Texas man aims for rare face transplant
Published: Monday, January 18, 2010 at 10:49 a.m.
Last Modified: Monday, January 18, 2010 at 10:49 a.m.
DALLAS — Dallas Wiens does not remember the moment his face was burned off.
He was standing inside a cherry-picker making repairs on a church window in Fort Worth, Texas. His cell phone was ringing.
The next thing he recalls was waking up in the burn unit at Parkland Memorial Hospital in Dallas. It was three months later.
His family had to tell him how his head had touched a high-voltage power line that day in November 2008. It burned nearly all the flesh from the crown of his head to the tip of his chin.
By the time he was awakened from an induced coma last February, Wiens had been through more than 20 surgeries to repair his fourth-degree burns. His face had become a smooth, featureless melon of skin and muscle harvested from elsewhere on his body.
Where his eyes and nose should be were slight indentations. His upper lip, roof and insides of his mouth were gone, as were most of his teeth.
His survival was an incredible victory that amazed his doctors and inspired his family.
But Wiens, 24, wants to take it even further.
He is hoping to become a candidate for a face transplant, a procedure so rare and risky that only a handful has been done successfully in the world.
"I understand the risks," Wiens said. "But if I opt for a transplant, I figure what I've already lived through is far worse.
"If that's the route I go, God's going to lead me and take care of me."
On Tuesday, Wiens and his grandfather, Delton Peterson, will fly to Boston to meet with the doctors who last April successfully transplanted a donor's face onto a similarly burned man.
Wiens' doctors at Parkland are supportive of his decision to try for a transplant.
"It's a long shot," said Dr. Jeffrey Janis, his plastic surgeon. "Face transplants are so novel and so cutting-edge that there have only been two in the U.S. so far."
His other option is facial reconstruction that would use prosthetic or artificial parts, including a nose and eyes, as well as a hair transplant and lip reconstruction.
If Wiens becomes a transplant candidate, his family will face a major financial challenge. While the surgery would be free, Wiens would be required to live in Boston for at least six months, undergoing tests and awaiting a donor.
"It would cost us about $2,500 a month for living expenses, plus travel costs and anything else," said his grandmother, Sue Peterson. "We've already paid everything we can pay toward this."
Before Wiens can get on the transplant list, he must go through a rigorous screening process. He will make at least two trips to Boston for tests at Brigham and Women's Hospital, where James Maki underwent a successful face transplant last year.
The 59-year-old Boston man's lower face was severely burned when he accidentally fell onto an electrified subway track in 2005. The transplant replaced his nose, upper lip and roof of his mouth.
Dr. Bohdan Pomahac, the lead surgeon in that case, said facial transplants would give severely deformed people an opportunity to rejoin society.
"It is hard for us to imagine how difficult it was for Jim. He feared going outside," the surgeon said last year. "I feel that we are here on a mission, using cutting-edge technology to restore patients' lives."
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Wiens, a frequent visitor to his neighborhood Starbucks, has no fear of being out in public because he cannot see how people are reacting to him.
But he knows they often are startled by his appearance.
"One woman got right up in his face and looked under his cap, like she couldn't believe what she was seeing. It was so rude," said Wien's grandmother and constant companion.
Wiens doesn't let such reactions spoil his positive attitude toward life.
"I've let go of the illusion of control," he said. "You can't control everything, and when you try, you just get frustrated."
His upbeat personality is a far cry from the way he was before the accident. Growing up in Fort Worth, he was better known in his family for causing trouble for his parents and two older brothers.
Wiens acknowledged a disruptive past that had forced him to graduate from a home-schooling program rather than high school. He's had minor brushes with the law but no convictions. And he's in the process of ending a two-year marriage.
He spent nine months in the Army before receiving an honorable medical discharge in 2006 because of knee problems.
"From the time I was 14, I consciously walked a path of turmoil," Wiens said. "The only thing good that came out of it was my daughter."
Wiens and his grandparents are attempting to get primary custody of his 2-year-old daughter, Scarlette. Wiens lives with the couple in their modest west Fort Worth home.
"We wanted to be available to help Dallas with whatever he needed and to help him raise Scarlette. She is the light of his life," said his grandmother, who retired from her teaching job when Wiens was discharged from Parkland last May. His grandfather also retired from his job as a banker.
"We always knew this accident was going to be a life-altering experience for Dallas," Sue Peterson said. "To see that happen is such a joy. We love being with him. He keeps us laughing."
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Wiens' transformation also was made possible by a massive team of doctors, nurses and therapists at Parkland, where CareFlight delivered him on Nov. 13, 2008, the day of the accident. He spent six months in Dallas' public hospital, most of it in the famed burn unit.
Janis, chief of plastic surgery at Parkland and an associate professor at University of Texas Southwestern Medical Center, recalled seeing Wiens shortly after his arrival and wondering how long he would live.
"These burns on his head, neck and face were down to the bone and including the bone," he said. "Usually, these patients do not survive."
Once Wiens was stabilized, burn surgeons began the massive reconstruction of his face.
"It was almost as if we had a skull attached to a normal body," Janis said. "It was a long shot to get him successfully reconstructed."
A two-day surgical effort, lasting 32 hours, allowed teams of doctors to methodically remove burned and dead flesh, most of Wiens' teeth and his badly damaged left eye. Other surgeons then stepped in to disconnect and graft muscles and skin from his back and legs and move them to Wiens' face.
His right eye, which lacked a protective eyelid, was covered by a skin graft. It is not known if the eye will work again, although Wiens insists that he has some "light perception" on that side.
Doctors had expected him to be paralyzed from the neck down and never walk, talk or eat regular food again. His family was told several times that he was not likely to survive.
But they never lost hope. His grandmother began holding his right hand and pressing her thumb against his thumb.
"When I felt that force from his thumb, I was so excited," Peterson recalled. "It was the first indication that he was really in there."
And, little by little, everything started coming back.
Wiens would end up joking with the doctor who had given him such a grim prognosis.
"I told him, 'If you have anything else you think I won't do, please tell me now, so I can try to do it,' " Wiens recalled. "The doctor said I wouldn't be doing push-ups. I'm up to 15 already."
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Wiens' recovery was astounding enough that Janis nominated him for "The Greatest Save," an annual competition held by members of the American Society of Plastic Surgeons.
Any surgeon with a compelling recovery can nominate a patient. At the group's annual meeting, held in Seattle last October, four surgeons are chosen to share the story of their patient's recovery.
"I presented Dallas as an extraordinary case because he ended up walking out of the hospital," Janis said.
The surgeons voted Wiens as The Greatest Save of 2009.
Also in the running was Maki, the face transplant patient in Boston, who was nominated by Pomahac, the lead surgeon on the transplant team.
"They all were huge tragedies with successful outcomes," Janis recalled. "But Dallas inspired everyone who heard his story.
"He's such an amazing young guy with his whole life ahead of him."
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