Patrick Hardison before and after his face transplant, which took a team of more than 100 medical staff 26 hours to complete.
Image credit: NYU Langone
The marathon surgery, concluded at NYU Langone Medical Center in New York, NY, on 15th August, 2015, took 26 hours to complete and involved a team of over 100 people, including physicians, nurses, technical and support staff, led by Dr. Eduardo D. Rodriguez, chair of plastic surgery.
Rodriguez says when he heard Hardison's story he knew he had to do all he could to help him, and every member of his team felt the same way. He notes that the "surgery sets new standards in facial transplantation and will serve as an amazing learning tool."
In 2012, while at the University of Maryland Medical Center (UMMC), Rodriguez had led a 36-hour surgical procedure that replaced a 37-year-old man's entire face, including his tongue, both jaws, teeth and nose. At the time, it was heralded as the most extensive face transplant ever, and hit the news again 7 months later when Rodriguez said the face transplant was exceeding all expectations.
A fellow firefighter and member of Hardison's church heard about Rodriguez's work and contacted the surgeon on his friend's behalf.
Hardison had lost his ears, lips, eyelids, eyebrows, most of his nose and all of his hair. After undergoing more than 70 surgeries, he was still unable to return to a normal life and was referred to Rodriguez, who evaluated him for a face transplant.
First time seeing patient has received new eyelids, blinking muscles
Hardison's operation is significant because he received the donor's eyelids and the muscles that control blinking - a procedure that had not been previously performed on a seeing patient. Hardison was in danger of losing his sight and had been unable to perform independent daily tasks, such as driving.
Blinking - and involuntary blinking in particular - helps prevent infection and preserve sight by keeping the eyes hydrated and clean.
In January 2015, the journal Plastic and Reconstructive Surgery published a study by Rodriguez and others where they explained the importance of eyelid preservation in face transplants.
Hardison says he is "deeply grateful" to the donor and his family, and:
"Even though I did not know who they would be, I prayed for them every day, knowing the difficult decision they would have to make in order to help me. I hope they see in me the goodness of their decision."
The donor was David P. Rodebaugh, a 26-year-old Ohio-born Brooklyn artist and cycling enthusiast who died from injuries sustained in an accident. He was a registered organ donor. His family decided to donate his face as well as his heart, liver, and kidneys to other recipients, and to research.
Complex procedure transplanted selective bone structures of face
Unlike other situations where organs can be recovered and transported to distant hospitals, the recovery of the donor's face for the face transplant had to take place in a room adjoining the one where the transplant was performed.
The complex procedure transplanted not only skin and muscle, ears and ear canals, but also selective bony structures from the donor.
Image credit: NYU Langone
In the donor's room, Rodebaugh's face and donated organs were procured, while in the recipient's room, Hardison's face and scalp burn were removed and prepared to receive the transplant.
The complex procedure transplanted not only skin and muscle, ears and ear canals, but also selective bony structures from the donor - including portions of the chin, cheeks and the entire nose.
To ensure a "snap-fit," the team used CT scans of both the donor and the recipient to create 3D models and print cutting guides and precisely place patient-specific metal plates and screws to secure the profile and symmetry of the transplanted face.
By the end of the surgery, Hardison's new face began to show color, indicating circulation was working. His hair and beard began to grow back immediately. Three days later, he was blinking. He was sitting in a chair within a week. And now, 3 months after surgery, the swelling has greatly reduced and he is returning to an independent normal life.
While it may seem that Hardison's journey is now complete, that is far from the case. There is still a tough time ahead involving extensive rehabilitation and the possibility that his body may reject the transplant.
He will need therapy to build physical strength and stamina, and learn to eat, swallow and speak using his new lips. He will also need help to re-learn daily tasks such as shaving - something he has not done for 14 years.
And like all transplant patients, Hardison will have to take anti-rejection medication for the rest of his life to minimize the risk that his body will reject the donor tissue.
Following his discharge, Hardison will continue to have monthly check-ups with Rodriguez and the face transplant team, for whom he has these words:
"I also want to thank Dr. Rodriguez and his amazing team. They have given me more than a new face. They have given me a new life."
Rodriguez launched NYU Langone's face transplant program in November 2013 when he joined the academic medical center. He has assembled and trained a team drawn from departments as diverse as plastic surgery, anesthesiology, critical care medicine, emergency medicine, nursing, perioperative services, radiology, physical medicine and rehabilitation, psychiatry, clinical psychology, medical ethics and social work.
Over 100 medical staff were involved in the procedure to give Hardison a new face. Their detailed and extensive preparation ensured they were ready and systems were in place to carry out the surgery when a donor was identified. Part of their preparation included careful surgical rehearsals - including practice on cadavers.
Meanwhile, Medical News Today learned that the first clinical trial of uterus transplantation in the US has been given the go-ahead. The trial - which will take place at the Cleveland Clinic in Ohio - will involve uterus transplants in 10 women with uterine factor infertility.