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Isabelle Dinoire (3 February 1967 – 22 April 2016) was a French woman who was the first person to undergo a partial face transplant, after her pet dog severely injured her face while she was passed out from an overdose of sleeping pills in May 2005. She underwent a 15-hour operation in November 2005 in which surgeons transplanted the nose, lips and chin from a brain-dead donor at a hospital in Amiens. She died at age 49 in April 2016, though her death was not announced until more than four months later.

Personal life

Dinoire lived in Valenciennes, northern France, and she was the mother of two children.

Mutilation incident

Dinoire took a large number of sleeping pills and neither woke up nor felt any pain while the dog mutilated her face. When she woke up it took her a while to realize what had happened. Dinoire's injuries affected her nose, lips, chin, and cheeks. In a statement made on 6 February 2006, Dinoire said that "after a very upsetting week, with many personal problems, I took some pills to forget ... I fainted and fell on the ground, hitting a piece of furniture."

Some reports following the initial surgery claim that her daughter said that the black cross of a Labrador and a Beauceron named Tania was "frantically" trying to wake Dinoire after she took sleeping pills in a suicide attempt, and that Dinoire wrote about her suicidal feelings in her own memoir. The hospital denied this, saying that she said she had taken a pill to go to sleep after a family argument and was bitten by her dog during the night.

Dinoire's daughter reported that the family is sure that the dog, which was euthanized, mutilated Dinoire by accident. They believe that the damage was caused when the dog, finding Dinoire wouldn't wake up, got more and more frantic, and began scratching and clawing her. Dinoire was "heartbroken" when Tania was euthanized and kept a picture of the dog by her hospital bed; she later adopted a different dog to aid in her recovery after surgery.

Doctors and the media debated whether the donor and/or the recipient had attempted suicide, with reports stating that the donor had hanged herself. The family of the donor told the funeral director who handled the donor's death that it had been accidental. Local French newspapers stated that Dinoire's daughter said that her mother had attempted suicide. Dubernard said that the recipient had not tried to kill herself. Olivier Jardé, an orthopedic surgeon from Amiens and a member of the French National Assembly, said that both the donor and the recipient had attempted suicide. The Sunday Times, a British newspaper, stated that Dinoire had said in a telephone interview that she had tried to commit suicide. In her 2007 memoir, Dinoire stated that the donor had killed herself, and this "gave Dinoire a feeling of sisterhood" with her.

Premortem animal depredating injury

What happened to Dinoire is described in medical literature as premortem animal depredating inury, a rare case of domestic animal depredation that can happen to people in a state of deep unconsciousness. This is a phenomena similar to post mortem animal depredating injury. There are several theories as to why pets start to mutilate their owners. Attempts to wake the owner up that escalate, displacement behavior resulting from the atypical human behavior and starvation are 3 possible reasons mentioned in scientific papers. It is typical that unclothed areas are affected first. In such cases, the mutilation of the face is described as extensive, including removal of facial features and the scalp.

Partial face transplant

The first partial face transplant surgery on a living human was performed on Dinoire on 27 November 2005 by Bernard Devauchelle, assisted by Jean-Michel Dubernard at the Centre hospitalier Universitaire Nord in Amiens, France. A triangle of face tissue, including the nose and mouth, was taken from a brain-dead female donor and grafted onto the patient. Scientists elsewhere had performed scalp and ear transplants, but the claim was the first for the transplant of a mouth and nose, the most difficult parts of the face to transplant. Dinoire was also given bone marrow cells to prevent rejection of the tissue. According to The Times, she had signed a contract with British documentary maker Michael Hughes before the operation.

Recovery

In 2009, Dinoire's doctors reported she was recovering well. Exactly one year following the partial face transplant, Dinoire stated she had the ability to smile again. On 28 November 2006, Dinoire's surgeon, Bernard Devauchelle, said that over the past year Dinoire's scars had become far less prominent.

There was a change in her appearance, as her original face had a wide, tilted nose, a prominent chin and thin lips, but the donated face gave her a straight and narrow nose, a smaller chin and a fuller mouth. In 2008, Dinoire admitted in an interview that she sometimes struggled to accept the appearance of her transplanted face, as she had expected it to look more like her own, saying: "It takes an awful lot of time to get used to someone else's face." In the same interview, she reported that full sensitivity had returned to her face.

The Associated Press released a picture of Dinoire on 28 November 2006, one year after the operation. The French newspaper Le Monde's website explained on 2 December 2006 that the Associated Press had eliminated the picture, because "The hair of Isabelle Dinoire and the background of this image were manipulated by the source."

On the second anniversary of the operation, her doctors published an article in the New England Journal of Medicine detailing her operation and recovery. Complications have included kidney failure and two episodes of tissue rejection (one after one month and one after one year), which have been suppressed by drugs. Dinoire had to take the drugs for the rest of her life. A Boston doctor said if she stopped taking drugs, her scenario would be a "disaster", with the new face sloughing off over time. Part of her pre-operative screening included psychological evaluations to ensure she would be capable of maintaining her treatment regimen and also could accept and withstand the effects of having a dead person's face grafted onto her own.

Illness and death

Dinoire died of cancer at a French hospital in April 2016. Her death was not announced until September 2016 to give her family privacy, according to hospital officials. According to newspaper Le Figaro, Dinoire's body had rejected the transplant in 2015 "and she had lost part of the use of her lips." The daily immunosuppressive drugs she was required to take left her vulnerable to cancer. Two cancers had developed, the paper said.

