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Skin

Skin

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A close up picture of a rhinoceros skin.

Skin is a soft outer covering of an animal, in particular a vertebrate. Other animal coverings such as the arthropod exoskeleton or the seashell have different developmental origin, structure and chemical composition. The adjective cutaneous means "of the skin" (from Latin cutis, skin). In mammals, the skin is the largest organ of the integumentary system made up of multiple layers of ectodermal tissue, and guards the underlying muscles, bones, ligaments and internal organs.[1] Skin of a different nature exists in amphibians, reptiles, and birds.[2] All mammals have some hair on their skin, even marine mammals which appear to be hairless. Because it interfaces with the environment, skin plays a key role in protecting (the body) against pathogens[3] and excessive water loss.[4] Its other functions are insulation, temperature regulation, sensation, and the protection of vitamin D folates. Severely damaged skin will try to heal by forming scar tissue. This is often discoloured and depigmented.

Hair with sufficient density is called fur. The fur mainly serves to augment the insulation the skin provides, but can also serve as a secondary sexual characteristic or as camouflage. On some animals, the skin is very hard and thick, and can be processed to create leather. Reptiles and fish have hard protective scales on their skin for protection, and birds have hard feathers, all made of tough β-keratins. Amphibian skin is not a strong barrier to passage of chemicals and is often subject to osmosis. A frog sitting in an anesthetic solution could quickly go to sleep

Wikipedia history

Wikipedia history

The wikipedia.org website, Wikipedia's homepage for all languages

Wikipedia was founded as an offshoot of Nupedia, a now-abandoned project to produce a free encyclopedia. Nupedia had an elaborate system of peer review and required highly qualified contributors, but the writing of articles was slow. During 2000, Jimmy Wales, founder of Nupedia, and Larry Sanger, whom Wales had employed to work on the project, discussed ways of supplementing Nupedia with a more open, complementary project. Multiple sources suggested the idea that a wiki might allow members of the public to contribute material, and Nupedia's first wiki went online on January 10, 2001.

There was considerable resistance on the part of Nupedia's editors and reviewers to the idea of associating Nupedia with a website in the wiki format, so the new project was given the name "Wikipedia" and launched on its own domain, wikipedia.com, on January 15 (now called "Wikipedia Day" by some users). The bandwidth and server (in San Diego) were donated by Wales. Other current and past Bomis employees who have worked on the project include Tim Shell, one of the cofounders of Bomis and its current CEO, and programmer Jason Richey. The domain was eventually changed to the present wikipedia.org when the not-for-profit Wikimedia Foundation was launched as its new parent organization, prompting the use of a ".org" domain to denote its non-commercial nature.

In May 2001, a wave of non-English Wikipedias was launched—in Catalan, Chinese, Dutch, Esperanto, French, German, Hebrew, Italian, Japanese, Portuguese, Russian, Spanish, and Swedish. These were soon joined by Arabic and Hungarian.[1] In September,[2] Polish was added, and further commitment to the multilingual provision of Wikipedia was made. At the end of the year, Afrikaans, Norwegian, and Serbo-Croatian versions were announced.

Wikipedia:About

Wikipedia:About

From Wikipedia, the free encyclopedia
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Wikipedia (pronounced /ˌwɪkɨˈpiːdi.ə/ WIK-i-PEE-dee-ə) is a multilingual, web-based, free-content encyclopedia project based on an openly editable model. The name "Wikipedia" is a portmanteau of the words wiki (a technology for creating collaborative websites, from the Hawaiian word wiki, meaning "quick") and encyclopedia. Wikipedia's articles provide links to guide the user to related pages with additional information.

Wikipedia is written collaboratively by largely anonymous Internet volunteers who write without pay. Anyone with Internet access can write and make changes to Wikipedia articles (except in certain cases where editing is restricted to prevent disruption or vandalism). Users can contribute anonymously, under a pseudonym, or with their real identity, if they choose.

The fundamental principles by which Wikipedia operates are the Five pillars. The Wikipedia community has developed many policies and guidelines to improve the encyclopedia; however, it is not a formal requirement to be familiar with them before contributing.

