0:00:02 > 0:00:04This programme contains some strong language from the start
0:00:04 > 0:00:08and some scenes which some viewers may find upsetting
0:00:08 > 0:00:13The survival rate amongst injured troops in Afghanistan is the highest in the history of combat.
0:00:13 > 0:00:17Wound on the right thigh. There's a massive wound on the right thigh.
0:00:24 > 0:00:27But keeping them alive is just the beginning.
0:00:27 > 0:00:31These unexpected survivors often have dreadful injuries.
0:00:31 > 0:00:34They're young and they have a lifetime ahead of them.
0:00:34 > 0:00:40'I want to see what medical science is doing to help them rebuild their lives...'
0:00:40 > 0:00:44- Can you imagine yourself back in Afghanistan?- Yeah, that's my job. That's what I do.
0:00:45 > 0:00:50'..from extraordinary prosthetics to growing spare body parts.'
0:00:50 > 0:00:54This doesn't look like the beginning of a scientific revolution, does it?
0:00:57 > 0:01:03'I want to find out how the conflict is driving areas of innovation that could help many of us.
0:01:03 > 0:01:05'From hand transplants...'
0:01:05 > 0:01:09There's something extraordinary about the idea that this was once on somebody else.
0:01:09 > 0:01:14'..to giving this man an entirely new face.'
0:01:14 > 0:01:19As I chat to you, I forget that this face came from somebody who died.
0:01:28 > 0:01:32Earlier this year I was in Camp Bastion in Afghanistan.
0:01:32 > 0:01:36I saw lots of troops brought in with horrific injuries.
0:01:36 > 0:01:41The injuries are: left below-knee, right below-knee with tissue damage up to the groin.
0:01:43 > 0:01:45When I was training as a doctor
0:01:45 > 0:01:50I saw some pretty terrible things, so I thought I was hardened.
0:01:53 > 0:01:57But the fact they were all so young really got to me.
0:01:59 > 0:02:03Like Corporal Chuck Donnelly, brought in with his left foot barely attached.
0:02:03 > 0:02:08Suffered from an IED blast, approximately 45 minutes ago.
0:02:08 > 0:02:09Do you know what happened?
0:02:09 > 0:02:14I stepped on a fuckin' IED.
0:02:20 > 0:02:24He's probably the same age as my son, Alex. 20.
0:02:26 > 0:02:32It's really upsetting. Really, really upsetting. These guys are so young. Really young.
0:02:32 > 0:02:37I was deeply affected by what had happened to him and to many others.
0:02:40 > 0:02:45Now I'm travelling to America to catch up with Chuck, but also
0:02:45 > 0:02:49to find out how this conflict is driving medical research.
0:02:55 > 0:03:00When I last saw Chuck it was touch and go whether he'd be able to keep his left foot.
0:03:00 > 0:03:03So I'm really keen to see how he's getting on.
0:03:04 > 0:03:09- Hi, Chuck.- Hi, Michael, how are you doing?- Very good. Very nice to see you.- Great to see you as well.
0:03:09 > 0:03:11I have to say you're looking fantastic.
0:03:11 > 0:03:17- Thank you very much.- The last time I saw you, you were not looking great. - It was a rough patch.
0:03:17 > 0:03:21- But you lost a leg.- It wasn't going to be too conducive to keep it,
0:03:21 > 0:03:25so we made the decision to have it come off.
0:03:25 > 0:03:33- How did you decide?- It was a no-brainer. They told me that the injury was so extensive that
0:03:33 > 0:03:37it was going to be 6-12 months before they could even start repairing the foot,
0:03:37 > 0:03:41and then there would be time for healing, so they told me
0:03:41 > 0:03:45it would be about a year before I'd be able to stand on it.
0:03:45 > 0:03:47And that's barring any infections.
0:03:47 > 0:03:52You want to get back to where you were. You want to be able to run, play sports,
0:03:52 > 0:03:58and once I got my leg cut off I was up walking around three weeks later.
0:03:58 > 0:04:00It was an ideal choice for me.
0:04:00 > 0:04:06- How's this one, then? - The difficulty with this leg is it's always at a 90 degree.
0:04:06 > 0:04:10That's where I run into trouble, doing sports, things like that.
0:04:10 > 0:04:11I have no flexion.
0:04:11 > 0:04:18- Is it tiring?- They say it takes 40% more energy to walk with a prosthetic.
0:04:18 > 0:04:21If I walk around on an average day I won't even notice.
0:04:21 > 0:04:28If I do something really strenuous or spend a lot of time on my feet it gets tired quickly.
0:04:28 > 0:04:34- When I saw you before you weren't in a great place. - It was a rough patch there!
0:04:34 > 0:04:37'I was really shocked to see that Chuck had lost his leg.
0:04:37 > 0:04:44'But I was also very impressed at how determined he is not to let his injury hold him back.
0:04:45 > 0:04:47'Chuck is one of many.
0:04:47 > 0:04:49'Because of he widespread use of IEDs -
0:04:49 > 0:04:51'Improvised Explosive Devices -
0:04:51 > 0:04:56'in Afghanistan, the number of amputees has risen dramatically in recent years.'
0:05:02 > 0:05:06This is the Walter Reed National Military Medical Centre.
0:05:06 > 0:05:09It is a vast military hospital.
0:05:09 > 0:05:12You see a lot of soldiers wandering around here.
0:05:12 > 0:05:15Also a lot of people missing limbs.
0:05:17 > 0:05:22'Last year the number of American troops that lost limbs in Afghanistan doubled.
0:05:25 > 0:05:29'I've come to meet head of amputee care Chuck Scoville.'
0:05:29 > 0:05:33It's striking, isn't it? You see all these fit young guns,
0:05:33 > 0:05:37but they just happen to be missing a limb, two limbs or three limbs.
0:05:37 > 0:05:39To me they're kids.
0:05:39 > 0:05:43They're young kids and they're just doing the things that young kids do.
0:05:44 > 0:05:49Very similar age to... I've got three boys and a girl,
0:05:49 > 0:05:52very similar ages to the older ones. 19, 20.
0:05:57 > 0:05:59- Morning.- Hey, how are you doing?
0:05:59 > 0:06:03'Sgt Adam Jacks lost his right leg four months ago.'
0:06:03 > 0:06:08Pretty smooth. How far have you got to go?
0:06:08 > 0:06:12- I usually do about five to eight miles. - What's the next stage?
0:06:12 > 0:06:14Continuing my physical therapy and things like that.
0:06:14 > 0:06:18Once I'm cleared, I do plan on returning back to my unit
0:06:18 > 0:06:20and training with my Marines again.
0:06:20 > 0:06:23Can you imagine yourself back in Afghanistan?
0:06:23 > 0:06:26Yeah, I want to go back, that's my job, that's what I do.
0:06:26 > 0:06:30So without war and things like that I wouldn't have no job.
0:06:30 > 0:06:33'Despite their injuries, it seems that these guys have
0:06:33 > 0:06:37'no intention of giving up their active lives.'
0:06:38 > 0:06:41Do you think there's a difference between military patients
0:06:41 > 0:06:44and civilian patients?
0:06:44 > 0:06:49For the majority of patients, yes. Our military population is a young, active population.
0:06:49 > 0:06:53Their desires and goals are to return to a very high level of function.
0:06:53 > 0:06:56The vast majority of patients on the civilian side
0:06:56 > 0:07:01are an older, often diabetic-disease population.
0:07:01 > 0:07:06So their goals and aspirations are sometimes different than the population we deal with.
0:07:06 > 0:07:12'I do admire the way the troops have such high expectations of themselves and their prosthetics.'
0:07:12 > 0:07:14- Good morning.- How are you?- Good.
0:07:14 > 0:07:18'Captain Bergan Flannigan was injured in February 2010.'
0:07:18 > 0:07:21Is this is your morning ritual?
0:07:21 > 0:07:26Yeah, just water and alcohol, just so it slides on easier.
0:07:26 > 0:07:30- How's this one, then?- It can do anything you want.
0:07:30 > 0:07:34Especially this one. I only wish it was a little lighter.
0:07:34 > 0:07:41when I put my combat boots on, it adds a little and when I'm in uniform it's definitely harder to walk in.
0:07:41 > 0:07:47- What happened?- I was hit by an IED. We were dismounted on a patrol with the Afghan Police.
0:07:47 > 0:07:50As I walked by a motorcycle it blew up.