Similar cases

• A 54-year-old woman from England passed out from alcohol and her pet dog caused severe tissue defect to her face while she was unconscious.
• A 74-year-old woman from Germany passed out from a mixture of alcohol and zopiclone and her small pet dog severely injured her buttocks region.

See also

• Connie Culp
• Dallas Wiens
• Bohdan Pomahač

External links

• Preoperative, premauling image of Isabelle Dinoire Archived 14 May 2006 at the Wayback Machine
• Immediately postoperative image of Isabelle Diniore compared with one year later
• La femme a deux visages. Le Monde (in French). 6 July 2007. Interview with Isabelle Dinoire.

References

1. Chrisafis, Angelique (6 September 2016). "Woman who received the world's first partial face transplant dies". The Guardian.
2. Bromwich, Jonah (8 September 2016). "Isabelle Dinoire, Recipient of First Partial Facial Transplant, Dies at 49". The New York Times.
3. "World's fifth face transplant: Man gets new nose, mouth and chin after shooting accident.", Daily Telegraph, 27 March 2009
4. ^ Associated Press, 11 April 2009, accessed 11 April 2009
5. Cojean, Annick (6 July 2007). "La femme aux deux visages". Le Monde (in French). Retrieved 16 December 2024.
6. The Independent Archived 9 February 2006 at the Wayback Machine Face transplant recipient Isabelle Dinoire faces the world Published: 7 February 2006
7. Cojean, Annick (6 July 2007). "La femme aux deux visages". Le Monde (Interview) (in French). Retrieved 15 December 2024. Je n'ai guère envie de m'attarder sur les circonstances de l'accident qui a bouleversé ma vie. Disons que ma chienne Tania - un labrador croisé beauceron qui n'avait jamais mordu - m'a arraché le visage. C'était pendant la nuit, j'étais assommée par un grand nombre de somnifères, et il est possible qu'elle ait voulu me réveiller. [I don't want to dwell on the circumstances of the accident that turned my life upside down. Let's just say that my dog Tania - a Labrador and Beauceron cross who had never bitten before - bit my face off. It was during the night, I was knocked out by a large number of sleeping pills, and it's possible that she wanted to wake me up.]
8. ^ "Newsmakers of the week: October 22". Macleans. 22 October 2007. Archived from the original on 6 March 2012. Retrieved 11 April 2009.
9. ^ Schindehette, Susan (19 December 2005). "Bold New Surgery Gives a Woman a New Face". People. Retrieved 11 April 2009.
10. ^ Smith, Craig S. (14 December 2005). "As a Face Transplant Heals, Flurries of Questions Arise". The New York Times.
11. Duval, Inga; Doberentz, Elke; Madea, Burkhard (1 June 2022). "Vitale anale Tierfraßverletzung durch einen Dackel". Rechtsmedizin (in German). 32 (3): 217–220. doi:10.1007/s00194-021-00545-x. ISSN 1434-5196.
12. Erkol, Zerrin; Hösükler, Erdem (14 February 2018), "Postmortem Animal Attacks on Human Corpses", Post Mortem Examination and Autopsy - Current Issues From Death to Laboratory Analysis, IntechOpen, ISBN 978-953-51-3793-1, retrieved 16 December 2024
13. Buschmann, C.; Solarino, B.; Püschel, K.; Czubaiko, F.; Heinze, S.; Tsokos, M. (1 December 2011). "Post-mortem decapitation by domestic dogs: three case reports and review of the literature". Forensic Science, Medicine, and Pathology. 7 (4): 344–349. doi:10.1007/s12024-011-9233-x. ISSN 1556-2891.
14. De-Giorgio, Fabio; Grassi, Simone; Berketa, John William (1 July 2019). "A case of Jack Russel Terrier scavenging: Images and three dimensional models for forensic interpretation". Journal of Forensic and Legal Medicine. 65: 105–107. doi:10.1016/j.jflm.2019.05.009. ISSN 1752-928X.
15. "Woman has first face transplant". BBC News. 30 November 2005. Archived from the original on 2 December 2005.
16. "World-first partial face transplant". The Sydney Morning Herald. 1 December 2005.
17. "French Doctors Do New Face Transplant". The Washington Post. 23 January 2007.
18. Face transplant woman to profit from picture sales, The Times, 8 December 2005
19. "7 face transplants have been done worldwide". Associated Press. 10 April 2009. Retrieved 11 April 2009.
20. "Face transplant woman can smile". 28 November 2006 – via bbc.co.uk.
21. Allen, Peter (2 November 2008). "Face transplant woman struggles with identity". The Daily Telegraph. London. Retrieved 5 May 2010.
22. "'She's perfect,' doctor says of face transplant patient." Associated Press at CTV News. Wednesday 12 December 2007. Retrieved on 20 January 2009.
23. "Transplant rejection: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 6 September 2016.
24. Anne Jouan (6 September 2016). "Décès d'Isabelle Dinoire, première greffée du visage" [Death of Isabelle Dinoire, first facial grafted]. Le Figaro (in French). Retrieved 6 September 2016.
25. "World's first face transplant recipient Isabelle Dinoire dies of cancer". The Daily Telegraph. 6 September 2016. Retrieved 6 September 2016.
26. "'My dog ate my face, but saved me'". BBC News. Retrieved 16 December 2024.
27. Duval, Inga; Doberentz, Elke; Madea, Burkhard (1 June 2022). "Vitale anale Tierfraßverletzung durch einen Dackel". Rechtsmedizin (in German). 32 (3): 217–220. doi:10.1007/s00194-021-00545-x. ISSN 1434-5196.

• 1967 births
• Face transplant recipients
• People from Valenciennes
• 2016 deaths
• Deaths from cancer in France