Since its creation in 2001, Wikipedia has grown rapidly into one of the largest reference websites, attracting nearly 78 million visitors monthly as of January 2010. There are more than 91,000 active contributors working on more than 17,000,000 articles in more than 270 languages. As of today, there are 3,572,103 articles in English. Every day, hundreds of thousands of visitors from around the world collectively make tens of thousands of edits and create thousands of new articles to augment the knowledge held by the Wikipedia encyclopedia. (See also: Wikipedia:Statistics.)

People of all ages, cultures and backgrounds can add or edit article prose, references, images and other media here. What is contributed is more important than the expertise or qualifications of the contributor. What will remain depends upon whether it fits within Wikipedia's policies, including being verifiable against a published reliable source, so excluding editors' opinions and beliefs and unreviewed research, and is free of copyright restrictions and contentious material about living people. Contributions cannot damage Wikipedia because the software allows easy reversal of mistakes and many experienced editors are watching to help and ensure that edits are cumulative improvements. Begin by simply clicking the edit link at the top of any editable page!

Wikipedia is a live collaboration differing from paper-based reference sources in important ways. Unlike printed encyclopedias, Wikipedia is continually created and updated, with articles on historic events appearing within minutes, rather than months or years. Older articles tend to grow more comprehensive and balanced; newer articles may contain misinformation, unencyclopedic content, or vandalism. Awareness of this aids obtaining valid information and avoiding recently added misinformation (see Researching with Wikipedia).

What Wikipedia is not circumscribes Wikipedia's scope. Further information on key topics appears below. Further advice is at Frequently asked questions, advice for parents, or see Where to ask questions. For help getting started with editing or other issues, see Help:Contents.

Jurisdiction and legality of content

Jurisdiction and legality of content

Publication of information found in Wikipedia may be in violation of the laws of the country or jurisdiction from where you are viewing this information. The Wikipedia database is stored on a server in the State of Florida in the United States of America, and is maintained in reference to the protections afforded under local and federal law. Laws in your country or jurisdiction may not protect or allow the same kinds of speech or distribution. Wikipedia does not encourage the violation of any laws; and cannot be responsible for any violations of such laws, should you link to this domain or use, reproduce, or republish the information contained herein.

Personality rights

Personality rights

Wikipedia contains material which may portray an identifiable person who is alive or deceased recently. The use of images of living or recently deceased individuals is, in some jurisdictions, restricted by laws pertaining to personality rights, independent from their copyright status. Before using these types of content, please ensure that you have the right to use it under the laws which apply in the circumstances of your intended use. You are solely responsible for ensuring that you do not infringe someone else's personality rights.

Trademarks

Trademarks

Any of the trademarks, service marks, collective marks, design rights or similar rights that are mentioned, used or cited in the articles of the Wikipedia encyclopedia are the property of their respective owners. Their use here does not imply that you may use them for any purpose other than for the same or a similar informational use as contemplated by the original authors of these Wikipedia articles under the CC-BY-SA and GFDL licensing schemes. Unless otherwise stated Wikipedia and Wikimedia sites are neither endorsed by nor affiliated with any of the holders of any such rights and as such Wikipedia cannot grant any rights to use any otherwise protected materials. Your use of any such or similar incorporeal property is at your own risk.

WIKIPEDIA MAKES NO GUARANTEE OF VALIDITY

WIKIPEDIA MAKES NO GUARANTEE OF VALIDITY

Wikipedia is an online open-content collaborative encyclopedia, that is, a voluntary association of individuals and groups working to develop a common resource of human knowledge. The structure of the project allows anyone with an Internet connection to alter its content. Please be advised that nothing found here has necessarily been reviewed by people with the expertise required to provide you with complete, accurate or reliable information.

That is not to say that you will not find valuable and accurate information in Wikipedia; much of the time you will. However, Wikipedia cannot guarantee the validity of the information found here. The content of any given article may recently have been changed, vandalized or altered by someone whose opinion does not correspond with the state of knowledge in the relevant fields. Note that most other encyclopedias and reference works also have similar disclaimers.

