Free Extreme Medicine by M.D. Kevin Fong Page B

finished, the face had been without a blood supply for over an hour and still had to be transferred by road and air back to the Brigham. It was going to be close.
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    B ACK IN B OSTON, E DRICH WAS MAKING his preparations. The team was assembled, the operating room ready, its microscopes and surgical sets prepared. Dallas, accompanied by his grandfather, was ushered into the operating theater suite. There was no time to lose; the face being brought by Pomahač would be fading. Dusky and starved of oxygen, its tissues were slowly dying. To survive, it needed a new host and a new supply of blood.
    Dallas was anesthetized almost as soon as he arrived. Edrich sited drip lines in his veins through which to give fluids and drugs and another line in an artery to monitor the blood pressure directly, with beat-to-beat precision.
    By the time Pomahač reached the Brigham hospital, the skin of the donated face was by now a dull thundercloud gray—the color of tissue and blood that has been stripped of its oxygen. It would not be long before it ceased to be viable at all.
    Pomahač had to move quickly. He dissected out Dallas’s external carotid artery. Having divided it, he pinched the free ends shut with an artery clamp. Then he began the delicate work of connecting that vessel to the face that he had just delivered. Working quickly, Pomahač threw stitch after stitch into place. Having made the connection, he released his arterial clamp. For the first time in nearly four hours, blood ran into the oxygen-starved tissues. The face blushed pink.
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    A FTER TWENTY-ONE HOURS of paring back tissue, stemming dangerous hemorrhages, and connecting blood vessels, muscles, and bones, the operation was finally complete. The orchestra of surgeons withdrew, and Edrich’s anesthetic team handed the patient over to the intensive-care unit. But Pomahač, despite having been awake for nearly forty-eight hours, wasn’t quite ready to go to bed. Once Dallas was settled in the ICU, Pomahač visited his room. After checking his patient’s new face, Pomahač told the nurse that he was going to take a shower and change his clothes, but that he would be back to spend the night at Dallas’s bedside.
    â€œDr. Pomahač,” she said with a smile, “I think we can take it from here.”
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    D ALLAS’S NEW FACE WASN’T immediately perfect in appearance. The tissues were swollen and bulky, and the lines of surgical incision were evident. The face itself remained largely inanimate and without sensation. Pomahač had expected all of this. It would take time before the full benefits of this procedure would make themselves known. But even in those early days, it was clear that Dallas had been transformed. He bore almost no facial resemblance to the man who had been injured in that cherry picker more than a year earlier. But now, where there had been a blank canvas of skin, there were individual features: a nose, eyes, a mouth, lips, and the more definite bony contours that make a face recognizable.
    Further sculpting of his features was necessary. Once the swelling had subsided, Pomahač trimmed excess tissue. Nerves and muscles needed time to become reeducated. But when Dallas returned many months later, it was clear to all that the surgery had been a great success. His appearance was improved to the point where he might enter a room without anyone giving him a second look.
    More impressively still, the nerves had begun to establish themselves. Dallas could now begin to express himself once more—relearning how to smile and frown. He even regained his sense of smell. But most important of all, he gained sensation in the skin of his new face. For the first time since his accident, he could feel his daughter’s kisses on his cheeks.
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    T HE TALE OF D ALLAS W IENS’S FACE tells us much about medical science’s most spectacular triumphs, but it is in burn units all over the