Saving Face

When Mycha Herbert was two, the family dog bit off his nose, cheeks, and lips. It took a team of Dallas surgeons almost forty hours to recreate them.

On Labor Day, 1998, Dr. A. Jay Burns, a plastic surgeon affiliated with the Children’s Medical Center of Dallas, got a call from a colleague at St. Francis Hospital in Tulsa, Oklahoma. “We’ve got a severe facial-trauma case to send you,” Burns recalls his friend saying, “a dog mauling like you’ve never seen before. We’ve done what we can to stabilize the patient, a two-year-old boy who was bitten by the family dog.”

Burns remembers telling his friend that it couldn’t be that big a deal. At 42, he had seen a lot of horrific facial injuries in his time and performed many difficult facial reconstructions. And he knew that what might seem like an extraordinary case of trauma to a smaller hospital like St. Francis was likely a routine case at Children’s, which has the busiest pediatric emergency room in the nation. “It was a dog bite,” he remembers thinking. “How bad could it be?”

But when he first saw little Mycha Herbert in Children’s Pediatric Intensive Care Unit three days after the incident, Burns says, “I was completely overwhelmed. I’d never seen anything like it before, and I knew I’d never see anything like it again.”

From just below his eyes to just under his chin, the toddler’s face had been filleted from the bone by the dog’s powerful jaws. The tissues of his cheeks, nose, lips, mouth, and chin were simply gone, leaving only the glistening white bone of his skull and two very stunned eyes where once there had been an impish face. Though Mycha’s tongue and teeth were intact, the damage was so total that the doctors at St. Francis had had to insert a tube through his throat so that he could breathe and a feeding tube directly into his stomach so that he could receive nourishment. Mycha’s parents — Bobby, 24, and Veronika, 19 — weren’t certain what had happened, but it appeared that their son had startled the family dog, a six-month-old Staffordshire terrier named Blue, and the dog had snapped at Mycha, locking his jaws on the lower two thirds of the boy’s face with a single bite. Mycha must have then stumbled, causing the facial tissue to shear off the cranium more or less in a single piece.

“For the first time in my career, I truly didn’t know what to do,” says Burns, a rangy, baby-faced man with a receding hairline and a self-effacing manner. But he knew instinctively that whatever solution he devised for Mycha (pronounced Mi-cah), he was probably going to make history with it. Reconstructive facial surgery had come a long way in just the decade and a half that he’d been practicing it. Vascular microsurgery had made the transfer of so-called free flaps — patches of tissue that include skin, muscle, fat, blood vessels, and nerves — from one place on the body to another a fairly routine matter, without the need for awkward connecting tubes of tissue (called pedicles) to supply blood to the grafted site, and improved anti-rejection drugs were allowing even grafts from donors to “take.” The occasional miracle was now possible. Still, as far as Burns knew, creating essentially a whole new face for a patient out of his own tissue had never been tried before.

So he began networking with colleagues for suggestions. Two serious options emerged. One, proposed by Dr. Steve Byrd, was a wholesale face transplant from a donor. This had never been done either, but the doctors learned from experts in the field that new techniques and medications made it at least feasible. However, they realized that a transplant would involve a lot of red tape — advertising for and finding a donor, for starters. “We just ran out of time,” recalls the 53-year-old Byrd. “We had a kid on a respirator we needed to save.”

The second option was even more daunting than a transplant. Though the most flap transfers any reconstructive surgeon had ever attempted in repairing a damaged face was three, Burns and Byrd could see how grafting as many as five flaps to intact tissue on different parts of the boy’s exposed skull could give surgeons the flexibility necessary to fashion somewhat more-normal facial features, restore more muscle movement and strength, and better re-establish nerve conduction. But

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