No formal peer review

We are working on ways to select and highlight reliable versions of articles. Our active community of editors uses tools such as the Special:Recentchanges and Special:Newpages feeds to monitor new and changing content. However, Wikipedia is not uniformly peer reviewed; while readers may correct errors or engage in casual peer review, they have no legal duty to do so and thus all information read here is without any implied warranty of fitness for any purpose or use whatsoever. Even articles that have been vetted by informal peer review or featured article processes may later have been edited inappropriately, just before you view them.

None of the contributors, sponsors, administrators, or anyone else connected with Wikipedia in any way whatsoever can be responsible for the appearance of any inaccurate or libelous information or for your use of the information contained in or linked from these web pages.

No contract; limited license

Please make sure that you understand that the information provided here is being provided freely, and that no kind of agreement or contract is created between you and the owners or users of this site, the owners of the servers upon which it is housed, the individual Wikipedia contributors, any project administrators, sysops or anyone else who is in any way connected with this project or sister projects subject to your claims against them directly. You are being granted a limited license to copy anything from this site; it does not create or imply any contractual or extracontractual liability on the part of Wikipedia or any of its agents, members, organizers or other users.

There is no agreement or understanding between you and Wikipedia regarding your use or modification of this information beyond the Creative Commons Attribution-Sharealike 3.0 Unported License (CC-BY-SA) and the GNU Free Documentation License (GFDL); neither is anyone at Wikipedia responsible should someone change, edit, modify or remove any information that you may post on Wikipedia or any of its associated projects.

Popular culture

Popular culture

  • The procedure was very grotesquely, yet somewhat accurately, highlighted in Georges Franju's 1960 cult horror film Les Yeux sans visage, which translates to "Eyes Without a Face."
  • Kōbō Abe, Japanese author and playwright, wrote The Face of Another (1964) about a plastics scientist who loses his face in an accident and proceeds to construct a new face for himself. With a new face, the protagonist sees the world in a new way and even goes so far as to have a clandestine "affair" with his estranged wife. This novel was made into a film of the same name by Hiroshi Teshigahara in 1966.
  • The plot of the 1997 film Face/Off is based on a face transplant operation that involved changing the underlying structure and actual face shape. In the film, the transplant is shown to be reversible, with the patient being able to replace his original face if desired.
  • An episode of The Simpsons, The Bob Next Door, features Sideshow Bob using face transplants to exchange his face with a cellmate as part of an elaborate prison escape plan so he can murder Bart.
  • The procedure is included in the eighteenth episode of fifth season of Grey's Anatomy, titled Stand By Me.
  • Episode 9 of Season 3 of Nip/Tuck includes the procedure.
  • There are advertisement posters in Repo! The Genetic Opera that display "Replace Your Face, Coming in 2057", That promote cosmetic face transplants.

Surgery and post-operation treatment

Surgery and post-operation treatment

The procedure consists of a series of operations requiring rotating teams of specialists. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (including the underlying fat, nerves and blood vessels, but no musculature). The surgery may last anywhere from 8 to 15 hours, followed by a 10–14 day hospital stay.

After the procedure a lifelong regimen of immunosuppressive drugs is necessary to suppress the patient's own immune systems and prevent rejection. Long-term immunosuppression increases the risk of developing life-threatening infections, kidney damage, and cancer. The surgery may result in complications such as infections that could turn the new face black and require a second transplant or reconstruction with skin grafts.

The transplant does not give the patient's face the appearance of the deceased donor's face because the underlying musculature and bones are different. Facial movements are controlled by the brain, so the personality as expressed by the face remains that of the patient

In the United States

In the United States

In 2004, the Cleveland Clinic in Ohio, United States, became the first institution to approve this surgery and test it on cadavers.