0:07:50 > 0:07:55Soon as they picked me up and put me on a stretcher, I saw my foot fall on the ground.
0:07:55 > 0:07:56I was like, "Oh, I'm going home!"
0:07:56 > 0:07:58- Can I see you in action?- Yeah, sure.
0:08:02 > 0:08:04Do you try out different sorts of legs?
0:08:04 > 0:08:09- To find one that suits? - This is my fourth one I've tried.
0:08:09 > 0:08:15I've tried two mechanical knees. I liked them, but you definitely have to watch how you're walking.
0:08:15 > 0:08:21If you're just casually walking and you catch something, you're doing down flat on your face.
0:08:21 > 0:08:25- Not a good look! - No, I've done that a lot!
0:08:26 > 0:08:30'These troops have the best artificial limbs there are.
0:08:30 > 0:08:33'Even so, they have limitations.
0:08:33 > 0:08:36'There is constant demand for better.
0:08:38 > 0:08:43'The large numbers of wounded and the extreme nature of their injuries
0:08:43 > 0:08:49'has resulted in the military investing huge amounts of money on new treatments and technologies.'
0:08:51 > 0:08:55The US Department of Defence are spending an awful lot of money
0:08:55 > 0:08:58on medical research and development.
0:08:58 > 0:09:04According to this website they're going to spend nearly 640 million alone this year.
0:09:04 > 0:09:08The research they're mainly interested in is the practical stuff that can be got from the laboratory
0:09:08 > 0:09:12to the patient as quickly as possible.
0:09:16 > 0:09:19'And much of that money is going into improving prosthetics.
0:09:23 > 0:09:28'I'm at the Massachusetts Institute of Technology to meet Professor Hugh Herr,
0:09:28 > 0:09:34'who believes artificial legs could one day be as good as real ones.'
0:09:35 > 0:09:39Morning. Hi there, Hugh.
0:09:41 > 0:09:44Michael Mosley.
0:09:44 > 0:09:51- Hello, Michael.- Hello, I have come to see your legs. - Fantastic, hopefully me as well.
0:09:51 > 0:09:53- Absolutely! Can I have a look? - Sure.
0:09:55 > 0:09:59This is the world's first bionic lower limb.
0:09:59 > 0:10:03'When he was l7, Hugh lost his legs in a climbing accident.
0:10:03 > 0:10:07'so he has a very personal interest in hi-tech prosthetics.'
0:10:07 > 0:10:10It's a beautiful piece of engineering, I must admit.
0:10:10 > 0:10:12Let me chat about how it's attached.
0:10:12 > 0:10:16When I push this button, the leg comes off.
0:10:16 > 0:10:18So I can just pop it off.
0:10:18 > 0:10:20Would you like to...
0:10:20 > 0:10:22Thank you. Oh, that's heavy.
0:10:22 > 0:10:24Can you talk me through it?
0:10:24 > 0:10:29There's a motorised system in here that moves the ankle joint,
0:10:29 > 0:10:33and this is just packed full of electronics.
0:10:33 > 0:10:35There's various computers and sensors inside.
0:10:35 > 0:10:39'It's normally hard work walking with a prosthetic.
0:10:39 > 0:10:42'But Hugh's systems mimics the actions
0:10:42 > 0:10:45'of the muscles and tendons in a human leg.'
0:10:46 > 0:10:50- Can we just stroll around? - Sure, if you give me my leg back!
0:10:52 > 0:10:54That is very neat.
0:10:56 > 0:10:58Do you think you can keep up?
0:10:58 > 0:11:00MICHAEL LAUGHS
0:11:00 > 0:11:03Wow, you're going so fast!
0:11:03 > 0:11:05Slightly squeaky sound.
0:11:05 > 0:11:07Yeah, a bit.
0:11:11 > 0:11:15Very impressive! Right.
0:11:15 > 0:11:17'Hugh understands only too well
0:11:17 > 0:11:20'the limitations of standard prosthetics.'
0:11:20 > 0:11:23There are three problems that amputees face.
0:11:23 > 0:11:26One is they walk with more energy so they're more tired at the end of the day.
0:11:26 > 0:11:28The second is they walk more slowly.
0:11:28 > 0:11:30The third is their stability is arrested.
0:11:30 > 0:11:33It's not uncommon for amputees to fall.
0:11:33 > 0:11:38So this device allows the amputees to walk with normal energy levels.
0:11:38 > 0:11:40We've shown it scientifically.
0:11:40 > 0:11:43It allows people to walk at normal speeds, we've shown it.
0:11:43 > 0:11:44And it improves stability.
0:11:44 > 0:11:49'Hugh's new leg not only reduces the energy it takes to walk,
0:11:49 > 0:11:51'it also helps with balance,
0:11:51 > 0:11:55'detecting what angle the foot should be when it hits the ground.'
0:11:55 > 0:11:59So what happens when you're walking on stairs?
0:11:59 > 0:12:01Can you describe it to me?
0:12:01 > 0:12:03There's five computers and 12 sensors.
0:12:03 > 0:12:07One of the sensors on board is called an inertial measurement unit.
0:12:07 > 0:12:12It was originally developed for missile technology, missile navigation,
0:12:12 > 0:12:17and we're using it on board to determine what speed the person's walking at,
0:12:17 > 0:12:19what the terrain is.
0:12:19 > 0:12:23So the sensor actually tells the computers the orientation,
0:12:23 > 0:12:26the positions of the limb in space.
0:12:26 > 0:12:30From those positions we can determine, are they stepping up a step,
0:12:30 > 0:12:33are they on level surface or a slope? What's the angle of the slope?
0:12:33 > 0:12:37The computers adjust the output of the muscle-like motor system appropriately,
0:12:37 > 0:12:40- giving the person more energy and more stiffness.- Right.
0:12:42 > 0:12:45'This project has been part-financed by the military,
0:12:45 > 0:12:49'which has, so far, invested 7 million.'
0:12:49 > 0:12:54How much difference has military funding made to the development of this sort of thing?
0:12:54 > 0:12:56Tremendous difference.
0:12:56 > 0:12:59Before the conflicts in Iraq and Afghanistan I had to struggle
0:12:59 > 0:13:02to get even a modest amount of money for research.
0:13:02 > 0:13:06So if there hadn't been the conflicts it would have happened but much more slowly?
0:13:06 > 0:13:09Much, much more slowly.
0:13:09 > 0:13:14This is just the beginning. It's going to get far more interesting.
0:13:14 > 0:13:19Next we'll build a bionic knee, which we'll attach to this.
0:13:19 > 0:13:23Ultimately we'll have an ankle and foot that fully articulates
0:13:23 > 0:13:28so we can take over completely the balance of the amputee's body.
0:13:28 > 0:13:33So this is just a modest beginning.
0:13:33 > 0:13:35Imagine where we'll be in 20 years.
0:13:37 > 0:13:42'US troops get this new design of artificial leg free.'
0:13:42 > 0:13:46They hope soon to be able to make it available to civilians,
0:13:46 > 0:13:47albeit at a fairly hefty price.
0:13:49 > 0:13:54I think that Hugh's feet are incredibly impressive.
0:13:54 > 0:13:57To be able to replicate the human feet in that way
0:13:57 > 0:14:01has required a lot of expertise and an awful lot of money.
0:14:01 > 0:14:03Now, some of it has come from the private sector
0:14:03 > 0:14:07but the thing that's really driving it is military funding.
0:14:15 > 0:14:18When I was in Afghanistan, I saw quite a number of young men
0:14:18 > 0:14:21who'd lost their legs as a result of standing on mines.
0:14:21 > 0:14:23And a few others who'd also lost a hand.
0:14:23 > 0:14:29I've was thinking today just how useful your hands are -
0:14:29 > 0:14:32you need them for doing everything, from brushing your teeth,
0:14:32 > 0:14:34feeding yourself, doing up your buttons -
0:14:34 > 0:14:38and just how difficult it would be to live life without a hand.
0:14:38 > 0:14:41'In trying to help upper-limb amputees,
0:14:41 > 0:14:47'the US military have turned to an ingenious way of controlling artificial arms,
0:14:47 > 0:14:51'one originally developed by civilian scientists.
0:14:51 > 0:14:54'It allows the user to control their limb with their mind.
0:14:56 > 0:15:00'I've arranged to meet one of the first people with this system,
0:15:00 > 0:15:03'ex-US Army Sergeant Glen Lehman.'
