In the most extensive full face transplant to date, the Plastic and Reconstructive Surgery team at the R Adams Cowley Shock Trauma Center at the University of Maryland gave a new face to a 37-year-old man who had lost much of his face after a gunshot wound more than a decade ago.
Along with facial tissue, the surgical team transplanted a tongue, teeth and both upper and lower jaws. The 36 hour surgery took place at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center, March 19th and 20th.
The face transplant, formally called a vascularized composite allograft (VCA), was part of a 72-hour marathon of transplant activity at one of the busiest transplant centers in the world. The family of one anonymous donor generously donated his face and also saved five other lives through the heroic gift of organ donation. Four of these transplants took place over the course of two days at the University of Maryland Medical Center.
The face transplant team was led by Eduardo D. Rodriguez, M.D., D.D.S., associate professor of surgery at the University of Maryland School of Medicine and chief of plastic, reconstructive and maxillofacial surgery at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. Dr. Rodriguez is board-certified in plastic and reconstructive surgery as well as in oral and maxillofacial surgery. This marks the first time in the world that a full face transplant was performed by a team of plastic and reconstructive surgeons with specialized training and expertise in craniofacial surgery and reconstructive microsurgery.
Also on the team was Canadian plastic surgeon Dr. Daniel Borsuk, a Montreal native who attended McGill University and then completed his plastic surgery studies at The University of Montreal. Dr. Borsuk, currently finishing up a one-year fellowship at the University of Maryland Medical Centre found out when he applied for the fellowship – a long hope of his – that the complex procedure was in the works. He was thrilled to be a member of the team.
As soon as his fellowship started last summer, he has been preparing with the team for the transplant. “The team had been practicing for more than a year in real-time operational settings. Dr. Rodriguez also secured the first research procurement of a donor face,” explains Dr. Borsuk.
The team of face transplant surgeons also benefited greatly from their experience treating high-velocity ballistic facial injuries at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. The team also includes research scientists and physician scientists from the University of Maryland’s nationally recognized Division of Transplantation who have been researching ways to reduce rejection of donated organs and minimize the side effects of long-term immunosuppressive use after transplantation.
“A project like the face transplant requires multi-disciplinary collaboration between numerous clinical services and in many ways is very similar to trauma care,” says Thomas M. Scalea, M.D., Francis X. Kelly Professor of Trauma Surgery, director, Program in Trauma, University of Maryland School of Medicine, and physician-in-chief, R Adams Cowley Shock Trauma Center. “Because we have an infrastructure built around multi-disciplinary care, it made sense for the facial transplant program to be housed at the Shock Trauma Center in the University of Maryland Medical Center.”
Dr. Borsuk agrees, “This surgery really demonstrated the importance of having a good team. This surgery involved so many people – six departments and 150 support staff – from the organ procurement coordinators before the surgery to the speech pathologists and anti-rejection team afterward. This level of coordination is unparalleled.”
The scientific team that includes Drs. Stephen Bartlett, Rolf Barth, and Eduardo Rodriguez focused on the anatomic and immunologic challenges to craniofacial transplantation. This work has been the basis for Dr. Rodriguez and his surgical team’s groundbreaking surgical achievement.
“This accomplishment is the culmination of more than 10 years researching the immune system’s response to vascular composite allograft transplants,” says Stephen T. Bartlett, M.D., Peter Angelos Distinguished Professor and Chair of the Department of Surgery at the University of Maryland School of Medicine and Surgeon-in-Chief at the University of Maryland Medical Center. “Our solid organ transplant immunosuppressive protocol has led to excellent outcomes for our patients and will be part of the long-term care plan for the face transplant patient.”
The patient, Richard Norris is recovering even better than hoped – being able to move his tongue, open and close his eyes, having regained his sense of smell, and even brushing his teeth. Media around the world are reporting not only that the face transplant is the most comprehensive to date, but the most aesthetically successful as well.
Dr. Daniel Borsuk completes his fellowship this summer and despite several offers to remain in the United States, is coming home to Montreal where he will perform reconstructive plastic surgery on children with congenital abnormalities at Ste. Justine Hospital, and on adults severely injured in accidents at Maisonneuve-Rosemont Hospital.
*With files from the University of Maryland Medical Centre.