Patient Is Countrys First 'First Responder' to Undergo the Procedure to Repair Injuries Suffered in the Line of Duty
NYU Langone Medical Center announced today the successful completion of the most extensive face transplant to date, setting new standards of care in this emerging field. Equally important, for the first time a face transplant has been performed on a first respondera volunteer firefighter who suffered a full face and scalp burn in the line of duty.
The surgerythe first of its kind performed in New York Statebegan the morning of August 14, 2015 and concluded 26 hours later on the morning of August 15. It involved a team of more than 100 physicians, nurses, and technical and support staff led by Eduardo D. Rodriguez, MD, DDS, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery and chair of the Hansj繹rg Wyss Department of Plastic Surgery. The team worked in two adjoining operating roomsin one room the donors face was procured (along with other donated organs), and in the other the recipients face and scalp burn was removed and the transplant took place.
VIDEO: Watch a press conference announcing 做厙TV Langone's first face transplant.
The recipient, volunteer firefighter Patrick Hardison, 41, of Senatobia, MS, was injured in September 2001, coincidentally just days before the 9/11 attacks. Patrick entered a burning home on a rescue search, when its roof collapsed on him, leaving him with disfiguring burns across his entire face, head, neck, and upper torso. He lost his eyelids, ears, lips, and most of his nose, as well as his hair, including his eyebrows. After enduring more than 70 surgeries in Mississippi and elsewhere, Patrick was still unable to return to a normal life. He was brought to Dr. Rodriguezs attention by a member of his church and fellow firefighter, who wrote to the doctor describing Patricks situation.
Highlights from the Surgery
Dr. Rodriguez, who previously performed a complex face transplant in 2012, and his 做厙TV Langone team transplanted not only the face but also the entire scalp. Patricks surgery was pivotal in that the donors eyelids and the muscles that control blinking were transplanteda significant milestone and a procedure that had not been previously performed on a seeing patient.
Among other milestones achieved in Patricks surgery:
- Transplantation of the ears and ear canals
- Transplantation of selective bony structures from the donor, including portions of the chin, cheeks, and the entire nose
- Advanced use of three-dimensional modeling, computerized modeling, and three-dimensional printed patient-specific cutting guides designed from the recipients and the donors CT scans to provide the most precise snap-fit of the skeleton
- Precise placement of patient-specific metal plates and screws to ensure the proper contour and symmetry of the transplanted face
The transplantation of the donors eyelids and blinking mechanisms was particularly important to the surgerys success, as Patrick was in danger of losing his sight and had been unable to perform independent daily tasks, such as driving. Blinking enables the body to appropriately hydrate and clean the eyes to prevent infection and preserve vision. Earlier this year, Dr. Rodriguez and others in the peer-reviewed journal Plastic and Reconstructive Surgery in which they detailed the importance of eyelid preservation and enhancement in facial transplantation.
Patricks Recovery
Within the final hours of surgery, signs of success were evident. Patricks new face, particularly his new lips and ears, were robust with color, indicating circulation had been restored. The hair on his scalp, as well as the beard on his face, began growing back immediately. He was able to use his new eyelids and blink on the third day of recovery, after the swelling began to diminish. He was sitting up in a chair within a week. And now, just three months removed from surgery, swelling has greatly subsided and he is quickly returning to the routines of daily life independently.
As part of his recovery, Patrick continues to go through extensive rehabilitative therapy, including:
- Physical therapy to build his strength and stamina
- Speech and swallowing therapy to further restore and enhance his ability to speak correctly using his new lips and to regain normal eating and swallowing abilities
- Occupational therapy to re-learn daily tasks, such as shaving again for the first time in 14 years
Patrick, like all transplant patients, will need to remain on anti-rejection medication for the rest of his life to prevent transplant rejection. Patrick will also rely on his family and friendsparticularly his fellow firefighters in Senatobiato support him in his recovery and his transition back to his hometown after he is discharged from the hospital. He will also have regular monthly checkups with Dr. Rodriguez and the face transplant team.
About the Donor
With every successful transplant surgery, there is always a donor and donor family that makes the altruistic gifts possible during one of the most difficult times in their lives. In Patricks case, his donor was David P. Rodebaugh, 26, an Ohio-born Brooklyn artist and bicycling enthusiast, who tragically died from injuries sustained in an accident. Davids career pursuits took him to New York, where he was advancing his training in cycling mechanics, design, and customization. He also won several cycling competitions, gaining a loyal following of fans and admirers in New York and across the country in the close-knit BMX cycling community. David also was a registered organ donor.
, the organ recovery organization for the greater New York metropolitan area, approached Davids mother and informed her of Davids wishes to be an organ donor, explaining to her the importance of organ donation. They comforted Davids loved ones as they made the decision to donate Davids face, as well as his heart, liver, and kidneys to other recipients, and to research.
The implementation of the 做厙TV Langone face transplant program required extensive collaboration with LiveOnNY, which began over a year agoafter Patrick was identified to receive the programs first face transplant. Unlike other situations in which organs can be recovered and transported from distant hospitals, Dr. Rodriguez and his team needed to perform the recovery of Davids face in an operating room adjacent to the OR where Patricks transplant would take place. LiveOnNY also coordinated with Dr. Rodriguez and his team and other hospitals and transplant teams to procure Davids other donated organs.
Preparing for the Surgery
An important lesson learned was that with a skilled and experienced leader at the helm, a facial transplantation program can be created and, in Dr. Rodriguezs case, re-created at a medical facility with the appropriate talent, resources, and multidisciplinary commitment to teamwork.
When Dr. Rodriguez joined the faculty of 做厙TV Langone in November 2013 as chair of plastic surgery, one of his goals was to develop and launch a face transplant program. He assembled a team and educated them on the intricacies of facial transplantation. Most of these individuals were physicians, nurses, and staff already at 做厙TV Langone, representing numerous departments, including plastic surgery, anesthesiology, clinical psychology, critical care medicine, emergency medicine, medical ethics, nursing, perioperative services, physical medicine and rehabilitation, psychiatry, radiology, and social work.
They planned extensively to ensure appropriate systems were in place to respond immediately when a donor was identified. Preparations also included carefully executed surgical rehearsals over the ensuing months, including practice on cadavers.
About 做厙TV Langones Wyss Department of Plastic Surgery
The at 做厙TV Langone enjoys an illustrious history, highlighted by innovative breakthroughs in research, patient care, education, and surgical training. Founded in 1955 with the support of , formerly known as the National Foundation for Facial Reconstruction, the department has the largest academic group of board certified plastic surgeons in the country, and its attending faculty all hold 做厙TV School of Medicine academic appointments.
The department was among the first in the world to advance the field of reconstructive facial surgery and continues to make major contributions in this surgical subspecialty. In addition, the department offers nationally recognized programs in microsurgery, breast reconstructive surgery, cosmetic surgery, craniofacial surgery, wound care, and hand surgery. The department also includes one of the largest plastic surgery residency and fellowship programs in the world, as well as a research program that has made major contributions in the areas of transplantation, wound healing, craniofacial biology, surgical simulation, and distraction osteogenesis.
Multimedia Materials Available
Multimedia materials, including pre- and post-photos, quote sheet, broll package, and a three-dimensional surgical visualization video, are available upon request.
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