0:15:04 > 0:15:08Good morning. Hello, Glen. Hello - Michael.
0:15:08 > 0:15:15- So, what happened?- I was on patrol in Iraq on 1st November 2008.
0:15:15 > 0:15:18I was the 4th vehicle in a four-vehicle convoy.
0:15:18 > 0:15:22We were travelling down a road very similar to this.
0:15:22 > 0:15:27My vehicle came to the intersection and they threw two hand grenades at my truck.
0:15:27 > 0:15:30The grenade travelled through and separated the arm here.
0:15:30 > 0:15:35There was a piece of flesh hanging and it travelled the length of the bones on the forearm,
0:15:35 > 0:15:38and it flayed it and exited right here, at my thumb.
0:15:38 > 0:15:41- So there was nothing left? - There was nothing left.
0:15:41 > 0:15:44Can we try going to the store and seeing you in action?
0:15:44 > 0:15:46'Glen operates his artificial arm
0:15:46 > 0:15:50'just by thinking about what he wants it to do.'
0:15:52 > 0:15:54What are you thinking as you do that?
0:15:54 > 0:15:57I'm just thinking about grabbing the bottle with my hand
0:15:57 > 0:16:00and closing my hand and then just picking it up.
0:16:01 > 0:16:04- Does it take a lot of practice? - It does, actually.
0:16:07 > 0:16:09'It's not the arm itself that's really special,
0:16:09 > 0:16:12'but the surgery he had which allows him to control it.'
0:16:18 > 0:16:21'To find out more, I've come back to Walter Reed with Glen
0:16:21 > 0:16:24'to meet his surgeon, Colonel Martin Baechler.'
0:16:25 > 0:16:28- How you doing?- Hi, Dr Baechler. - How you doing?- Good, how are you?
0:16:28 > 0:16:31- Hello. Michael Moseley. - Nice to meet you.
0:16:31 > 0:16:34Why don't you have a seat here. How are things going for you?
0:16:34 > 0:16:38Good. I don't have any problems that I know of.
0:16:38 > 0:16:41Can you take it off? We'll look at your residual limb.
0:16:41 > 0:16:45'Glen had surgery where they took the nerves that once controlled his hand
0:16:45 > 0:16:49'and moved them to the muscles in his upper arm.'
0:16:49 > 0:16:51Flex elbow.
0:16:51 > 0:16:53And extend elbow.
0:16:53 > 0:16:57OK, and close fist, closing hand.
0:16:57 > 0:16:58And palm up.
0:16:58 > 0:17:03So, if you're thinking, basically different muscles are moving,
0:17:03 > 0:17:05and that's what's actually animating the hand?
0:17:05 > 0:17:09Right. Basically the nerves that were cut and used to supply
0:17:09 > 0:17:13the amputated part, we re-routed those to healthy local muscle.
0:17:15 > 0:17:18'Glen's operation was filmed.
0:17:18 > 0:17:22'It's something Glen himself has never seen.'
0:17:23 > 0:17:25So this is the first time you've seen it?
0:17:25 > 0:17:28This is the first time I've seen anything with myself.
0:17:28 > 0:17:31'The operation re-routes the three main nerves
0:17:31 > 0:17:33'that once controlled the amputated hand.'
0:17:33 > 0:17:37It's a very elegant, simplistic surgery.
0:17:37 > 0:17:41It gives you much better intuitive control over your prosthetic.
0:17:41 > 0:17:43That's the median nerve right there.
0:17:43 > 0:17:46So the median nerve would normally be doing what sort of things?
0:17:46 > 0:17:51The median nerve controls the thumb, opposition, controls a large portion of grip
0:17:51 > 0:17:55and controls a large portion of wrist flexion.
0:17:55 > 0:17:59'But now that nerve has been connected to a muscle
0:17:59 > 0:18:00'in his upper arm.'
0:18:00 > 0:18:04Now the median nerve will grow back down into the muscle
0:18:04 > 0:18:05and re-enervate it.
0:18:05 > 0:18:08Now that muscle will contract based on what the brain is thinking
0:18:08 > 0:18:13and the prosthesis will interpret what the brain's thinking by the signal from the muscle.
0:18:14 > 0:18:17'When Glen thinks "open hand",
0:18:17 > 0:18:22'the nerve that would have opened his hand now moves a muscle in his upper arm instead.
0:18:22 > 0:18:25'Electronic sensors detect and respond to that movement.'
0:18:25 > 0:18:29The sensors tell the motorised hand to do exactly what he's thinking.
0:18:29 > 0:18:32They're sensing the electrical activity of the muscle.
0:18:32 > 0:18:35It connects it just like a light switch.
0:18:35 > 0:18:42How did you feel about it when the suggestion was made that Dr Baechler would be re-routing you?
0:18:42 > 0:18:43I was pretty excited.
0:18:43 > 0:18:49The idea of getting more control out of the prosthetic, making it more natural, was pretty exciting to me.
0:18:51 > 0:18:52'The surgery is clever,
0:18:52 > 0:19:00'but the arm itself only has three different movements - a human arm has 30.
0:19:00 > 0:19:04'So, the military are investing 50 million dollars
0:19:04 > 0:19:10'to develop better ones, that are controlled in the same way as Glen's.
0:19:11 > 0:19:16'This one, designed at the John Hopkins University, has 22 different movements.
0:19:17 > 0:19:21'They're hoping to offer it to veterans in 2012.
0:19:24 > 0:19:28'It's an impressive advance but, like all artificial hands,
0:19:28 > 0:19:30'there is no sensation of touch.'
0:19:35 > 0:19:40The obvious alternative to a mechanical hand is to have
0:19:40 > 0:19:43a flesh and blood one, a hand transplant.
0:19:43 > 0:19:47I've been following that particular story for nearly 12 years.
0:19:49 > 0:19:52My first thoughts when I saw my hand was that it was a miracle.
0:19:52 > 0:19:59The total join actually goes around in quite a jagged...join.
0:19:59 > 0:20:04'Clint Hallam had the world's first hand transplant in 1998.
0:20:04 > 0:20:08'But he needed powerful anti-rejection drugs
0:20:08 > 0:20:12'to prevent his body's immune system attacking the donor hand.'
0:20:12 > 0:20:17Initially it seemed to work but he didn't really take the drugs and developed side effects.
0:20:17 > 0:20:22Diabetes, also gynaecomastia - male boobs, if you like - and as a result
0:20:22 > 0:20:27the hand started to reject, and then it looked really horrible.
0:20:27 > 0:20:32'Without drugs, Clint's body violently rejected the hand.'
0:20:32 > 0:20:37Yes, my body, or my mind, HAS said, "Enough is enough."
0:20:37 > 0:20:42'Eventually, he had his hand removed.'
0:20:42 > 0:20:44That sort of made me, and a lot of people,
0:20:44 > 0:20:48wonder whether hand transplants were the right way to go,
0:20:48 > 0:20:55because these drugs... if you didn't take the drugs, then your hand...rotted.
0:20:55 > 0:20:59But if you did take the drugs, there was a risk of side-effects
0:20:59 > 0:21:03and they calculated that it would cut 10 years off your life.
0:21:08 > 0:21:13'I'm really interested in the trial of a new approach to hand transplants,
0:21:13 > 0:21:19'one that dramatically cuts the amount of anti-rejection drugs a patient needs to take.
0:21:19 > 0:21:23'The trial involves both military and civilian patients.
0:21:23 > 0:21:28'And I've come to meet one of the first participants.
0:21:33 > 0:21:38'Chris Pollock lost both hands in a farming accident.'
0:21:38 > 0:21:40- Can you feel that? - I can feel that, yeah.
0:21:40 > 0:21:44- Was sensation a big reason why? - Oh, yes.
0:21:44 > 0:21:47With hooks, you don't feel anything.
0:21:47 > 0:21:52You had to guess at everything. Now, you pick things up and you don't even realise you're doing it.
0:21:52 > 0:21:56There's something extraordinary about the idea that this was once on somebody else.
0:21:56 > 0:22:02- It is really exciting, I think. - Yes. Can I see you in action?
0:22:02 > 0:22:06- Sure. Would you like some eggs? - That would be lovely.
0:22:06 > 0:22:11'Chris had a double hand transplant in February 2010.'
0:22:11 > 0:22:14Here we go.
0:22:14 > 0:22:18Sorry, Michael, you're going to have to have scrambled eggs.
