CLOSE

Notable Moments in Limb and Face Transplant History

In 2008, surgeons completed two procedures that could forever change transplant surgery. In August, doctors in Munich announced that a farmer was recovering from a double-arm transplant—the first double-arm transplant in the world. In December, the Cleveland Clinic announced they'd replaced about 80 percent of a woman's face. Many surgeons think that arm, hand, and face replacements are the next logical steps in transplants. Is the world ready?

Being first isn't always best

In 1964, physicians around the world were attempting transplants of all kinds when doctors in Ecuador performed the first hand transplant. Unfortunately, like early organ transplants, it didn't work—within two weeks the hand was rejected and doctors had to remove it.

Being second isn't much better

In 1998, doctors performed delicate microsurgery on New Zealander Clint Hallam. For 13 hours at Edouard Herriot Hospital, an international team of scientists led by French surgeon Jean Michel Dubernard stitched a cadaver's forearm and hand to Hallam's upper arm. Completing the hand transplant required microsurgery skills and patience—doctors knitted medial nerve to medial nerve, radial artery to radial artery, radius to radius. Like with other transplants, both donor and recipient must share the same blood type.

After years of studying transplant pioneers and earning a PhD based in xenographs research (he transplanted organs from one species of monkeys to another), Dubernard felt he was prepared to perform a hand transplant on a human. When he was unable to find a suitable French candidate, an Australian colleague recommended Hallam. Fourteen years earlier, Hallam had lost his forearm in a circular saw accident. It was later revealed the accident actually occurred in jail and that Hallam was a longtime con-man.

hands.jpgCritics claimed that Dubernard performed the surgery for the media attention, but the surgeon argued he and his staff did a thorough psychological evaluation of Hallam as well as a background check. (Unsurprisingly, Dubernard had a role in the first partial face transplant, also surrounded by controversy.)

At first, the forearm and hand worked well for Hallam, although he hated that the donor limb was larger than his other arm and a different skin tone. He hid his freak arm as much as he could. Hallam's arm wasn't just grotesque-looking, though; it began itching and flaking, and he was plagued daily by pins and needles. He begged the doctors to remove it, but they refused. Hallam felt emotionally detached from his hand. Finally, a group of British surgeons agreed to remove the limb in 2001. The physicians from France claimed the only reason Hallam's arm rejected is because he failed to take his immunosuppressant drugs and exercise it.

From hands to a face

Frenchwoman Isabella Dinore received the first partial face transplant in 2005.

After taking too many sleeping pills, Dinore had passed out. As she lay unconscious on the floor, her black Lab chewed off her nose, mouth, and lower face. Without lips, muscles, and skin on the bottom half of her jaw, Dinore struggled to speak and eat—she had to eat through a tube. Physicians couldn't help her with traditional plastic surgery and thus felt she would be a good candidate for a face transplant.

Bernard Devauchelle, a French maxillofacial surgeon at Lyon University, saw a picture of a brain-dead woman with a mouth, nose, and lips similar to Dinore's features. He removed a triangle of Maryline St. Aubert's skin with its arteries, nerves, and veins and spent hours graphing the skin onto Dinore's face.

Dinore.jpgIt was rumored St. Aubert was brain-dead because she tried to kill herself. Many people thought Dinore had attempted suicide, too. Dubernard, who had worked alongside Devauchelle in the surgery, argued Dinore accidentally overdosed. Physicians criticized the decision to give a suicidal woman a face transplant. People once again alleged Dubernard had performed the surgery for media attention—Corbis had an exclusive deal for photos—and some urged an ethics investigation.

Dubernard oversaw Dinore's recovery. Shortly after the surgery, he injected some of St. Aubert's stem cells (from her bone marrow) into Dinore in the hopes her body wouldn't reject the transplant, but the stem cell infusion failed. Dinore suffered two bouts of rejection, contracted herpes and a pox virus, and struggled with kidney failure.

A year later, Dinore appeared in the media, showing off her new face. She used her new lips to smoke again.

