A 21-year-old woman with a gunshot wound to the face has undergone a total face transplant at Cleveland Clinic. It’s the hospital’s first transplant of effectively 100 percent of a patient’s facial tissue, and its third face transplant overall.
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The woman underwent surgery in May 2017 for the injury, which she incurred as a teenager. Her recovery so far has been good, her physicians say. She is walking and talking, and her physicians say they expect she will be able to eat with her mouth soon.
“To reach this point of recovery has often times been a difficult road to travel, but I’m thankful there’s been a road — and Cleveland Clinic has been the vehicle to help drive me along,” the woman says.
The goals of the surgery are to help the woman speak more clearly, better express her emotions, and to breathe, chew and swallow more easily, as well as improve her appearance.
“I am forever grateful for the care this hospital has given me and continues to offer on my journey of recovery and healing,” she says. “And to my donor and her family – words cannot express the appreciation I have for this incredible gift. With a grateful heart, I say thank you to all who have made this possible for me.”
The woman is undergoing extensive rehabilitative services that include physical, occupational, speech and swallowing therapy.
Reconstruction alone would not have corrected the woman’s disfigurement from the gunshot wound or adequately improved her quality of life, her physicians say.
Hospital officials are not releasing further personal details about the woman or the tissue donor, at the request of those directly involved and their families.
A 31-hour procedure
The facial transplant took 31 hours. Surgeons replaced effectively 100 percent of the woman’s facial tissue, including:
- The scalp
- The forehead
- Upper and lower eyelids
- Eye sockets
- The nose
- Upper cheeks
- The upper jaw and half of the lower jaw
- Upper and lower teeth
- Part of the facial nerves
- Facial muscles and skin
The woman had undergone a number of facial reconstructions before the transplant, but the end goal had always been a face transplant, her physicians say.
The surgeons prepare
The surgical team took great care during the initial reconstructive surgeries to safeguard blood vessels that might be used for the transplant, says Frank Papay, MD, Chairman of Cleveland Clinic’s Dermatology & Plastic Surgery Institute.
Dr. Papay co-directed the surgical team with Maria Siemionow, MD, PhD, former director of Cleveland Clinic’s Department of Plastic Surgery Research, who now is with the University of Illinois at Chicago College of Medicine.
“Plastic surgery is about restoring form and function,” Dr. Papay says. “Function comes before form, and prior to the face transplant, this patient had extremely poor function and form.
“Our job in reconstruction is to weigh the risk versus the benefit of doing face transplantation, and we felt the risk was well worth it to give this patient better function, better social form and, ultimately, a better life.”
The surgical team used surgical rehearsal, 3-D-printed models and virtual reality to plan before the surgery. This helped enhance the accuracy of the procedure and ensure the best outcomes in appearance and function.
“With a new nose and new lips, palate, eyelids and jaw, our patient now has the full opportunity to reintegrate into society and have a future just like any other young adult,” says Brian Gastman, MD, the woman’s primary plastic surgeon and a member of the transplant team. “This surgery can give her back the self-esteem and confidence she lost.”
A complex case
In addition to plastic surgeons, the extensive team overseeing the complex procedure included specialists in anesthesiology, bioethics, dentistry, ophthalmology, endocrinology, infectious disease, psychiatry, pharmacy and transplantation medicine.
“This case is a prime example of how we are much more capable together than we are individually,” Dr. Papay says. “I’m extremely proud of this team for their commitment to making a difference in this patient’s life.”
Cleveland Clinic is the first U.S. hospital to perform a face transplant and one of only six U.S. institutions that have performed the procedure. With this latest transplant, Cleveland Clinic now has performed three of the fewer than three-dozen face transplants worldwide.