0:22:18 > 0:22:22- I'll go for scrambled eggs, I prefer scrambled eggs. - I'll throw these in the trash.
0:22:22 > 0:22:27'Worldwide, over 30 people have had hand transplants.
0:22:27 > 0:22:32'Normally, they take large numbers of harmful anti-rejection drugs.'
0:22:32 > 0:22:33- Very good.- Thank you.
0:22:33 > 0:22:36So, what level of drugs are you taking at the moment?
0:22:36 > 0:22:40I'm only taking one anti-rejection medicine.
0:22:40 > 0:22:43Would you have done it, do you think, otherwise?
0:22:43 > 0:22:46No, because I did have some information given to me
0:22:46 > 0:22:49right after my accident and I read about it and it was like,
0:22:49 > 0:22:53four or five different medicines. I thought, I'm already on enough.
0:22:53 > 0:22:58Really what sold me is the one medicine, having one medicine.
0:22:58 > 0:23:03- Do you think of them as your hands now?- Yes. I do.
0:23:05 > 0:23:08'I was nervous when Chris offered to drive me
0:23:08 > 0:23:12'to his physiotherapist's, but he was in complete control.'
0:23:12 > 0:23:15Do you know anything much about the donor?
0:23:15 > 0:23:18I often wonder to myself, I wonder what that person did.
0:23:18 > 0:23:23It's short-lived. I don't ponder on it for ages.
0:23:23 > 0:23:29I just kind of think about it for a minute or two then I'm on to the next thing.
0:23:32 > 0:23:37- This is your second home, is it? - It is.- You spend so much time here. - Yes.
0:23:37 > 0:23:41'Chris is still learning how to use his new hands.'
0:23:42 > 0:23:47That's improved, with the small muscles working so much better.
0:23:47 > 0:23:50Just rolling them around, is that what you're doing?
0:23:50 > 0:23:52And has there been a lot of improvement?
0:23:52 > 0:23:55Just even in six months I see a difference.
0:23:57 > 0:24:01'Chris's own nerves are slowly growing into the new hands.'
0:24:02 > 0:24:06I ask him to close his eyes and I touch a finger.
0:24:06 > 0:24:11- This is difficult. - Yeah, it's pretty difficult.
0:24:11 > 0:24:16He knows he's being touched but he can't always tell you which digit's being touched.
0:24:16 > 0:24:19So, I just do this and what's your immediate thought?
0:24:19 > 0:24:23I can tell you're touching me but I just can't tell which finger.
0:24:23 > 0:24:27- Right, and when I do this? Can you? - My thumb.
0:24:27 > 0:24:29But when I just squeeze?
0:24:29 > 0:24:33It feels like you're squeezing my middle finger.
0:24:33 > 0:24:38- I'm actually squeezing your thumb but it feels like your middle finger?- Exactly, exactly.
0:24:38 > 0:24:40Right, yes.
0:24:42 > 0:24:46I enjoyed meeting Chris and I was really impressed by what
0:24:46 > 0:24:50he can do with his hands, or at least, somebody else's hands.
0:24:53 > 0:24:58'And now, I want to find out how his medical team were able to
0:24:58 > 0:25:01'cut his anti-rejection drugs down to just one.'
0:25:09 > 0:25:12'Chris had his operation in Pittsburgh.
0:25:12 > 0:25:15'I've come here to meet Dr Losse,
0:25:15 > 0:25:17'who is overseeing the transplant trial
0:25:17 > 0:25:20'and was part of the original surgical team.'
0:25:20 > 0:25:24Chris was a very good match, I have to say. I looked at it, and thought, "Ooh, yeah."
0:25:24 > 0:25:28I guess that's the most fascinating thing about what you're doing,
0:25:28 > 0:25:34is the fact that the amount of immunosuppressant you have to take is so dramatically reduced?
0:25:34 > 0:25:37- Mm-hm.- So, what do you actually do?
0:25:37 > 0:25:38On the day of transplantation,
0:25:38 > 0:25:43the patient is given a rather significant immunosuppressant.
0:25:43 > 0:25:45It really turns down your immune system.
0:25:45 > 0:25:49- You are then given the donor's arm. - The hand is basically attached?
0:25:49 > 0:25:53The hand is attached and the next day you're started with a single drug.
0:25:53 > 0:25:56You're given, two weeks later, the donor's bone marrow.
0:25:56 > 0:25:59'This is a donor hand being removed.'
0:25:59 > 0:26:01Wow.
0:26:01 > 0:26:05I have never seen anything like this before.
0:26:05 > 0:26:07I've seen hands being attached
0:26:07 > 0:26:12but I've never seen a hand being detached from a dead person.
0:26:12 > 0:26:16'With Dr Losse's procedure, they also remove bone marrow,
0:26:16 > 0:26:19'which contains the donor's immune cells.'
0:26:19 > 0:26:22The second team, our team, stays behind,
0:26:22 > 0:26:28closes up the donor site and then retrieves the vertebral bodies.
0:26:28 > 0:26:32So you take the spine, you separate the spine out from the dead person
0:26:32 > 0:26:35and you basically mince that, do you, to retrieve the bone marrow?
0:26:35 > 0:26:38It's quite gruesome, when you think about it.
0:26:39 > 0:26:43'Two weeks later, the marrow is injected into the donor.
0:26:43 > 0:26:45'What happens next is still being researched.'
0:26:45 > 0:26:49So, you are infused an IV infusion of what looks to be
0:26:49 > 0:26:53a blood transfusion of the donor's bone marrow, and somehow -
0:26:53 > 0:26:55this is all theoretical -
0:26:55 > 0:26:59it's felt to help re-educate the immune system
0:26:59 > 0:27:04so that it tolerates the donated arm.
0:27:05 > 0:27:08'It's thought that immune cells from the donor's bone-marrow
0:27:08 > 0:27:11'alter the recipient's immune system,
0:27:11 > 0:27:15'so it no longer aggressively attacks the new arm.'
0:27:15 > 0:27:20I find it extraordinary how much has changed in a short period of time.
0:27:20 > 0:27:23This really is an area which is a rocketing, isn't it?
0:27:23 > 0:27:27- There's huge need.- Right.- You just go to places like Afghanistan
0:27:27 > 0:27:29and you see all these young men with bits blown off
0:27:29 > 0:27:33and you can absolutely see why you'd want to have a transplant programme available.
0:27:33 > 0:27:37And the military's been very supportive and that's how
0:27:37 > 0:27:39many of the programs function here.
0:27:42 > 0:27:44'Medics like Dr Losse
0:27:44 > 0:27:46'are increasingly finding their research projects
0:27:46 > 0:27:48'supported by the US military.
0:27:50 > 0:27:52'But they are not natural bedfellows.'
0:27:52 > 0:27:57I think a lot of doctors are probably quite uncomfortable about military funding,
0:27:57 > 0:28:00but there is a long tradition of doing so
0:28:00 > 0:28:04and diseases like malaria, yellow fever, would probably
0:28:04 > 0:28:08never have been overcome if it hadn't been for military might.
0:28:11 > 0:28:14- Hi there.- Hey there, how are you? - Good, thanks.
0:28:14 > 0:28:18- Could I have a cup of tea? - Sure, large or small?- Small, please.
0:28:18 > 0:28:24'Nowadays, the military are funding projects which are far more futuristic,
0:28:24 > 0:28:26'some would say speculative.'
0:28:26 > 0:28:33Regenerative medicine is a really sexy buzz-phrase in medical circles at the moment.
0:28:33 > 0:28:38The idea is that rather than simply replacing or repairing
0:28:38 > 0:28:42a damaged organ, what you do is you grow new tissue,
0:28:42 > 0:28:44even whole new organs.
0:28:44 > 0:28:48Recently, the US military announced they were part of a consortium
0:28:48 > 0:28:53putting together 250 million into regenerative medicine.
0:28:57 > 0:29:01'I'm heading to the McGowan Institute of Regenerative Medicine,
0:29:01 > 0:29:07'where they're growing bits of human from a most unlikely source.'
0:29:13 > 0:29:15'A team led by Dr Stephen Badylak
0:29:15 > 0:29:21'are using pigs' bladders to regrow lost or damaged human muscle.'
0:29:21 > 0:29:24Pig's bladder is something that is easily obtainable.
0:29:24 > 0:29:27It's a throwaway part from the agricultural industry.