Full-face transplant

Coler.jpgLaurent Lantieri, head of plastic surgery at Henri-Mondor Hospital in France, spent 16 hours stitching new lips, cheeks, nose, and mouth to Pascal Coler's face. Since Coler was six years old, large masses had been growing on his nerves because of a condition called neurofibromatosis. As the masses increased in size, Coler's face became less recognizable. Strangers pointed at him because of his misshapen visage.

The large masses compressed the nerves, arteries, and fat in Coler's face, causing lasting damage; the transplanted cadaver's face stops the masses from developing. Lantieri didn't alter Coler's bone structure, so Coler looks as he would if he never had the disease.

What the doctors say

When a patient receives a lung or a liver, the body's white blood cells attack the new organ because the body believes it is an invader. That's why immunosuppressant drugs are so important for transplant patients: immunosuppressants mollify the immune system. When a transplant includes so many different tissues, organs, veins, arteries, nerves, fat, and bones, the body targets the limb even more ferociously than it attacks one organ—the white blood cells believe the more transplanted tissue means there are more invaders.

In 2007, a study was published with the results of 18 transplants of 24 hands/digits/forearms. (11 folks received one hand, four received two hands, two received two forearms, and one received one thumb.) The good news: limb transplantation has a 100 percent survival rate. (In the early days of organ transplantation, most patients died.) And graph survival is also 100 percent for the first two years. The bad news: 12 patients suffered acute rejection and six Chinese recipients had their hands removed. All patients had enough nerve function in their new limbs that they knew when they were hurt, but few used fine motor skills or had sophisticated nerve function.

Some experts wonder if limb transplants should be conducted when prosthetic limbs are available. Fifteen people in the 2007 study said the limbs improved their quality of life, but many suffer with lingering problems from the immunosuppressant drugs, kidney failure, diabetes, and infections.

One thing is certain, though: Dubernard won't be performing any more limb transplants. He reached the maximum age to practice medicine in France.

nextArticle.image_alt|e
NOAA, Wikimedia Commons // Public Domain
arrow
Animals
Watch the First-Ever Footage of a Baby Dumbo Octopus
NOAA, Wikimedia Commons // Public Domain
NOAA, Wikimedia Commons // Public Domain

Dumbo octopuses are named for the elephant-ear-like fins they use to navigate the deep sea, but until recently, when and how they developed those floppy appendages were a mystery. Now, for the first time, researchers have caught a newborn Dumbo octopus on tape. As reported in the journal Current Biology, they discovered that the creatures are equipped with the fins from the moment they hatch.

Study co-author Tim Shank, a researcher at the Woods Hole Oceanographic Institution in Massachusetts, spotted the octopus in 2005. During a research expedition in the North Atlantic, one of the remotely operated vehicles he was working with collected several coral branches with something strange attached to them. It looked like a bunch of sandy-colored golf balls at first, but then he realized it was an egg sac.

He and his fellow researchers eventually classified the hatchling that emerged as a member of the genus Grimpoteuthis. In other words, it was a Dumbo octopus, though they couldn't determine the exact species. But you wouldn't need a biology degree to spot its resemblance to Disney's famous elephant, as you can see in the video below.

The octopus hatched with a set of functional fins that allowed it to swim around and hunt right away, and an MRI scan revealed fully-developed internal organs and a complex nervous system. As the researchers wrote in their study, Dumbo octopuses enter the world as "competent juveniles" ready to jump straight into adult life.

Grimpoteuthis spends its life in the deep ocean, which makes it difficult to study. Scientists hope the newly-reported findings will make it easier to identify Grimpoteuthis eggs and hatchlings for future research.

nextArticle.image_alt|e
Penn Vet Working Dog Center
arrow
Stones, Bones, and Wrecks
New Program Trains Dogs to Sniff Out Art Smugglers
Penn Vet Working Dog Center
Penn Vet Working Dog Center

Soon, the dogs you see sniffing out contraband at airports may not be searching for drugs or smuggled Spanish ham. They might be looking for stolen treasures.

