This document discusses nursing care after a face transplantation. It presents the case of a 35-year-old male patient, T.C., who underwent a total face transplantation. The transplantation involved transplanting the patient's whole skin, mimic muscles, eyelids, tear ducts, hairskin and right ear from a donor. The patient required intensive nursing care including monitoring, administration of immunosuppressive drugs and antibiotics, and rehabilitation to adapt to his new face. The nursing care aimed to prevent complications, utilize the new face effectively and provide psychological support to improve the patient's quality of life.

1. NURSİNG CARE AFTER FACE
TRANSPLANTATİON
Presentation of the case
Nurse Havva Demircan
Plastic surgery and reconstruction
Person in charge of the clinic

2.  Consisted of the formation of anatomical
and structural units taken from human
receiver and includes more than one
tissue,
 Provides to become vigorous with the
unification of the nerves after the
transplantation

3.  To bring in motion and sense by the
coaptation of the nerves
 Depends on blood circulation and when
there is not, the duration of it should be
very brief

4.  Possibility of rejection by the recipient and
the necessity to utilize drugs for the
immune system,
Defined as vascularization composite
allogreft, face, hand, foot, larynx,
abdominal wall, small intestine,etc., such
constitutions is the transplantation from
cadaver to the patient which has one or
more content tissues.

5.  The first face transplantion was performed
on the patient named İ.D. in France, 2005.

6. The first composite tissue transplantation in
Turkey, bilateral arm transplantation, was
performed by Prof. Dr. Ömer Özkan and
his team at the Akdeniz University Hospital
in September, 2010. 10 composite tissue
transplantations were being performed in
our country and 7 of these occurred in our
hospital.

7. This transplantations:
 Bilateral arm transplantation
 Uterus transplantation
 Bilateral arm and lower extremity
transplantation
 Face transplantation (4 total, 1 partial)

8. Content:
 Story of the medical process
 Nursing care
 Discharge education

9.  Name of the patient: T.Ç.
 Sex: Male
 Age: 35
 Educational level: Primary school
 Job: Gardener
 Marital status: Single

10.  When our patient was at his 3.5 age, he fell
in the oven and burned his whole face,
frontal hair skin and right ear. The patient
has been operated five times after the
treatments with the adjustment of
reconstruction, but the expected changes
did not occur in his/her face.
 This situation made him very sad when
people were afraid and felt sorry for him
when they saw his face and they turned
their faces against him and the children
moved away by screaming.

11.  Our patient made some researches about
face transplantation and collected some
information from the internet and the
media. He decided to undergo a
transplantation when he saw the first face
transplant news in Turkey.

12.  He admited to Akdeniz University Hospital
in February, 2012. preoperative
administration took three months, when
the appropriate donor was found, the
operation of total face transplantation to
our patient, named as T.Ç, was completed
on 15 May 2012.
The transplantation was performed on the
patient named T.Ç. to his whole skin,
mimic muscles, eyelids, tear ducts,
hairskin and right ear.

15.  Routine anaesthesia revisal
 Color tone of skin (fitzpatrick classification)
 X-Ray
 Transplantation scans(Eliza, HIV, CMV,
HLLA...)
 Blood group assignation
 Confirmation of Scientific Committee

16.  Collacating periodical meetings during 3
months our patient has been prepared for
face transplantation socially, physically
and psychologically. Side effects of
İmmunosuppressive drugs was told and
confirmation was taken for the operation.

17.  After fourteen-hour operation patient was
taken to intensive care unit.
 After monitarisation, to be able to ensure
the balance of liquid electrolyte % 0,9+% 5
dextrose was transfused. Electrolytes
which have to be put into place were
planned.
By giving semi-fowler position to the
patient, immobilization of flap was obtained
properly.

18.  At first half an hour taking vital findings,
urine volume and IV liqiuds (% 0,45 NaCI)
were noted.
 To ensure vasodilatation and to increase
tissue perfusion light source was flashed
on to the tranplanted face.
 Body temperature of patient was held at
36,5 C˚
 Due to order of the doctor
immunosuppressive therapy was started. .

23.  48x1 temperature-pulse-breath and SPO2
have been chased on our patient
 Given and Taken Fluids Persuasion was
made per hour.

 According to the Doctor’s order, these
were given properly, IV serums, blood ( 5
unit RBC, 3 units Fresh Frozen Plazma)
and as cures ( ATG, antibiotics, steroid…).

24.  On postoperative day 1 he separated
from T tube and mechanical ventilator
 On postoperative day 2 his tracheostomy
tube was removed.
 On postoperative day 3 he could
respirate spontaneously , transfered to
our clinic.