0:29:27 > 0:29:31'A pig's bladder, like any tissue, is made up of cells
0:29:31 > 0:29:35'that grow on a biological scaffold known as a matrix.'
0:29:35 > 0:29:39And you'll see that, as we remove the outer layers,
0:29:39 > 0:29:45the matrix that's left on the more inner layers now is not constrained
0:29:45 > 0:29:48by these muscle sets, so it starts to stretch out very quickly.
0:29:50 > 0:29:56'Dr Badylak discovered that when this extracellular matrix, ECM,
0:29:56 > 0:29:58'is introduced to areas of damaged muscle,
0:29:58 > 0:30:04'it encourages the local cells to grow, replacing lost tissue.'
0:30:04 > 0:30:09The interesting thing about the matrix is the sophistication
0:30:09 > 0:30:12that Mother Nature has put into what it's made of.
0:30:12 > 0:30:17It's got collagen fibres that give it structure and form.
0:30:17 > 0:30:20It's got growth factors in it that tell the cells there
0:30:20 > 0:30:25what to do and, depending upon where you put the tissue, the cells that are there say,
0:30:25 > 0:30:30"I should become a muscle," or "I should become a nervous tissue," that sort of thing.
0:30:33 > 0:30:35It just...it doesn't look like it's the beginning of
0:30:35 > 0:30:38some sort of scientific revolution, does it?
0:30:38 > 0:30:40You look at that and you don't go "Wow."
0:30:41 > 0:30:45'Before the ECM can be used, it's dried into a sheet.'
0:30:45 > 0:30:48What Scott's making will eventually look like this.
0:30:48 > 0:30:52This is the same material. That's bladder matrix.
0:30:52 > 0:30:55We can take this material and we can pulverise it, basically,
0:30:55 > 0:31:00comminute it into a powder, which would look like this.
0:31:01 > 0:31:03'I was feeling rather sceptical
0:31:03 > 0:31:06'until Dr Badylak showed me a time-lapse
0:31:06 > 0:31:09'of muscle stem cells growing on ECM.'
0:31:10 > 0:31:16So what we have here is a video that watched these cells
0:31:16 > 0:31:20for eight days, and you can start to see that these cells,
0:31:20 > 0:31:23which were little round cells, start to become long
0:31:23 > 0:31:27and start to form a structure that's starting to look like muscle.
0:31:27 > 0:31:32'It is amazing. Without the ECM, these cells would not have grown.'
0:31:32 > 0:31:36The bottom line is that something in the matrix
0:31:36 > 0:31:39has the ability to instruct a muscle stem cell
0:31:39 > 0:31:42to turn into a muscle-like tissue.
0:31:42 > 0:31:43It's very cool.
0:31:43 > 0:31:47I mean, the way that you can see, before your very eyes, muscle fibres forming.
0:31:48 > 0:31:51'I know that the science is impeccable,'
0:31:51 > 0:31:53but there is something a bit implausible
0:31:53 > 0:31:56when you have a look at this bit of pig's bladder,
0:31:56 > 0:32:00and somehow it's going to be turned, ground down into a powder
0:32:00 > 0:32:04and it becomes this sort of magic substance which can repair anybody.
0:32:04 > 0:32:07I know they're doing clinical trials at the moment,
0:32:07 > 0:32:11so I'm keen to catch up with some of the people who have had it put into them,
0:32:11 > 0:32:14and see what benefits, if any, they've got from it.
0:32:20 > 0:32:26Corporal Isaias Hernandez was the first to try this experimental treatment.
0:32:26 > 0:32:31He was caught in a mortar blast in Iraq in 2004.
0:32:31 > 0:32:3570% of the muscle in his right thigh was blown away.
0:32:35 > 0:32:39He was told his leg would have to be amputated.
0:32:41 > 0:32:43Hi there.
0:32:43 > 0:32:47- How's it going?- Good. Just doing another work-out.
0:32:47 > 0:32:52Ooh, wow. It's quite dramatic on the leg there, isn't it?
0:32:52 > 0:32:56To cover it up, they took some from my left side, put that in here,
0:32:56 > 0:33:01but it was still weak, though. I couldn't really do anything, walk, even stand.
0:33:01 > 0:33:04Sitting and standing up from a seat would be difficult.
0:33:04 > 0:33:08'Isaias was desperate to keep his leg,
0:33:08 > 0:33:13'so he opted to have his thigh opened up and sheets of ECM inserted.'
0:33:13 > 0:33:17- Is that real muscle there, then? Can I see?- Yes, yes.
0:33:17 > 0:33:18It's very impressive.
0:33:18 > 0:33:21How quickly did you start to notice the difference?
0:33:21 > 0:33:26As far as the feeling, within a few days,
0:33:26 > 0:33:29there was a little different tingling, different twitching.
0:33:29 > 0:33:32I could feel it wanting to push more further.
0:33:32 > 0:33:37'This lump of muscle is where the ECM was placed.'
0:33:37 > 0:33:40Before ECM, I couldn't cycle.
0:33:40 > 0:33:45Now I can do up to 35, 40-mile rides.
0:33:45 > 0:33:48Walking, running, I can go up and down stairs.
0:33:48 > 0:33:51It's made a big difference.
0:33:51 > 0:33:53'Isaias is planning to have another course of ECM
0:33:53 > 0:33:55'to try and regain even more muscle.'
0:33:56 > 0:34:03The idea that you can just put this stuff in and it turns back into muscle is... It is startling.
0:34:05 > 0:34:07'I am genuinely impressed.
0:34:07 > 0:34:11'Regenerative medicine has been promising wonderful things for so long
0:34:11 > 0:34:15'that it's great to see it finally making real progress.'
0:34:17 > 0:34:22And there are plenty of scientists who, after slogging away for decades,
0:34:22 > 0:34:24think this is just the beginning.
0:34:24 > 0:34:28I'm in Winston-Salem, North Carolina,
0:34:28 > 0:34:31to meet a man who's printing body parts.
0:34:32 > 0:34:36So, in terms of the military, of course,
0:34:36 > 0:34:42our major interest has been how can we start applying these technologies for our wounded warriors?
0:34:42 > 0:34:48'Dr Anthony Atala is working on a range of military-funded projects.
0:34:48 > 0:34:52'He first prints body parts, like ears and fingers,
0:34:52 > 0:34:55'and then he sprinkles them with stem cells.
0:34:55 > 0:34:59'He's also working on a machine that can print skin cells
0:34:59 > 0:35:02'on to a patient with open flesh wounds.
0:35:02 > 0:35:06'It's intended for use in battlefield hospitals.'
0:35:06 > 0:35:13This is actually one of our printers that we're creating for the military,
0:35:13 > 0:35:15which is a skin printer.
0:35:15 > 0:35:18Just imagine that this here is the patient bed,
0:35:18 > 0:35:21and that the patient's laying right here.
0:35:21 > 0:35:24- Do you want to give it a try? - OK. Do I just put my hand...
0:35:24 > 0:35:27- Yes, just put your hand in there.- OK.
0:35:27 > 0:35:31- Right, so I'm imagining that that's a big burn, or something like that? - That's right.
0:35:31 > 0:35:33'It's all rather Star Trek.
0:35:33 > 0:35:37'The machine measures the size and depth of your wound,
0:35:37 > 0:35:42'then sprays it with human skin cells that have been cultivated in the lab.'
0:35:42 > 0:35:45So how long before you expect to see it actually in use?
0:35:45 > 0:35:49We expect to see this in patients hopefully fairly soon.
0:35:49 > 0:35:52We're hoping to get this within the next five years.
0:35:53 > 0:35:56'Dr Atala also believes that in future we will use printers
0:35:56 > 0:36:02'to create fully-working complex human organs, such as the kidney.'
0:36:02 > 0:36:05The whole concept behind this type of printing
0:36:05 > 0:36:09is that we're printing it layer by layer with all the internal structures that it needs.
0:36:09 > 0:36:13And so, once the cells are printed, it creates a new tissue and the concept would be,
0:36:13 > 0:36:15can we then implant it and will it be functional?
0:36:15 > 0:36:18Which, of course, is the next step for us.
0:36:18 > 0:36:23The 3D printer uses a scan of the patient's own kidney
0:36:23 > 0:36:26to build an exact replica.
0:36:26 > 0:36:32It creates an entire organ from human kidney cells grown in the lab.
0:36:34 > 0:36:37Can you imagine within your lifetime you would see kidneys
0:36:37 > 0:36:41being manufactured, effectively, and implanted in people?
