

“This delicate operation is the result of years of concerted, meticulous work by an incredible team and the incredible bravery and cooperation of the patient and his family,” Borsuk said. “Through the combination of science, technology, engineering and art we attempted to build on the knowledge and experience of the pioneers in the field to perform the best facial transplant possible for our patient.”

Seven years ago, the man was severely disfigured by an accidental gun shot. He lived in constant pain, undergoing five reconstructive surgeries Forced to live with a tracheostomy (an opening in the trachea), the man had great trouble breathing, sleeping, eating and speaking. Moreover, social interactions and public appearances proved to be challenging and resulted in the patient choosing to remain indoors and isolated.

A natural extrovert, he lived in hope of once again having a normal life and being in contact with others. The face transplant was his only option to restore his two jaws, facial muscles and nerves, teeth, lips and nose. Four months after the procedure, the patient is doing well. He has fully recovered the ability to breathe and has begun to chew with his new jaws, smell through his new nose and speak using his new lips.

The team behind the face transplant

“The CIUSSS is proud to have reconstructive surgery excellence within its walls, a discipline which gives the hope of returning to a normal life to many patients,” said Yvan Gendron, CIUSSS-EMTL president and CEO.

The medical team was comprised of nine surgeons: in plastic surgery, Dr. Daniel Borsuk, Dr. André Chollet, Dr. Dominique Tremblay, Dr. Jenny Lin, Dr. Charles Guertin and Dr. Michelle Tardif; in ear-nose-and-throat surgery, Dr. Tareck Ayad and Dr. Akram Rahal; and in maxillofacial surgery, Dr. Jean Poirier.

But medical expertise was part of the reason why the operation was a succces. Many partners also contributed to this immense undertaking, starting with the donor and his family, who, thanks to their generosity, gave a man a chance at a more normal life, Borsuk said.

A family’s generosity, Transplant Québec’s crucial role

“As a plastic surgeon, I know that, no matter large or small, injuries to the face have a particularly symbolic aspect and are closely linked to our identity,” the surgeon said. “Facial disfigurement can have a detrimental effect on self-confidence and productivity, and therefore, this transplant offered immense hope and possibility to our patient.

“Transplant Québec is very pleased with the success of this, the first face transplant in Quebec and Canada, made possible through organ donation,” added Louis Beaulieu, Transplant Québec’s managing director. “We would like to acknowledge the donor family, who showed great empathy and generosity in accepting that their loved one donate his face and his organs.

Image credit: Hopital Maisonneuve – Rosemont.

“The tremendous collaboration between Dr. Borsuk’s team and Transplant Québec’s is one of the keys to the success of this first, which was so beneficial for the receiver,” he continued. “The innovative character of this transplant is proof of the professional maturity of Transplant Québec and its health institutions in Quebec, which are valued partners.”

Other important partners involved in the face transplant include Johnson & Johnson Inc. Canada, which provided free medical equipment, including instruments and surgical products.

A lengthy preparation for the team and the patient

Such a surgery requires years of meticulous preparation, for both the surgeons, who honed their expertise beforehand, and the patient, who underwent many in-depth physical and psychological examinations and procedures. This type of surgery also requires significant ethical and logistical preparation on the donation side, as well as having to deal with consent issues with the donor’s family.

“We wanted to ensure that the recipient would take on what was going to be a major change in his existence in the best physical possible health, armed with all the necessary information and psychological support,” Borsuk said. “We will continue to support the patient so he can completely adapt to his life post-surgery.”

Face transplant milestones and the right hospital

Face transplants are extremely complex and rarely performed. Since 2005, only 40 were done, in a variety of countries. The transplant done by Borsuk and his team at Hôpital Maisonneuve-Rosemont is not only Canada’s first, but also a first in the Commonwealth.

Despite its complexity, however, the procedure is relatively inexpensive when compared to the multiple surgeries that would have been required to attempt to repair this type of injury. Most importantly, the surgery makes it possible for individuals who undergo facial vascularized composite allotransplantation to enjoy a more productive and normal life

And Hôpital Maisonneuve-Rosemont is well-placed to do the surgery. Specializing in complex reconstructions of the face and neck, its multidisciplinary team of adult cranio-maxillofacial surgeons is unique in Quebec. With extensive experience in transplants, the hospital is also an international leader in hematology and research in transplants and the immune system, cellular therapy, ophthalmology and nephrology.

An experienced plastic surgeon

Dr. Borsuk brought all of his experience as a pioneer in facial reconstruction to this surgery. Previously, he made history as the only Canadian doctor on an American face transplant team that operated on a 37-year-old man disfigured by a gunshot wound in 2012. More recently, in an eight-hour surgery on an adult patient at Hôpital Maisonneuve-Rosemont, his team performed a facial reconstruction with virtual surgery techniques and 3D models; they also removed a piece of vascularized pelvic bone and sculpted it to use on the face, then transplanted it from the inside of the mouth, so as not to leave any scars on the face. Dr. Borsuk is also recognized for his work with children injured by dog bites.

Dr. Borsuk obtained his B.Sc., MBA and M.D. from McGill University before pursuing his training in plastic and reconstructive surgery at Université de Montréal. Subsequently, he completed a sub-speciality in cranio-maxillo-facial surgery and adult and pediatric micro-surgery in the U.S. at Johns Hopkins University and at the R. Adams Cowley Shock Trauma Center in Baltimore, under the direction of Dr. Edouardo Rodriguez, one of the world’s pioneers in face transplants.

Watch a documentary on the surgery this Sunday

A detailed documentary about the entire procedure was produced by the French-language science program Découverte (Radio-Canada). It will air September 16 at 6:30 p.m. on ICI Radio-Canada Télé and at 8 p.m. on ICI RDI.

Source: University of Montreal

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