Landmark case: (From top) Dr Abraham Thomas, Sandeep Kaur after operation and her detached scalp and face

The world’s first full-face replant surgery was unwittingly accomplished by a plastic surgeon in India, 11 years ago. The face and scalp (see picture below) of Sandeep Kaur, a nine-year-old girl in a village near Ludhiana, arrived at the Christian Medical College and Hospital, Ludhiana, in two pieces. The hapless girl’s face was amputated when her braids got caught in a threshing machine while her mother was chopping grass to feed the family buffaloes. The grass-cutter kept on dragging in until the skin above her neck tore, and her scalp got ripped off.

The distressed family packed the detached face in a plastic bag and rushed the unconscious girl to the hospital, 150 kilometres away from their village, Chak Khurd. As luck would have it, the plastic surgeon, Dr Abraham George Thomas, was on duty.

“It was an utterly frightening sight to see that blood-drenched face,” recalled Thomas, now the principal, Pondicherry Institute of Medical Sciences, while talking to KnowHOW. “Initially I didn’t think I could do anything.”

Thomas knew that any effort to repair Sandeep’s face with skin grafts harvested from elsewhere on her body would backfire. As an experienced microsurgeon he was well aware how such skin grafts are readily rejected by the reciepient’s immune system. So he decided to put back Sandeep’s own detached face and scalp from the plastic bag. It was an arduous job, because he had to reconnect numerous nerves and blood vessels. As soon as he sewed the first artery the reattached face turned scarlet with blood.

“It took more than 10 hours to reattach the entire face and scalp,” said Thomas. However, he didn’t realise at that moment that he had made history until the case was reported to the Plastic and Reconstructive Surgery.

Sandeep has not only recovered from the trauma, but also now leads a normal life. “She has been studying to become a nurse at our institute,” said Thomas. “After that miraculous recovery she was so impressed by the medical profession that she decided to be a nurse.”

According to Thomas, it was considered a landmark surgery, because until his feat, it was believed that blood had a limitation to flow from one vascular territory to another. There are two clear zones in a face surgery ? demarcated at the eyebrow level. “We showed that the barrier can be opened up whenever it is stimulated by an ischaemia (reduction of blood supply), for instance in accidents in which entire scalp and face is torn off from the body,” said Thomas.

His success has evoked another question: if it’s possible to sew one’s own torn-off face, is it not possible to transplant an entire face?

Prasun Chaudhuri