0:36:41 > 0:36:44I think...that's certainly the hope.
0:36:46 > 0:36:50Although growing your own organs is some way off,
0:36:50 > 0:36:54military funding is undoubtedly helping push it along.
0:36:56 > 0:37:01But doctors faced with major injuries need solutions now,
0:37:01 > 0:37:07and at the moment that means patching things up and repairing, rather than replacing.
0:37:07 > 0:37:10And, of course, much of what doctors know about repairing humans
0:37:10 > 0:37:12comes from the battlefield.
0:37:14 > 0:37:16Plastic surgery was utterly transformed
0:37:16 > 0:37:18by the First and Second World War.
0:37:18 > 0:37:21Since then, there have been enormous numbers of innovations.
0:37:21 > 0:37:25But even so, it has reached its limits.
0:37:25 > 0:37:28With so many troops coming out of Iraq
0:37:28 > 0:37:31and Afghanistan with severe facial injuries,
0:37:31 > 0:37:36the US military have decided to put 3.4 million
0:37:36 > 0:37:39into one of the most challenging areas of modern surgery -
0:37:39 > 0:37:41face transplants.
0:37:41 > 0:37:46There are plenty of people, on and off the battlefield,
0:37:46 > 0:37:48who suffer from terrible facial injuries,
0:37:48 > 0:37:53but I wonder how many would consider having such an extreme procedure?
0:37:56 > 0:37:59I've come to Boston, to the Brigham and Women's Hospital,
0:37:59 > 0:38:05to meet one of the world's leading face transplant surgeons, Dr Bohdan Pomahac.
0:38:05 > 0:38:08- Good morning.- Morning. How are you? - Hi. Michael Mosley.
0:38:13 > 0:38:14Good-looking boy, isn't he?
0:38:14 > 0:38:19He was, until he stepped on that live wire about ten years ago.
0:38:19 > 0:38:23'Mitch Hunter was just 20 years old when his car crashed into a pole
0:38:23 > 0:38:26'containing a 10,000 volt electrical cable.
0:38:26 > 0:38:29'The injuries to his face were horrendous.'
0:38:29 > 0:38:31Ooh. Ahh.
0:38:31 > 0:38:34That was the actual arrival, following injury.
0:38:36 > 0:38:38There's something about it.
0:38:38 > 0:38:41I was prepared for it, but that was...that's a shock.
0:38:41 > 0:38:46'For ten years, plastic surgeons tried to rebuild his face.'
0:38:46 > 0:38:48There are a number of issues here.
0:38:48 > 0:38:50Obviously, he's lost all of the skin from the face.
0:38:50 > 0:38:52Where's this skin come from, then?
0:38:52 > 0:38:57- That's from the thighs or elsewhere. - It's a very different sort of tissue, isn't it?- Yeah.
0:38:57 > 0:39:01Different colour, different texture. Doesn't look, doesn't feel like skin.
0:39:01 > 0:39:04He actually has no normal sensation in the face.
0:39:04 > 0:39:06And he lost a bulk of his lips,
0:39:06 > 0:39:08so this is when he's trying to close his mouth,
0:39:08 > 0:39:10and he has huge gaps, so he was drooling.
0:39:10 > 0:39:13This is state of the art of conventional reconstruction.
0:39:13 > 0:39:17- How many operations would he have had to get to this point? - Maybe 20, 25.
0:39:17 > 0:39:19That's the best we can do without the transplant.
0:39:19 > 0:39:22Face transplant, presumably you have to take so much tissue away
0:39:22 > 0:39:26that, if a face transplant fails, is it not catastrophic?
0:39:26 > 0:39:29What we try very hard, and will do in his case as well,
0:39:29 > 0:39:32is not to destroy anything that's functional
0:39:32 > 0:39:37and anything that would not be reconstructable to essentially the picture that he looks like now.
0:39:37 > 0:39:40So, even if the face fails, we would be able to restore
0:39:40 > 0:39:44his appearance the way he looks now relatively simply, maybe in one or two operations.
0:39:44 > 0:39:51'Mitch is one of eight face transplants the military are funding Dr Pomahac to do.'
0:39:51 > 0:39:53There are a few groups around the world
0:39:53 > 0:39:56that have spent a lot of time designing the operations
0:39:56 > 0:39:59and developing their own operative approach,
0:39:59 > 0:40:03and I think we have planned on simplifying it,
0:40:03 > 0:40:05making it more reproducible and easier for people to do,
0:40:05 > 0:40:07and I think we've accomplished that goal.
0:40:07 > 0:40:12But with every operation we learn an enormous amount of information.
0:40:12 > 0:40:16Dr Pomahac makes a face transplant sound almost easy.
0:40:16 > 0:40:20But it is extremely experimental. Only a handful have been done.
0:40:20 > 0:40:23And there are plenty of things that can go wrong.
0:40:26 > 0:40:30- How are you? We met last time you were here. How are you doing? - Pretty good.
0:40:30 > 0:40:34'After living with a badly damaged face for ten years,
0:40:34 > 0:40:38'Mitch is about to have a completely new one.
0:40:42 > 0:40:44'It's a massively complex operation.
0:40:51 > 0:40:57'First, a team of 14 surgeons has to carefully remove his old face.
0:41:01 > 0:41:05'When Dr Pomahac arrives with the donor face on ice,
0:41:05 > 0:41:09'the whole operation becomes a race against time.'
0:41:09 > 0:41:13When the blood supply stops or the circulation stops in donor,
0:41:13 > 0:41:16we have four hours to reconnect and re-establish the flow.
0:41:16 > 0:41:21So it's a fairly tight window, especially if you travel to get a donor from elsewhere.
0:41:21 > 0:41:25'Painstaking microvascular surgery
0:41:25 > 0:41:29'is needed to attach Mitch's arteries to the new face.
0:41:29 > 0:41:34'This allows his heart to start supplying his new face with blood.'
0:41:35 > 0:41:38Blood supply is absolutely critical.
0:41:38 > 0:41:41Without blood supply to the face, it's not going to be alive.
0:41:41 > 0:41:45'Three of Mitch's nerves are also attached
0:41:45 > 0:41:48'to give the face sensation and movement.
0:41:50 > 0:41:54'Finally, the face is stitched to Mitch's own skin.
0:41:56 > 0:42:00'After 14 hours, the operation is complete.'
0:42:05 > 0:42:08Hi there. Can I pay for this one?
0:42:08 > 0:42:12'Mitch was Dr Pomahac's third face transplant.'
0:42:12 > 0:42:14How did the operation go, then, for you?
0:42:14 > 0:42:17It went well. It went very well.
0:42:17 > 0:42:19Actually, it was the shortest we have done.
0:42:19 > 0:42:23Not that we would rush, but it's a reflection of things going smoothly.
0:42:23 > 0:42:26Does he have any sensation, or any facial movement?
0:42:26 > 0:42:31Just after the operation, there's really not much of a sensation.
0:42:31 > 0:42:33It's numb and swollen.
0:42:33 > 0:42:36The first sensation develops within a month, two.
0:42:36 > 0:42:40And it's very crude, and then it continues to improve.
0:42:40 > 0:42:45And in about 18 months I would expect he's going to be feeling near normal.
0:42:46 > 0:42:52'I'll meet Mitch once the swelling on his face has had more time to go down.'
0:42:52 > 0:42:55Dr Pomahac's work is impressive,
0:42:55 > 0:43:00but there is one organ doctors are as yet unable to transplant.
0:43:00 > 0:43:01Eyes.
0:43:03 > 0:43:08With so many troops in Afghanistan being blown up by improvised explosive devices,
0:43:08 > 0:43:12it is inevitable that some will be left permanently blind.
0:43:12 > 0:43:17I've come back to the UK to look at the trial of a new piece of technology
0:43:17 > 0:43:20that could restore a sense of sight.
0:43:22 > 0:43:26The first Brit to be enrolled in the trial is Lance Bombardier Rob Long.
0:43:26 > 0:43:31He is 23 years old, and has lost the sight in both eyes.
0:43:31 > 0:43:34He relies heavily on his wife, Em.
0:43:34 > 0:43:37I was on tour in Afghanistan last year,
0:43:37 > 0:43:43and, erm, I was on patrol, and my patrol 2IC triggered an IED.
0:43:43 > 0:43:47Unfortunately, he was killed.
