French face transplant specialist awaits go-ahead to help wounded GIs

IED explosion aftermath in Mosul, Iraq, 2008. Photo: Staff Sgt. Jason Robertson. www.army.mil

Face transplant specialist Laurent Lantieri has accused the French government of foot-dragging in response to his request for permission to operate on wounded American soldiers. U.S. military and medical authorities contacted Lantieri to teach them the highly specialized techniques developed in France. About 200 U.S. troops are candidates for facial transplants, according to Lantieri.

Contacted last year by American authorities for his knowledge and experience in facial transplants, professor Laurent Lantieri, MD, transmitted their appeals to French authorities. Since that time he has not received permission to accede to the Americans’ request and he has the impression that France is ignoring his efforts and putting administrative obstacles in his way.

Lantieri, a plastic surgeon and pioneer in facial transplantation, recently sounded the alarm in an interview given to French daily L’Express, in which he vented his frustrations and explained the issues.

American armed forces in Iraq have repatriated thousands of seriously wounded personnel to the United States since 2001; about 2,500 of them with facial wounds. The face is the least protected part of a soldier’s body and in cases where they are caught in explosions, facial damage can be severe. About 200 victims are estimated to be in need of partial or total facial transplants.

The French possess extensive know-how in facial transplants, and the first-ever operation was carried out in France in 2005 on a young French woman. French specialists have carried out many more transplants since with a relatively high success rate, although the body’s rejection of the transplant remains a major risk. The French are generally acknowledged to be the world leaders in this field.

It is in this context that American military authorities invited Lantieri, who is a world-leading authority on facial transplants, to visit the United States and share French transplant techniques with American military personnel and to see how French and American surgeons could pool their resources in an efficient manner.

Lantieri informed the French health, research and foreign ministries -- and even the president’s health counsellor -- of the American request and his wish to help, but he has not received any positive responses from anyone. He says that the government is stalling by informing him that they didn’t understand what he wanted. He said the Health Ministry responded to repeated queries saying it had not received his demands and asked him to send another demand along with all the “relative explanations for your request.”

The response leaves Lantieri frustrated. “What are they waiting for?” he asked. “Both civil and military medical authorities in America are asking me to train their people here in France for a six-month period, but because their qualifications and diplomas are not recognised here I do not even have the right to discuss the matter with them. The Americans need specialist teams all over the United States and they do not exist at this time. Our specialists have a substantial lead in this field and the Americans know it. That’s why they are asking for our help. But here in France my demands are met with silence.”

Lantieri has visited the United States on several occasions over the last year and is scheduled to visit San Antonio, Texas, in March to meet senior members of American severe burns facilities there and elsewhere.

The challenges posed by facial injuries sustained by American soldiers are substantial in his view. Some of those injuries are of a ballistic nature – caused by bullets or shrapnel – but burning and searing caused by IED (Improvised Explosive Device) explosions are the most common, and they often present extensive lesions of a type and severity which push current operating techniques to their limits. Lantieri claims that this kind of injury would be better treated by transplants than by superficial reparation methods, which can take up to 15 years to complete. This can lead to victims’ lives being constantly disrupted by long and frequent interventions.

No facial transplants have yet been carried out on blast victims. The Americans have adequate personnel according to Lantieri, but he says they need to learn from the more extensive experience of French specialists who have more research and practical work to draw upon. He has been invited to several congresses on the subject, stressing that he is sharing “the character of transplants at this time, but the reality of this type of operation can be completely different.” 

The Americans, meanwhile, are making efforts to try and move things forward. The Pentagon recently released $3.4 million (€2.5 million) to fund between six and eight transplants at the Brigham and Women’s Hospital in Boston over the coming year, but Lantieri considers this to be both an unrealistically high target and a drop in the ocean given the timescale and available resources. He adds: “...and even if those operations are carried out, there will still be a waiting list of around 190 patients.”