September 1, 2018

Full face transplant gives gunshot victim 2nd chance at life

Full face transplant gives gunshot victim 2nd chance at life

L-R: Katie in 2015 before the facial surgery and after the surgery in 2018

By Sola Ogundipe

Twenty one-year-old Katie Stubblefield has a brand new face. Her old face was destroyed when she sustained severe facial trauma from a gunshot wound on March 25, 2014.

Katie  who was 18  at the time of the incident shot herself in the face. Today, at 21, she is one of the youngest persons in the US and one of the youngest in the world to have received a full face transplant.

L-R: Katie in 2015 before the facial surgery and after the surgery in 2018

It took a team of 11 Cleveland Clinic surgeons and multiple specialists to perform the Ohio hospital’s third face transplant—and it’s first total face transplant—on Katie.

The surgery was extensive. It included transplantation of the scalp, the forehead, upper and lower eyelids, eye sockets, nose, upper cheeks, upper jaw and half of lower jaw, upper teeth, lower teeth, partial facial nerves, facial muscles, and skin—with 100 percent of her facial tissue effectively replaced.

Despite the success of the transplant, Katie’s journey is far from over, the hospital noted in a statement to Health Rendezvous. Katie currently remains unable to see, so she is learning Braille. She’s also undergone additional surgeries to improve function in her tongue and jaw.

Katie’s parents, Robb and Alesia Stubblefield, have been by her side. “Katie gets a second chance at life,” said Alesia her mother. Katie herself told the Cleveland Clinic Ethics Committee, during a meeting to ensure she was ready for her face transplant surgery: “I can’t go backward. I have to go forward.”

Katie suffered life-threatening, severely traumatic injuries from her gunshot wound. The single bullet pierced through her mouth and nasal cavity, exiting her skull between her eyebrows, it miraculously only grazed her brain tissue.

Sped by ambulance to hospital near her Oxford, Mississippi, home, Katie was stabilized, then flown by helicopter to a neighboring state’s top-level trauma centre.

By the time her parents arrived, by car, a half-hour or so later, Katie was already in surgery; it would be the first of more than a dozen operations she would receive in the ensuing years.

Five weeks later, in early May 2014, Katie was flown hundreds of miles north and admitted to Cleveland Clinic. Soon afterwards, the opportunity for her to undergo a possible face transplant emerged.

On a Sunday morning, the family met Dr Brian Gastman, who would become Katie’s primary plastic surgeon and a member of the face transplant team. They learned face transplantation was the ultimate goal, but it would be “way down the road somewhere,” said Robb. To get there would require many preparatory procedures including a jaw reconstruction surgery, using bone from Katie’s leg and a metal prosthesis.

Over time, as Katie endured many other operations, dozens of other physicians and specialists from other disciplines entered her life. Throughout the process, Cleveland Clinic psychiatrist, Dr Kathy Coffman, was a key specialist. Coffman has counseled all three of Cleveland Clinic’s face transplant patients, typically starting a year before the surgery and extending a full year or more afterwards.

Katie was determined to have a full facial transplant. Dr. Coffman was speaking about all the risks involved. Katie let her finish, and then she says, ‘I still want to do this, Dr. Coffman. I want to be able to go out in the world. And not be looked at like this.’

Katie signed the consent forms for facial transplant surgery in November 2015. It would be another 18 months before she would be physically and mentally prepared—and the search could then begin for a suitable donor.

It would prove to be a difficult process. Because of Katie’s small stature, and relatively young age. The biggest concern was getting the right donor, Dr. Gastman noted months before the transplant. In those long months before her surgery, Katie’s team assembled. Dr Frank Papay, chairman of Cleveland Clinic’s Dermatology & Plastic Surgery Institute, would co-direct the surgical team with Maria Siemionow, former director of Cleveland Clinic’s Department of Plastic Surgery Research.

As her primary team readied her for surgery, the face transplant team conducted numerous practice surgeries—some using an innovative technology called HoloLens, a self-contained mixed-reality computer headset that allowed the user to see holograms of 3D images of Katie’s head. The technology allows surgeons to virtually practice aspects of the surgery, prior to entering the operating room.

From the moment of Katie’s arrival, the team had the end goal of face transplantation in mind—as facial reconstruction alone would not correct her facial disfigurement or improve her quality of life. Thus, during her preparatory reconstruction surgeries, the surgeons were able to safeguard any potential blood vessels that could be used for the transplant.

“Plastic surgery is about restoring form and function,” said Dr. Papay. “Function comes before form, and prior to the face transplant, Katie had extremely poor function and form.” A face transplant was the only option to truly transform her life.

It would be three years to the day Katie arrived in Ohio that Cleveland Clinic doctors would receive a call for a potential donor. That donor would ultimately be Katie’s. When the day for surgery arrived, Katie was ready. And her “longest nap ever” began.

At various points during the 31-hour procedure, Drs. Papay and Gastman would leave the surgical suite armed with photos taken during the surgery to discuss next steps and options with Robb and Alesia.

As Dr. Papay explained, “We were well prepared. But we knew our game plan could change in the middle of surgery. And that’s what happened. We ended up using more of the donor’s face than we originally planned and went to option B about halfway through the surgery,” which would increase the risk but improve both the form and function of her face.

Ultimately, with option B, doctors effectively replaced all of Katie’s facial tissue with the donor’s, from mid-scalp all the way down to her jaw and neckline. Further, her upper jaw and the area beneath her orbital floors, as well as two-thirds of her lower jaw, are bone from the donor. One of the trickiest parts of the surgery involved her vascularity, ensuring blood vessels remained functional and sufficiently carried blood throughout her body.

Including her face transplant, Katie has endured more than 17 operations at Cleveland Clinic. Collectively, those procedures have given her the capability to breathe, chew, and swallow more effectively. She’s also able to use her face to better express emotions. In addition to significantly improved physical function, Katie is on the way to having enhanced physiological, psychological, and social function.

On reflection, a year later, Dr. Papay calls Katie’s transplant a success. She has not suffered any signs of rejection, or side effects from being on immunosuppressant drugs, and a series of subsequent operations to fine-tune certain areas (including her tongue to improve speech) have gone as planned.

In a statement when her face transplant was complete, Katie spoke of her gratitude to everyone involved. “I am forever grateful for the care this hospital has given me and continues to offer on my journey of recovery and healing.