AMS Spring 2023

World’s Most Complex Face Transplant Operation Made Possible with 3D Modeling & 3D Printing

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before injury

Patrick Hardison before the fire

Fourteen years ago, 27-year-old volunteer firefighter Patrick Hardison responded with his colleagues to a call for the Senatobia Fire Department in northwest Mississippi. Inside a burning mobile home on September 5, 2001, searching for one of the homeowners, Hardison was caught as the ceiling collapsed on his second trip into the flaming structure. His mask melted, his face caught fire, and his vision and lungs were saved only because he closed his eyes and held his breath as he climbed out through a window. Hardison had been a volunteer with SFD for seven years at that point, but as he was loaded into an ambulance, his colleagues were unable to recognize him. His ultimate injuries were extensive; Hardison lost his ears, eyelids, hair, lips, and much of his nose, and was burned extensively across his entire head, neck, and upper torso.

While 71 surgeries helped Hardison to survive over the days, months, and years following the fire, it wasn’t until recently that he found a different hope: a friend from the SFD and his church heard about Dr. Eduardo Rodriguez, who had previously performed reconstruction work at the University of Maryland Medical Center. Dr. Rodriguez, who had performed a complex facial transplant in 2012, took Hardison on as a patient, continuing his work following a transfer to NYU Langone Medical Center. Between Dr. Rodriguez and LiveOnNY, which matches organ donors and patients in need, in August 2014 Hardison found himself on the donor registry waiting for a potential match.

dr patient

Dr. Rodriguez and Hadrison, after the surgery

In August 2015, 26-year-old David Rodebaugh was declared brain dead following a biking accident in late July. Rodebaugh, about the same age as Hardison had been at the time of his own accident, was a donor match. Dr. Rodriguez summoned Hardison to NYU Langone for what would become the most complex face transplant the world has yet seen.

Hardison risked his life in agreeing to the operation; should any of myriad parts of the operation go poorly, or the donor face be rejected by the recipient’s body immediately, he was unlikely to survive. A father of five, Hardison’s decision was not easy; his ex-wife counseled against it, noting that the kids saw their father as normal.

“People don’t understand how hard it is just to face the day. And it doesn’t end. It’s every day,” Hardison told New York Magazine. “…I lost everything. I was so young.”

The 26-hour operation required a team of more than 100 medical professionals–including doctors, nurses, and technical and support staff–working simultaneously in two operating rooms to prepare both donor and recipient for the long-prepared-for procedure.

The surgery began early on August 14, and represented several firsts: it was the first such procedure in New York, the first performed on a first responder, and the first to transplant eyelids and the requisite muscles to control blinking onto a seeing patient. It was also LiveOnNY’s first involvement in a face transplant procedure.scaffold 2

Noted for its complexity, the incredible surgery involved several major milestones, as explained by the team at NYU Langone:

  • 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 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

before afterWhile the entire procedure was clearly incredible, it relied very strongly on pre-planning. The team would have only one shot at the operation–which, as Dr. Rodriguez warned Hardison, had a 50/50 chance of success.

“You only have one chance to land the Rover. The same goes with the face,” Dr. Rodriguez told Reuters.

scaffoldAmong the extensive pre-planning for Hardison’s operation was 3D imagery and printing, which served to fully prepare the team. Through 3D models generated from CT scans of both Hardison and Rodebaugh, the team could approach the surgery in a manner something like putting on a hood. With every millimeter of the fit requiring a perfect fit, the team were able to deduce the exact procedure ahead, which included not just redraping the skin, but also using donor bone at the chin, nose, and cheekbones, as well as many of the connecting veins and arteries. Images provided by NYU Lagnone indicate that technology from 3D Systems played a huge role in this case.

We’ve previously seen ways in which 3D printed models assist in face transplant surgeries, and this procedure serves to underscore the critical nature of pre-operative planning.

scaffold 3Three months later, Hardison still has quite a long ways to go in his post-op recovery. He’ll be on anti-rejection medication for the rest of his life, must undergo extensive physical/occupational/speech therapy (even re-learning to shave), and will require follow-up surgery to adjust his final facial features. The road may be long, but at only 41 years old, Hardison certainly has a new lease on a long, full life that he can face proudly.

What are your thoughts on this incredible procedure?  Let us know in the 3D Printed Face Transplant forum thread on 3DPB.com.

Watch the full press conference from NYU Langone below:

[Images: NYU Langone]

team

patient progress

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