0:43:47 > 0:43:50One other guy was injured apart from me...
0:43:50 > 0:43:54and, yeah, the IED took both my eyes.
0:43:54 > 0:43:55How do you feel about it?
0:43:55 > 0:43:59We haven't got a choice but to be strong and get on with it, cos there's nothing...
0:43:59 > 0:44:03You're not going to get your eyes back, are you? There's no choice.
0:44:03 > 0:44:07- What do you miss most about not being able to see?- Um...
0:44:07 > 0:44:11People's faces. People's faces is...
0:44:12 > 0:44:17When you first meet someone, it's great to see what they look like.
0:44:17 > 0:44:21My wife's face, in particular, I really miss seeing that.
0:44:24 > 0:44:29'Today, Rob is going to try out a new device called BrainPort.'
0:44:29 > 0:44:32That's the specs, and that's the camera,
0:44:32 > 0:44:38and it's attached to a cable, which goes to the control device, OK?
0:44:38 > 0:44:43'The trial is led by military surgeon Wing Commander Rob Scott.'
0:44:43 > 0:44:45They feel so snazzy!
0:44:45 > 0:44:48- They're very cool, actually! - Yeah, yeah.
0:44:48 > 0:44:50The camera is now working.
0:44:50 > 0:44:53If you put the device onto your tongue...
0:44:56 > 0:45:00'The camera turns what it sees into 400 black and white pixels,
0:45:00 > 0:45:04'which are felt as tiny electric shocks on the tongue.
0:45:04 > 0:45:07'The brighter the image, the stronger the shock.'
0:45:08 > 0:45:16- Do you notice some kind of... - Mm-hmm.- ..going side-to-side?
0:45:16 > 0:45:19- What do you think? - Yeah, it's interesting. - It's a bit weird, isn't it?
0:45:19 > 0:45:23It's interesting. It's not what I expected, it's really interesting.
0:45:23 > 0:45:27I think what we'll do is get you to see some shapes.
0:45:27 > 0:45:31- Handle this side.- No, it's actually the other side, have another look.
0:45:32 > 0:45:35And trace around it.
0:45:40 > 0:45:45'After a few hours' practice, Rob attempts to follow a white line on the floor.'
0:45:46 > 0:45:48- Can you see that?- Ooh.
0:45:48 > 0:45:51What are you seeing, Rob?
0:45:51 > 0:45:54The sensation is there's a line
0:45:54 > 0:45:58going up my tongue in the direction that hopefully this is going.
0:45:58 > 0:46:01- Can you see another line? - Mm-hm.- What direction?
0:46:01 > 0:46:04I'd say this line goes to about here,
0:46:04 > 0:46:08and then there's another line going up that sort of direction.
0:46:08 > 0:46:10Well, if you think you see it, follow it.
0:46:14 > 0:46:18It comes to about here and then sort of veers that way.
0:46:18 > 0:46:23What do you think the most likely uses of this sort of technology are?
0:46:23 > 0:46:28It's really designed to get him able to orientate himself outside,
0:46:28 > 0:46:33so that he can maybe see a post or a lamppost, or a sign
0:46:33 > 0:46:37or a manhole cover that might be there or not there while he's outside.
0:46:37 > 0:46:39So a bit of a warning of things.
0:46:39 > 0:46:43It is quite remarkable when you think you've got the camera there,
0:46:43 > 0:46:46it's taking the data, it's feeling on his tongue,
0:46:46 > 0:46:49and somehow his brain is translating that into a three-dimensional object.
0:46:49 > 0:46:51It takes, obviously, time.
0:46:51 > 0:46:54You've seen him do it for a while, what do you think?
0:46:54 > 0:46:57I'm really impressed, cos I thought it would take days and days
0:46:57 > 0:47:04just to see outlines, but straight away he's getting stuff.
0:47:04 > 0:47:06I'm really amazed. Within a couple of hours...
0:47:06 > 0:47:10'Rob will take it away and see how useful it is in everyday life.'
0:47:12 > 0:47:17Although Rob was following the white lines and all that very impressively,
0:47:17 > 0:47:20and he could, after a while, detect shapes,
0:47:20 > 0:47:24it wasn't really, in the end, any of that which blew me away.
0:47:24 > 0:47:26It was his relationship with Em and the fact,
0:47:26 > 0:47:31which is incredibly obvious in retrospect but didn't occur to me beforehand,
0:47:31 > 0:47:34that what he really wanted from that piece of technology,
0:47:34 > 0:47:38and what anybody who's blind, I imagine, would want,
0:47:38 > 0:47:40is just the ability to see other people's faces,
0:47:40 > 0:47:45to be able to react to other people, see whether they're smiling, laughing at your jokes.
0:47:51 > 0:47:57There is nothing available that would let people like Rob see someone's face,
0:47:57 > 0:48:01but American scientists, with military funding,
0:48:01 > 0:48:04are working on something that might help blind people recognise faces.
0:48:06 > 0:48:10I've come to Carnegie Mellon University.
0:48:11 > 0:48:13COMPUTER: 'Hello there.'
0:48:13 > 0:48:17'Walk past my desk and turn down the corridor on your right.'
0:48:17 > 0:48:21- OK, thank you.- 'If you don't want to talk anymore...'- I don't, thank you!
0:48:21 > 0:48:27'Here, Dr Amy Nau is working on the next generation of BrainPort.'
0:48:27 > 0:48:33- Hi there, hello.- Hi.- This is a very prototype-y piece!
0:48:33 > 0:48:38I recognise my friend here, which is a BrainPort, but this is what?
0:48:38 > 0:48:44What we're trying to do is we're trying to take the BrainPort to the next level.
0:48:44 > 0:48:47Today we're working on facial recognition software.
0:48:47 > 0:48:52That's important because, if you have no sight, you can't tell if someone's in front of you or not.
0:48:52 > 0:48:56So what we're trying to do is find a way that we can present that information to the tongue,
0:48:56 > 0:49:00and a simple way that we can let the patients recognise things quickly.
0:49:01 > 0:49:06'This device has software which targets people's faces.
0:49:06 > 0:49:09'It exaggerates features, like a fringe.
0:49:09 > 0:49:13'These become white pixels, which are felt on the tongue.'
0:49:13 > 0:49:16So I can see there that, Carl,
0:49:16 > 0:49:20it's basically sampling your hair and your eyebrows.
0:49:20 > 0:49:23- Is that right? - Broadly speaking, yeah.
0:49:23 > 0:49:26- Would you like to try it? - I would love to try it.
0:49:26 > 0:49:28You will be blind for the rest of this session.
0:49:28 > 0:49:31So you'll tell me... First of all I'll get some sense. This is Carl?
0:49:31 > 0:49:36So you will try to differentiate between me, Amy, and Carl.
0:49:36 > 0:49:40OK. What I'm sensing at the moment is a sort of oval,
0:49:40 > 0:49:43- and that would be Carl's hair, yeah? - Correct.- OK.
0:49:43 > 0:49:46That is interesting, because as soon as you sat there,
0:49:46 > 0:49:50whereas Carl has got hair at the top, you've got hair at the bottom.
0:49:50 > 0:49:51It's the beard, isn't it?
0:49:51 > 0:49:54So, you have to guess who we are.
0:49:54 > 0:49:58I'll keep saying when you should guess who it is.
0:49:58 > 0:50:00Guess who this is.
0:50:02 > 0:50:06I think that's Amy.
0:50:06 > 0:50:09- Who's that?- Amy.
0:50:09 > 0:50:12- How am I doing? - Not so well, actually!
0:50:12 > 0:50:14THEY LAUGH
0:50:14 > 0:50:18'But, after a bit of time, I was able to sense a difference between the faces.'
0:50:18 > 0:50:21- Who is this? - I think that's Yasser.
0:50:25 > 0:50:27That's not Yasser, I think it's Carl.
0:50:27 > 0:50:29And who is that?
0:50:30 > 0:50:32I think that's Amy.
0:50:32 > 0:50:34Right, three out of three.
0:50:39 > 0:50:43Ultimately, the purpose of all the medical innovations I have seen
0:50:43 > 0:50:45is to help rebuild lives.
0:50:45 > 0:50:51And there is one last person whose life has been transformed beyond recognition.
0:50:52 > 0:50:57This is Indianapolis, Indiana, and it's home to Mitch Hunter,
0:50:57 > 0:51:00who had his face replaced by Dr Pomahac.
