2000 HYUNDAI ACCENT REPAIR MANUAL

Amiens University Hospital, via Reuters

A woman who received a partial face transplant was taken from the operation in Amiens, as shown in this image released Friday in Lyon.

December 3, 2005
Dire Wounds, a New Face, a Glimpse in a Mirror
By CRAIG S. SMITH

LYON, France, Dec. 2 - The world's first person to wear a new face awoke Monday, 24 hours after her operation in the northern city of Amiens, and looked in the mirror.

The swollen nose, lips and chin she saw there were not her own - those had been ripped from her head by her pet Labrador in May - but for the 38-year-old woman, whose face had become a raw, lipless grimace, they were close enough. She took a pen and paper and wrote for the doctors, "Merci."

On Friday, those doctors defended their rush to give the woman a partial face transplant just months after her disfigurement, despite the enormous risks of death and psychological difficulties. They dismissed objections that they were bent on glory at the expense of the patient, whose identity is being withheld at her request.

"We are doctors," said Jean-Michel Dubernard, who led the transplant team and who helped carry out the first hand transplant in Lyon seven years ago. "We had a patient with a very severe disfigurement that would have been extremely difficult, if not impossible, to repair with classic surgery."

In a news conference at Edouard-Herriot Hospital in Lyon, where the patient was transferred for monitoring of immunosuppressive therapy that will continue throughout her life, the doctors explained how the woman's gruesome wounds almost immediately made her a candidate for the world's first face transplant. They heatedly denied local news reports that quoted her estranged teenage daughter as saying she was suicidal, raising questions about whether she was psychologically stable enough for the operation.

Dr. Dubernard has faced such accusations before. Clint Hallam, the man he selected for the world's first hand transplant, refused to keep up with the lifelong drug regimen required to suppress immune responses, along with regular exercises to train the new hand. After three years he had the hand removed.

According to Dr. Dubernard, the woman had quarreled with her daughter one evening in May at her home in the northern city of Valenciennes, and the daughter had left to spend the night at her grandmother's.

The woman was agitated, he said, and took a sleeping pill. At some point during the night, he said, she arose and stumbled through the house, encountering the dog.

Local news reports have suggested that the woman, who is divorced, fell unconscious and that the dog chewed and clawed her face in an attempt to revive her. But Dr. Dubernard said the dog had been adopted from the local pound and was known to be aggressive. The dog has since been destroyed.

Shortly after the woman's injury, Dr. Bernard Devauchelle, head of face and jaw surgery at Amiens University Hospital, decided that the woman was a candidate for a partial face transplant and sent an urgent request for help in locating a donor to the French Biomedicine Agency, which oversees the allocation of organs for transplant in France. The window for a successful transplant was narrow, the doctors said, because the wound was developing scar tissue.

Dr. Benoit Lengele, a Belgian surgeon who assisted in the transplant, said the woman would have required at least three or four traditional plastic surgery operations to rebuild her face with skin flaps from other parts of her body, but the results would never have been aesthetically or functionally satisfactory.

Meanwhile, the woman's injury had made it difficult for her to talk or even drink and eat, because food and liquid spilled easily from her mouth. The doctors said her ability to open her jaw was also progressively diminishing as her wounded tissue stiffened. In July, Dr. Devauchelle consulted with Dr. Dubernard, who visited the woman in early August.

"The moment she removed her mask, which she always wore, I had no more hesitation," Dr. Dubernard said Friday.

No information was given about the donor, a brain-dead woman whose anonymity is protected by law. She was located on Saturday at a hospital in the northern city of Lille, 85 miles from Amiens.

Brain-dead patients in France are presumed to be organ donors unless they have made explicit provisions to the contrary, and approval by next of kin is not normally required. But given the delicacy of the case, the donor's family was consulted about the possible harvesting of part of the donor's face during the initial interviews that are undertaken to ensure that the deceased had not given instructions preventing organ donations.

A special team of psychologists worked with the family on Saturday afternoon as the doctors involved were notified that a potential donor had been found. By midnight Saturday, Dr. Devauchelle, who led the surgical team, was in Lille to begin harvesting the

Manufacturer: Boeing Rocketdyne

Date: 2004

Country of Origin: United States of America

Dimensions:
Overall: 9ft 9in. x 13ft 6in. x 7ft 8in., 14125lb. (297.18 x 411.48 x 233.68cm, 6407.1kg)

Materials:
Nozzle, partly steel; throat, copper; injector plate, steel; pipes along nozzle, non-ferrous metal; hoops around nozzle, non-ferrous metal; bulbous joint, on main pipe, on powerhead, steel; 6-inch pipe, steel; smaller pipes, primarily aluminum, some with diagonal yellow plastic wrappings; red rubber pipe holders on both sides of powerhead; impeller or pump, on left, non-ferrous metal; equi-distant nuts around this impeller, non-ferrous metal; identical impeller on right, steel; clear covering over cutaways of both impellers, plexiglass; largest, curved, main pipe around top of powerhead, from back of left impeller to back of right impeller, steel; low, V-shaped large pipe at bottom of powerhead, non-ferrous; sphere under lower right of powerhead, near right impeller, non-ferrous; black plastic wire protectors on right side of powerhead; large rectangle protruding at angle on right side of powerhead, with many electrical cables leading into it, with black and white plastic insulated wires, some wires with braided, silver, non-ferrous metal insulation; others exposed; some with white plastic covering and soft, fabric insulation; transporter, overall, steel

This is the Space Shuttle Main Engine (SSME). Three SSME's plus two Solid Rocket Boosters (SRBs) power the reusable Space Shuttle. Each SSME produces 375,000 lbs of thrust or a total of 1,125,000 lbs and uses liquid oxygen and liquid hydrogen as propellants.

This SSME is made of up of components of SSMEs that have flown into space. The flights have included the first four Shuttle missions, the second Hubble Space Telescope repair mission, the missions that launched the Magellan and Galileo space probes, and the John Glenn flight. The engine was donated by Rocketdyne to the Smithsonian in 2004.

Smithsonian National Air and Space Museum Steven F. Udvar-Hazy Center Virginia