Boston’s Top Docs: 14 Medical Breakthroughs

By Janelle Nanos | Boston Magazine |

Transcendental Operation

Richard Mangino, 65, lost his arms and legs in 2002 after contracting a blood infection from an undetected kidney stone. In October, Bohdan Pomahac supervised a double hand transplant for Mangino. The Revere native can now open and close his fingers. “I look at the other person’s eyes when they see my hands for the first time,” he says. “It’s like they’re looking at magic.”

“IT GIVES YOU A COLD SWEAT when you’re taking a face off the donor,” Bohdan Pomahac says. He should know. As the head of the plastic surgery transplant team at Brigham and Women’s Hospital, Pomahac this year oversaw three separate procedures in which a patient received a brand-new face. Oh, and he also supervised a transplant that resulted in an amputee getting two new hands.

Pomahac is a man of science, of course, but he gets a little mystical when describing the intricate process. First he has to cut away the donor’s tissue. After the face is removed, it’s transferred to a preservative solution that makes it appear ghostlike. “It’s pale, there is no color in the lips; it’s almost gray,” Pomahac says. “And then we bring it over here to the hospital and connect the vessels that provide the inflow and outflow of blood. That’s the magical moment. You see the blood rushing in, and suddenly a wave of pigment spreads through the face from one side to the other. You can’t believe it’s
happening.”

After seeing successful face transplants in Europe, Pomahac became convinced that he could do the procedure here. The biggest challenge, he says, was proving to the hospital that these non-lifesaving surgeries were a worthy endeavor. Yes, the patients may be alive, he argued, but what kind of lives were they living? “There is no functional prosthetic for the face. These are the aspects of human life that we can restore,” he says. And “no matter what prosthesis you have, the hand is not just something that’s mechanical. You want to touch your family or loved ones.”

After convincing the teaching hospital to develop the plastic surgery transplant program, Pomahac had to persuade the transplant-organ community to allow him to harvest donor tissues. He then raised millions of dollars and worked with healthcare providers to get his patients covered for the immunosuppressant drugs they’d need to prevent rejection.

 

Pomahac performed his first partial face transplant on James Maki in 2009. Then, this past March, he oversaw the very first full face transplant ever done in the U.S. He and his team did the procedure on two more patients in April and May. Then in October, Pomahac led the hospital’s first double hand transplant, performed on Richard Mangino, a 65-year-old quadruple amputee who lost his limbs to a blood infection.

While his work has drawn international acclaim, Pomahac seems most gratified by what the transplants will do for future clinical research. “We will learn how the brain reintegrates the tissues and relearns how to use parts that were lost,” he explains. “It’s moving forward our knowledge about the human body and physiology, and all that goes along with it.” — Janelle Nanos

Above photo: James Maki, 61, suffered disfiguring burns to his face after falling on the T’s electrified third rail in 2005. After the accident, he kept largely to himself, until he saw Bohdan Pomahac on television talking about face transplants. “Right then, I started wondering, Is my face going to be saved because of this?” he now recalls. “I said to myself, There have to be some lucky people in this world.”

Photographs by by Michael Warren