K-9 Artifact Finders, a new collaboration between New Hampshire-based cultural heritage law firm Red Arch and the University of Pennsylvania, is training dogs to root out stolen antiquities looted from archaeological sites and museums. The dogs would be stopping them at borders before the items can be sold elsewhere on the black market.

The illegal antiquities trade nets more than $3 billion per year around the world, and trafficking hits countries dealing with ongoing conflict, like Syria and Iraq today, particularly hard. By one estimate, around half a million artifacts were stolen from museums and archaeological sites throughout Iraq between 2003 and 2005 alone. (Famously, the craft-supply chain Hobby Lobby was fined $3 million in 2017 for buying thousands of ancient artifacts looted from Iraq.) In Syria, the Islamic State has been known to loot and sell ancient artifacts including statues, jewelry, and art to fund its operations.

But the problem spans across the world. Between 2007 and 2016, U.S. Customs and Border Control discovered more than 7800 cultural artifacts in the U.S. looted from 30 different countries.

A yellow Lab sniffs a metal cage designed to train dogs on scent detection.
Penn Vet Working Dog Center

K-9 Artifact Finders is the brainchild of Rick St. Hilaire, the executive director of Red Arch. His non-profit firm researches cultural heritage property law and preservation policy, including studying archaeological site looting and antiquities trafficking. Back in 2015, St. Hilaire was reading an article about a working dog trained to sniff out electronics that was able to find USB drives, SD cards, and other data storage devices. He wondered, if dogs could be trained to identify the scents of inorganic materials that make up electronics, could they be trained to sniff out ancient pottery?

To find out, St. Hilaire tells Mental Floss, he contacted the Penn Vet Working Dog Center, a research and training center for detection dogs. In December 2017, Red Arch, the Working Dog Center, and the Penn Museum (which is providing the artifacts to train the dogs) launched K-9 Artifact Finders, and in late January 2018, the five dogs selected for the project began their training, starting with learning the distinct smell of ancient pottery.

“Our theory is, it is a porous material that’s going to have a lot more odor than, say, a metal,” says Cindy Otto, the executive director of the Penn Vet Working Dog Center and the project’s principal investigator.

As you might imagine, museum curators may not be keen on exposing fragile ancient materials to four Labrador retrievers and a German shepherd, and the Working Dog Center didn’t want to take any risks with the Penn Museum’s priceless artifacts. So instead of letting the dogs have free rein to sniff the materials themselves, the project is using cotton balls. The researchers seal the artifacts (broken shards of Syrian pottery) in airtight bags with a cotton ball for 72 hours, then ask the dogs to find the cotton balls in the lab. They’re being trained to disregard the smell of the cotton ball itself, the smell of the bag it was stored in, and ideally, the smell of modern-day pottery, eventually being able to zero in on the smell that distinguishes ancient pottery specifically.

A dog looks out over the metal "pinhweel" training mechanism.
Penn Vet Working Dog Center

“The dogs are responding well,” Otto tells Mental Floss, explaining that the training program is at the stage of "exposing them to the odor and having them recognize it.”

The dogs involved in the project were chosen for their calm-but-curious demeanors and sensitive noses (one also works as a drug-detection dog when she’s not training on pottery). They had to be motivated enough to want to hunt down the cotton balls, but not aggressive or easily distracted.

Right now, the dogs train three days a week, and will continue to work on their pottery-detection skills for the first stage of the project, which the researchers expect will last for the next nine months. Depending on how the first phase of the training goes, the researchers hope to be able to then take the dogs out into the field to see if they can find the odor of ancient pottery in real-life situations, like in suitcases, rather than in a laboratory setting. Eventually, they also hope to train the dogs on other types of objects, and perhaps even pinpoint the chemical signatures that make artifacts smell distinct.

Pottery-sniffing dogs won’t be showing up at airport customs or on shipping docks soon, but one day, they could be as common as drug-sniffing canines. If dogs can detect low blood sugar or find a tiny USB drive hidden in a house, surely they can figure out if you’re smuggling a sculpture made thousands of years ago in your suitcase.

SECTIONS

arrow
LIVE SMARTER
More from mental floss studios