Surgeons at NYU Langone Medical Center perform the most extensive face transplant to date
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 responder – a volunteer firefighter who suffered a full face and scalp burn in the line of duty.
The surgery — the first of its kind performed in New York State — began 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, technical and support staff, led by Eduardo D. Rodriguez, MD, DDS, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery and chair of the Hansjörg Wyss Department of Plastic Surgery. The team worked in two adjoining operating rooms — in one room, the donor's face was procured (along with other donated organs), and in the other, the recipient's face and scalp burn was removed and the transplant took place.
The recipient, volunteer firefighter Patrick Hardison, 41, of Senatobia, MS, was injured in September 2001 – ironically 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, 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. Rodriguez's attention by a member of his church and fellow firefighter, who wrote to the doctor describing Patrick's situation.
Highlights from the Surgery
Dr. Rodriguez — who previously performed a complex face transplant in 2012 — and his NYU Langone team transplanted not only the face, but also the entire scalp. Patrick's surgery was pivotal in that the donor's eyelids and the muscles that control blinking were transplanted–a significant milestone and a procedure that had not been previously performed on a seeing patient.
Among other milestones achieved in Patrick's 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 3D printed patient-specific cutting guides designed from the recipient's and the donor's 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 donor's eyelids and blinking mechanisms was particularly important to the surgery's 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 published a study in the peer-reviewed journal, Plastic and Reconstructive Surgery, in which they detailed the importance of eyelid preservation and enhancement in facial transplantation.
Within the final hours of surgery, signs of success were evident. Patrick's 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 friends — particularly his fellow firefighters in Senatobia — to 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 a donor family that makes the altruistic gifts possible during one of the most difficult times in their lives. In Patrick's 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. David's 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.
LiveOnNY, the organ recovery organization for the greater New York metropolitan area, approached David's mother and informed her of David's wishes to be an organ donor, explaining to her the importance of organ donation. They comforted David's loved ones as they made the decision to donate David's face, as well as his heart, liver, and kidneys to other recipients, and to research.
The implementation of the NYU Langone face transplant program required extensive collaboration with LiveOnNY, which began over a year ago – after Patrick was identified to receive the program's 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 David's face in an operating room adjacent to the OR where Patrick's transplant would take place. LiveOnNY also coordinated with Dr. Rodriguez and his team and other hospitals and transplant teams to procure David's other donated organs.
Preparing for the Surgery
An important lessons learned was that with a skilled and experienced leader at the helm, a facial transplantation program can be created and — in Dr. Rodriguez's case — re-created at a medical facility with the appropriate talent, resources and multi-disciplinary commitment to teamwork.
When Dr. Rodriguez joined the faculty of NYU 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 NYU 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 once a donor was identified. Preparations also included carefully executed surgical rehearsals over the ensuing months, including practice on cadavers.
About NYU Langone's Wyss Department of Plastic Surgery
The Hansjörg Wyss Department of Plastic Surgery at NYU Langone enjoys an illustrious history, highlighted by innovative breakthroughs in research, patient care, education and surgical training. Founded in 1955 with the support of myFace, 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 NYU 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, can be found in our online Dropbox: http://bit.ly/1MMcUXo.
Media Relations Department
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COMMENTS FROM KEY INDIVIDUALS
Face Transplant Recipient
"I am deeply grateful to my donor and his family. 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. 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. Lastly, I want to thank my family and friends who have stood by me and helped me through this process. I am very excited to share my story to help others, especially fellow firefighters and members of the armed services who have been injured in the line of duty. Now I look forward to returning home to my own family and loved ones."
Eduardo D. Rodriguez, MD, DDS
The Helen L. Kimmel Professor of Reconstructive Plastic Surgery
and Chair, Hansjörg Wyss Department of Plastic Surgery NYU Langone Medical Center
"When I met Patrick and heard his story, I knew that I had to do all that I could to help him — and every member of my team felt the same way. His surgery sets new standards in facial transplantation and will serve as an amazing learning tool. I am particularly encouraged with the success we have achieved in transplanting David's eyelids and blinking mechanisms to Patrick. This is a major milestone – one that could lead to preserving vision in future patients. We could not have helped Patrick without amazing teamwork. My thanks to all the staff at NYU Langone who helped, in some way, to get us to this point. I also want to thank LiveOnNY, without whose assistance this could not have happened, and to the donor family for their courage at a most difficult time in their own lives."
Robert I. Grossman, MD
The Saul J. Farber Dean and CEO
NYU Langone Medical Center
"This is a proud moment in the history of NYU Langone Medical Center and NYU School of Medicine. When we recruited Dr. Rodriguez in 2013 to lead our Hansjörg Wyss Department of Plastic Surgery, we did so with the full intention to develop a premier facial transplantation program – the first of its kind in New York. His team achieved remarkable results – and advanced our institutional goal to be recognized as a major organ transplant center. But let us not forget that none of this would have been possible without courageous individuals like Patrick Hardison and David Rodebaugh's brave family. They took incredible risks and made very difficult decisions that will greatly advance medical research and clinical care. It is our fervent hope that Patrick's amazing story will be the first of many of its kind here at NYU Langone."
Helen Irving, MBA
President and CEO
"Patrick's story underscores the importance of organ donation and how organ procurement is changing dramatically. Innovative breakthroughs in science and medicine are advancing the field of transplantation. These breakthroughs also are coming at a time of escalating demands across the country for organ donations. That is why people like David Rodebaugh and his family are so important to procurement efforts. David was a young man, an age when individuals typically would not think about their own mortality. But, despite his youth, he signed his donor card on his driver's license, which helped us identify him. We need more individuals, especially young people like David, to register as organ donors so that others, like Patrick, can live on through their kindness."
David P. Rodebaugh's Mother
"I love my son very much, and was so proud of his achievements. No parent should ever go through the pain of losing a child. But we felt that perhaps something good could come from something so tragic. That's why we decided to honor David's decision to donate his organs – so that others like Patrick Hardison can live on in his memory and benefit from his generosity. I wish Patrick and his family all the best as he embarks on a new life."
Robert R. Latham, Jr
Executive Director, Mississippi Emergency Management Agency Patrick Hardison's Friend and Former Fire Chief
"I've had the privilege of knowing Pat Hardison for most of his life, observing him as he grew up in Senatobia along with my two sons. Like many young boys in small communities, Pat found an interest in firefighting and the camaraderie that came with being a member of the Senatobia Fire Department. I was chief at the time that Pat became a member, and it was a pleasure to watch him grow and mature as a firefighter, ultimately achieving the rank of captain. Although I was not chief when his accident occurred, his injury and physical and emotional journey affected everyone who knew him. His accident, most importantly, reminded us all once again of the dangers that firefighters face every day. Pat's accident and personal sacrifices have translated into improved training requirements for volunteers and fire scene management in Mississippi. Pat has always been a person who put others before himself. We are all thrilled and grateful beyond words with his miraculous transformation and what this means for him and his family."