0:51:00 > 0:51:03I haven't seen him since the operation,
0:51:03 > 0:51:05and I have no idea what to expect.
0:51:08 > 0:51:12It's been four months since Mitch had his operation.
0:51:24 > 0:51:26BABY CALLS
0:51:26 > 0:51:27- Hello.- Hello.
0:51:27 > 0:51:28Hi, Mitch. Michael.
0:51:28 > 0:51:31- Who's this?- Nice to meet you, Michael. This is Clayton.
0:51:31 > 0:51:34Hi, Clayton. Hello. How old's he?
0:51:34 > 0:51:36He is 16 months.
0:51:36 > 0:51:39I've seen the photos of you after the accident,
0:51:39 > 0:51:41and I have to say this is one hell of an improvement.
0:51:41 > 0:51:43It is extraordinary, isn't it?
0:51:43 > 0:51:45There's a resemblance between you and Clayton.
0:51:45 > 0:51:49I wasn't quite sure whether what I was going to see
0:51:49 > 0:51:52was what you looked like before,
0:51:52 > 0:51:56or a sort of halfway house between you and whoever the donor was.
0:51:56 > 0:51:57Do you think you look like you?
0:51:57 > 0:51:59Starting to.
0:51:59 > 0:52:00Right.
0:52:00 > 0:52:03Still a bit of extra skin in some places,
0:52:03 > 0:52:07but I think once everything's said and done and finalised,
0:52:07 > 0:52:10I think I'll look a lot like I used to.
0:52:10 > 0:52:13Sorry to manhandle you, Mitch, can I move you around here?
0:52:13 > 0:52:16I want to look at your face in the light. Thank you.
0:52:18 > 0:52:19Can I have a look at the scarring?
0:52:19 > 0:52:22So it goes all the way around there,
0:52:22 > 0:52:24all the way round there,
0:52:24 > 0:52:25and round up there.
0:52:25 > 0:52:28And you can absolutely see...
0:52:28 > 0:52:29Mm-hm.
0:52:29 > 0:52:32..where they must have taken the face and put it on.
0:52:33 > 0:52:36I must admit, it is...
0:52:36 > 0:52:39It far exceeds my expectations.
0:52:39 > 0:52:40I didn't know what I was expecting,
0:52:40 > 0:52:44but frankly, I was expecting something a bit...rough.
0:52:44 > 0:52:46It was a lot different to what I expected too.
0:52:46 > 0:52:50Was it a bit...initially, presumably immediately after the operation,
0:52:50 > 0:52:52it was pretty...?
0:52:52 > 0:52:54It was really, really swollen.
0:52:54 > 0:52:58It looked like my face would be on a 200lb, 300lb guy,
0:52:58 > 0:53:00it was that swollen.
0:53:00 > 0:53:02Your speech is good, has it improved?
0:53:02 > 0:53:05It has improved, it's not as good as I would like it to be.
0:53:05 > 0:53:10It's getting better and better as I do my facial exercises and stuff.
0:53:10 > 0:53:13- What do you have to do? - Smile, scrunch my eyes.
0:53:13 > 0:53:15- Give me the range.- Um...
0:53:17 > 0:53:22Like smiling, either side,
0:53:22 > 0:53:28scrunching the nose, raising the eyebrows, pursing the lips.
0:53:30 > 0:53:33- This is, obviously, before, when I was in the military.- Yeah.
0:53:34 > 0:53:36That's me last year.
0:53:36 > 0:53:39Why did you want to have the transplant?
0:53:39 > 0:53:43I've had kids hide and run behind their mom scared.
0:53:45 > 0:53:49That was hard to cope with cos my friends started having kids,
0:53:49 > 0:53:51my older brother had a kid.
0:53:51 > 0:53:55I didn't want, you know, any kids to be afraid of me.
0:53:55 > 0:53:59As I chat to you, I forget for long chunks of time that this is
0:53:59 > 0:54:01not the face you were born with.
0:54:01 > 0:54:07That this face came from somebody who died not so very long ago.
0:54:07 > 0:54:11It really is starting to feel more like mine everyday,
0:54:11 > 0:54:16and the sensation that I've gained back is just extraordinary.
0:54:19 > 0:54:21I wanted to find out how people close to Mitch
0:54:21 > 0:54:24felt about his new face.
0:54:24 > 0:54:26Anyone for water?
0:54:26 > 0:54:30'His brother, Mark, is just one year older
0:54:30 > 0:54:34'and bears a strong resemblance to how Mitch once looked.'
0:54:34 > 0:54:38We were very close, we were a year and just a couple of weeks apart.
0:54:38 > 0:54:41And everybody always thought we were twins.
0:54:41 > 0:54:44So do you find it at all spooky that that face belonged to someone else?
0:54:44 > 0:54:47Definitely don't find it spooky. I didn't know how I was going to react,
0:54:47 > 0:54:51but I walked in the door and it was my brother.
0:54:51 > 0:54:55'Mitch's relationship with Katarina began two years ago
0:54:55 > 0:54:59'when Mitch still had his scarred face.'
0:54:59 > 0:55:01- What do you think about this? - I think it's crazy.
0:55:04 > 0:55:08The fact that medical science has come so far,
0:55:08 > 0:55:13where they are able to do that, it's just... It's amazing.
0:55:13 > 0:55:19When you first kissed him, after the face, was that strange?
0:55:19 > 0:55:26Yeah, I had never kissed him with lips before.
0:55:26 > 0:55:28So when you kiss, you feel it?
0:55:31 > 0:55:34Sometimes even hot food, I can feel the heat.
0:55:34 > 0:55:40Yeah. So it's all still coming back. And is that recent?
0:55:40 > 0:55:43I would say within the first month I started getting sensation
0:55:43 > 0:55:46and I think I'm going on to fourth or fifth month
0:55:46 > 0:55:50and it's ten times better than what it was the first month.
0:55:50 > 0:55:51Yes.
0:55:52 > 0:55:56I can feel a lot, like I can feel the breeze on my face now.
0:55:58 > 0:55:59Which is nice, isn't it?
0:55:59 > 0:56:03It's just amazing how much sensation I've gained back in such a short time.
0:56:03 > 0:56:06- And will it go on improving?- Uh-huh.
0:56:09 > 0:56:12'Mitch said to me earlier that his real reason for doing this'
0:56:12 > 0:56:14was for his child.
0:56:14 > 0:56:17And also just so he could just walk down the street,
0:56:17 > 0:56:20not have adults stare at him, not have children point and go,
0:56:20 > 0:56:22"There's the monster," and run away screaming.
0:56:22 > 0:56:25And in all my time when we were just chatting, nobody was looking.
0:56:25 > 0:56:28Nobody was paying any real attention.
0:56:28 > 0:56:32So I think, if nothing else, that is what that surgery has achieved.
0:56:32 > 0:56:36And actually I think it's probably achieved a lot more than that,
0:56:36 > 0:56:40because I think it has absolutely exceeded everyone's expectations.
0:56:40 > 0:56:44He's getting facial expression back, he's getting sensitivity back.
0:56:44 > 0:56:47I think it's truly remarkable.
0:56:51 > 0:56:58It feels like I've been on a long journey from Afghanistan to this cafe in Indianapolis,
0:56:58 > 0:57:04yet Mitch's new face, like everything I've seen recently, is linked to the current conflicts.
0:57:06 > 0:57:11The devastating injuries suffered by so many troops has driven a demand
0:57:11 > 0:57:14for new medical treatments and technologies.
0:57:16 > 0:57:21But though the results of this boom in medical research will help some of the wounded,
0:57:21 > 0:57:26I suspect the real benefits will take a lot longer to emerge.
0:57:29 > 0:57:33I was just thinking that I've seen some terrible things over the last few months,
0:57:33 > 0:57:39and they're just a tiny fraction of the pain that these conflicts have created.
0:57:39 > 0:57:43But I was also thinking I've seen some magnificent things.
0:57:43 > 0:57:45Things which are at a terribly early stage
0:57:45 > 0:57:48may turn out to be hugely significant.
0:57:48 > 0:57:52And I hope that when we look back in years to come, we'll say,
0:57:52 > 0:57:55"Yes, the conflicts were terrible,
0:57:55 > 0:57:58"but perhaps some good did come out of them."
0:58:17 > 0:58:19Subtitles by Red Bee Media Ltd
0:58:19 > 0:58:22E-mail subtitling@bbc.co.uk