25.  For the patient, single room has been
prepared. Cleaning and dysenfection of
the room has been made.
 To the room oxygen and aspiration system
was set up. The monitor was put into the
room.
 Two light sources have been put into.
 Medicines and devices to be used for
patient, was prepared..
 Personal blood pressure monitor,
stethoscope, pulse oximetre device and
infusion equipment were put into the room.

26.  One refrigerator and Tv was available in
the room.
 In the room there was a nursing care
dossier, glove mask, shirt, and hand
disinfectant.
 The scrutiny panel was also available in
the room. The results were being recorded
by the doctor.

27.  We paid attention to form a silent and safe
place for the patient.
 The security was being kept 24 hour to
prevent the antries and the exits of the
room.
 The mirror inside the room was covered
up to prevent the patient saw his face from
the mirror

29. TRANSFERE OF THE PATİENT TO OUR
SERVİCE

32.  Preventing the complication and early
acknowledgement of the session , the
interference to apply the planning of the
treatments.
 Providing of the new face to utilize at the
most efficient level.

33.  to maintain the normal limit of the
hemodynamic situation of the patient
 Providing of the adaptation to his new face
and provide psychological support to
enhance the quality of his life.

34.  Because of his healthy general situation,
the patient was transported to our service
on postoperative day 3.
 The patient has been taken to the insulated
room.
 The continuety of the liquids ıv is provided
after monitorization of the patient.
 Diagnosis of vital findings , ıntravenous
fluıds(%0,45 NaCl, AT6, anthibiotic,
steroid…) amount of the urine were all
recorded.
 The flanks of the bed were removed for the
safety of the patient.

35.  The vital findigs was being recorded
hourly. TA:143/87 mmhg, Pulse:96/min,
left: 24/min, T: 36,8C
 Intravenous fluıds and urine output was
recorded hourly.
 Flap immobilization has been provided to
the face by given the semi fowler position.

36.  Anthibiotic and immunesupressive drugs
was given at the right dose and planning
with doctor’s permission.
 Patient’s blood patterns were taken every
morning ( hemogram, cd3, Tacrolimus
bun, creatine, electrlits, CRP, down
ast,pt,inr)


37.  The revision surgery for correction of ptosis
(falling of the eyelid) was performed on
postoperative day 22 (Drain was sustained
which provided the nasolacrimal canal open
at the time of the operation.
 The level of the blood glucose rised at the
postoperative day 68. (glucose: 287mg/dl.
Consultation was demanded from
theendocrine department. Follow up were
held 7x1 a day of the blood glucose.
 The diet was converted to diabetic food.
 The patient started to use novonorm tablets.
His blood glucose turned into normal level in
one week.

38.  The daily care of cathetery and foley was
done with water and soapy water.
 The catheter and incision lines was
controlled to to avoid infection everyday.
 The catheter of the patient was removed by
the doctor because of the risk of injection.
 The performing date of IV Catheter was
recorded on the serum set and was changed
to new one every 72 hours.

39.  The patient was being helped with the shower.
 The treatments was being held with expressing
what to do to the patient and his relatives and
provided them to participate.
 Eye drops were put regularly every day 4x1.
 Self cure was corresponded. ( shower, shaving,
oral care was made with sodiumbicarbonat.
Micostatin drops was used 4x1.
 The importance of personal cleaning was told to
the patient and his relatives.

40.  İmmunesupressives: Prograf caps, Cellcept tb,
Prednol ampul , Deltacortyl tb, ATG flk .
 H2 receptor antagonist and bronchodilator:
Ulcuran amp. Omeprol cps .Asist amp.
 Antikoagulan: Clexan 0,4
 Anthibiotics: Antiviral, Antifungal: Tazocin flk,
Bactrim tb, Meronem flk, Cosmofungin
flk,Cmevene flk, Valcayt tb.
 Eye drops: Kemicettin pom. Gentagutt dam.
Exocin coll, Refrech coll. Siccopos jel. Nevanac
gutt.
 Other drugs: Diltizem tb, Parol tb, Novonorm tb

41.  İmmunesupression: The immunesupressive treatment is
necessary even if the ideal tissue donors is founded in
order to prevent organ rejection.
 Cellcept: Prevents the increasing of the T and B
Lymphocyte. Leukopenia (%5) possibility of GIS
bleeding or perforation, rigorous of nausea, and vomit, (
The drug was given on an empty stomach to increase
the absorption)
 Tacrolimus: to reduce the activity of the patient’s immune
system and so lower the risk of organ rejection.
Possibility to observe HT,kidney function failure, KCFT,
DEFORMİTY, diabetes, hand tremor, sleep disorder.(
orange juice was given to the patient after diner 2-3
hour.

