Charla Nash, 57, underwent a full face and double hand transplant late last month, but the hands failed to thrive because of complications and were removed, Dr. Bohdan Pomahac, leader of the 30-member surgical team at Brigham and Women's Hospital, said Friday. Overall, her prospects are excellent, he said.
"It will certainly help her tremendously to feel human again," Pohamac said.
In February 2009, she was attacked by a neighbor's 200-pound pet chimpanzee, named Travis, which went berserk after its owner asked Nash to help lure it back into her Stamford, Conn., house. The animal ripped off Nash's hands, nose, lips and eyelids before being shot and killed by police.
After the mauling, Nash's eyes were gone and she had only a small opening instead of a mouth to take in pureed food. She could talk but was barely understandable.
More than two years later, Nash received skin, underlying muscles, blood vessels, nerves, a hard palate and teeth from a dead person whose identity was not released. It was the third full face transplant in the U.S.
Over the next several months, she will develop more control over facial muscles and more feeling, letting her breathe through her nose and develop her sense of smell. She remains blind.
She did not appear at a hospital news conference Friday, and no photographs of her after the surgery were released.
Nash will be able to go out in public without feeling self-conscious, Pomahac said. She had to skip her only daughter's high school graduation last spring because she was worried she would become the center of attention.
"We know it broke her heart," Pomahac said, pausing to control his emotions. "I think her new face will allow Charla to be present when Briana graduates from college in a few short years."
Her brother Steve Nash said his sister wants to enjoy hot dogs and a slice of pizza from their favorite pizza parlor in Poughkeepsie, N.Y., where they spent their childhood. Fighting back tears, he called the operation "miraculous."
"We are confident Charla will gain her goal to regain her health and independence in the future," he said. He said he hopes that someday she has grandchildren who can "look her in the eyes and smile at her."
"Charla hated to have her picture taken. Any family gathering, she'd disappear," said Kate Nash, her sister-in-law. "She doesn't want to be the center of attention ever, you know. That's why she wants this. She's so happy about getting a face, so people won't say, `Look at that lady with the veil."'
About a dozen face transplants have been done worldwide, in the U.S., France, Spain and China. The two previous full-face transplants in the U.S. were also done at Brigham and Women's Hospital. The U.S. military has given the Boston hospital a grant for five face transplants in hopes that the operations can eventually benefit soldiers disfigured in battle.
This was the hospital's first hand transplant attempt, though it has reattached hands for other patients for many years.
While the loss of her transplanted hands was disappointing, Pomahac said in an interview with The Associated Press that doctors will probably attempt another double hand transplant on her with a new donor after waiting at least six months for Nash to heal.
"For a blind patient, I think the hands do provide the contact to the outside world, and ultimately the road to independence ... and that's why I think she will want to have it done in the future," he said.
Nash still has an optic nerve, even though the chimp attack destroyed her eyes. Transplanting eyes is "science fiction at this point, but you never know," Pomahac said.
He said at the news conference that her left arm was replaced at the mid-forearm. Her right hand was replaced at the wrist, except for the thumb, which was all she had left.
Several days after the operation, Nash developed pneumonia and suffered a drop in blood pressure, which compromised blood flow to the hands. Doctors eventually had to remove the transplanted hands.
Experts not connected with the case said it was riskier than previous transplants, but not unethical.
"Hand transplants and face transplants are big operations. When you combine the two big operations, it can be a challenge," said Dr. Joseph Losee of the University of Pittsburgh.
Doing the operations separately, or attempting another hand transplant for Nash in the future, raises the risk of rejection because tissue from two different donors would be involved, said Dr. Warren Breidenbach, who led the nation's first hand transplant, in 1999 at Jewish Hospital and the University of Louisville. He is now chief of reconstructive and plastic surgery at the University of Arizona.
The Cleveland Clinic performed the nation's first face transplant, a partial, in 2008, and had declined to attempt one on Nash.
"Her injuries were complex and we had never done a hand transplant before, so she did not meet the criteria of our protocol," said clinic spokeswoman Eileen Sheil.
Nash's family is suing the estate of the chimp's owner, Sandra Herold, for $50 million and wants to sue the state for $150 million, saying officials failed to prevent the attack. Herold died last year of an aneurysm.
Herold speculated that the chimp was trying to protect her and attacked Nash because she had changed her hairstyle, was driving a different car and was holding a stuffed toy in front of her face to get Travis' attention.
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