In October 2006, surgeon Peter Butler at London's Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out the face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals.[17]

In 2005, the Cleveland Clinic became the first US hospital to approve the procedure. In December 2008, a team at the Cleveland Clinic, led by Dr Maria Siemionow and including a group of supporting doctors and six plastic surgeons (Dr Steven Bernard, Dr Mark Hendrickson, Dr Robert Lohman, Dr Dan Alam and Dr Francis Papay) performed the first face transplant in the US on a woman named Connie Culp.[18][19] It was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date. This operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels, and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw, and even some teeth from a brain-dead donor. As doctors recovered the donor's facial tissue, they paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures. The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure. She had been disfigured to the point where she could not eat or breathe on her own as a result of a traumatic injury several years ago, which had left her without a nose, right eye and upper jaw. Doctors hoped the operation would allow her to regain her sense of smell and ability to smile, and said she had a "clear understanding" of the risks involved.

The second partial face transplant in the US took place at Brigham and Women's Hospital in Boston on April 9, 2009. During a 17-hour operation, a surgical team led by Bohdan Pomahac, MD, replaced the nose, upper lip, cheeks, and roof of the mouth - along with corresponding muscles, bones and nerves - of James Maki, age 59. Mr. Maki's face was severely injured after falling onto the electrified third rail at a Boston subway station in 2005. In May 2009, he made a public media appearance and declared he was happy with the result.[20] This procedure was also shown in the eighth episode of the ABC documentary series Boston Med.

Full face transplant

Full face transplant

On 20 March 2010, a team of 30 Spanish doctors carried out the first full face transplant on a man injured in a shooting accident.[15] On 8 July 2010, the French media reported that a full face transplant, including tear ducts and eyelids, had been carried out at the Creteil Henri-Mondor hospital

Partial face transplant

Partial face transplant

The world's first partial face transplant on a living human was carried out on November 27, 2005[7][8] by Dr Bernard Devauchelle, an Oral and Maxillofacial Surgeon, and Dr Jean-Michel Dubernard in Amiens, France. Isabelle Dinoire[7] underwent surgery to replace her original face that had been ravaged by her dog. A triangle of face tissue from a brain-dead human's nose and mouth was grafted onto the patient. On 13 December 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine and documents that the patient is happy with the results but also that the journey has been very difficult, especially with respect to her immune system's response.[9][10]

In April 2006, the Xijing military hospital in Xian, China carried out a similar operation, transplanting the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear while protecting his sheep.[11][12]

On 21 December 2008 it was reported that Li Guoxing had died in July in his home village in Yunnan Province. Prior to his death, a documentary on the Discovery Channel showed he had stopped taking immuno-suppressant drugs in favor of herbal medication. This was suggested to be a contributing factor to his death by his surgeon, Dr Guo Shuzhong.

A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a neurofibroma caused by a genetic disorder. The tumor was so massive that the man could not eat or speak properly.

In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after he received what his doctors call the world's first successful almost full face transplant.

History

History

[edit] Self as donor ("face replant")

The world's first full-face replant operation was on nine year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher. Sandeep's mother witnessed the accident. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag. An article in The Guardian recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin."[4] The operation was successful, although the child was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on. Sandeep's doctor was Abraham Thomas, one of India's top microsurgeons. In 2004, Sandeep was training to be a nurse.[5]

In 1997, a similar operation was performed in the Australian state of Victoria, when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached.

Face transplant

Face transplant

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A face transplant is a still-experimental procedure to replace all or part of a person's face.

Contents

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[edit] Beneficiaries of face transplant

People with faces disfigured by trauma, burns, disease, or birth defects might aesthetically benefit from the procedure.[1] Professor Peter Butler at the Royal Free Hospital first suggested this approach in treating people with facial disfigurement in a Lancet Article in 2002..[2] This suggestion caused considerable debate around the ethics of this procedure at that time.[3]

The alternative to a face transplant is to move the patient's own skin from their back, buttocks or thighs to their face in a series of as many as 50 operations to regain even limited function and a face that is often likened to a mask or a living quilt.

L. Scott Levin MD FACS, Chair, Department of Orthopaedic Surgery at University of Pennsylvania School of Medicine, has described the procedure as "the single most important area of reconstructive research."