42.  The speed and depth of respiration was
being assessed by giving the semi fowler
position after the acceptance of the patient
named T.Ç.
 He was followed up after the monitorization.
 The SPO was checked hourly.
 O2 was given to the patient if it were
necessary.
 There was not any respiration failure.

43.  The nourishment started with liquid food
after the 7th day of the postoperative.
(Neutropenic food)
 The patient passed to solid food at the 14th
day. There was a cooperation with the dietist
for enteral nutrition.
 The nutrition was provided with foods of a
rich source of protein.
 The patient was advised about the steroid
drugs which would increase the desire for
food.The after effects was being watched of
the immunesupressive operation upon GİS

44.  The patient was mobilized to support at the
10th day of the postoperative.
 The patient and his relatives were being
informed about the importance of the
mobilization.
 The physical therapy was applied to the flap
on his face on the 20th day of postoperative.
 The patient got support from the psychiatry
before meeting his new face and he was
provided with regular meetings.

45.  The sleep pattern of the patient was asked at
his home ( 6-7 hours at night )
 The reasons of hindrance of his sleep was
investigated of the patient. ( to harm the flap
at his face, the immensity of the operation,
curiosity on his new face and what will
happen in his life with his new face..)
 The patient was allowed to express his self
and his anxiety.

46.  Providing the tissue perfusion regularly,
 The immobilization of the flap was applied to
the patient after given the semi fowler
position with the doctor.
 The colour and heat of the flap were followed
up hourly. The changes were being informed
to the doctor.
 The application of light source was done to
protect the heat and to increase the flap
perfusion.
 Liquid and drug treatments were applied
regularly according to the will of the doctor.

47.  Anxiety and fears for the future were
researched of the patient. (fear of rejection of
what will happen with his new face in his life )
 The patient was enough informed about the
operation and applications before hand.
 The information given to the patient were
simple and clear.
 The patient and his relatives were being
inspired about asking some questions about
the disease.

49.  The patient was provided to Express his
emotions about what will happen or
change in his life with his new face.
 The patient was allowed to express his
self and his anxiety. The patient and his
family were supported.
 He was being informed about how to deal
with stress.
 He was also being informed about the
awareness of his new face and how to
deal with it.

50.  The patient was being informed of any risk
against the rejection of the patient’s
temperature rising to 37.7 Celsius
 Gulucose over 100 mg/dl – 130 mg/dl, TA
over 140 mgHg
 He was also being informed that he could
feel pain and burning while urinating
 The phone numbers were given to the patient
in any case of feeling any heat at his face,
fried, or sensitivity.
 The patient was also being informed to take
the medicine regularly and at the right time.

51.  The patient was demanded for protection
against the risk of infection.
 Medicine of immunesupressive inhibits the
immune system
 The patient was asked to pay attention to his
nourishment and diet and must avoid food
which is undercooked.
 The patient must not hug or kiss anybody
and he must be avoided by those people who
can be an infectious disease.
 The patient was also informed about the
importance of the mouth hygiene.

52.  The medicine should be consumed at
recommended doses and hour, and when
he forgot to consume it, he need to have a
reserve medicine.
 The patient was told not to drink grapefruit
water because it dissolves the interaction.

53.  The patient was asked to bring the medicine
time schedule with his to the controls.
 During the trip, the patient was informed
about keeping the medicine with his and
should not be delivered the medicine box to
the baggage, and the medicine should be
well protected from the warmth, cold and the
sun.

54.  Washing of the raw vegetables and the
fruits propery.
 Being fiber-containing diets with high level
of protein
 Consuming 2.5 lt. water a day
 The patient was proposed not to gain
weight.

55.  The importance of mobilization
 Avoiding exercises which requires too
much effort and energy.
 Jogging was told which is appropriate 3-4 ,
30-40 minutes a week.

56.  The persons and the numbers are given to
the patient on any case.
 The patient was also being informed about
when to come to the medical
establishment and his family was also
being informed about the appointments.

57.  With the applications of plastic surgery,
the development of the quality of life is
provided physically, psychological and
social dimensions. (which deals with
humans life)

59.  Nursing care
plays an
important role
in asserting
the operation
process of
the patient
and helps the
transplanted
patients to
gain their
conducting
ability of life.