Building Katie’s New Face
Katie Stubblefield lost most of her face when she shot herself in 2014. She was stabilized in a Memphis, Tennessee, hospital, but when her wound couldn’t be closed, she was moved to Ohio’s Cleveland Clinic. Once there, she began the journey to rebuild her face, which would include a 31-hour full-face transplant.
Self-inflicted gunshot wound with extensive damage to the face and intracranial injuries. Initially hospitalized at Oxford, Mississippi, then transferred to Memphis, Tennessee.
Put lower jaw, upper jaw, and cheekbones back in place, stabilized with plates. Surgically close eyelids to facilitate corneal healing.
Repair torn brain membrane.
Open skull to relieve bleeding in the brain.
Close open facial wound with tissue graft from stomach.
Tissue graft fails; remove graft.
Insert feeding tube, and exchange tracheostomy tube.
Katie is transferred to Cleveland Clinic.
Keep Her Alive
When Katie is first admitted to the Cleveland Clinic, she has already undergone multiple procedures to stabilize her.
The clinic continues this work, removing shattered bones in her jaw and skull, keeping her windpipe open for breathing, and covering her wounds for healing.
Rebuild Her Nose and Skull
Doctors construct a nasal cavity, which will help protect Katie’s brain from infection and make eating and breathing easier. Plates and screws from previous operations are taken out, and her open face wound is sealed. Infected bone from her skull is removed.
Build a Nasal Passage
A skin graft from Katie’s thigh is rolled up and used to create a new nasal passage. The top side of the tube seals off her brain, protecting it from infection. The bottom becomes her upper lip.
Refine the Jaw
Katie’s jaw needs hardware to stabilize her face. Her sister is scanned to provide the necessary dimensions to build an appropriately sized jaw made of titanium and grafted leg bone. Composite tissue of muscle, skin, and part of the Achilles tendon is used to form a lower lip.
Size the Jaw
A scan of Katie’s sister’s lower jaw is reduced by 2.5 percent to make the model better match Katie. Tissue from her lower leg and part of her fibula are then used to form her lower jaw based on the digital model.
Operations and Complications
Acute deep vein thrombosis
Implant titanium mesh.
Fix Her Skull
An earlier operation opened Katie’s skull to remove damaged tissue and prevent swelling of the brain. This hole is now at risk for infection.
A custom-made titanium mesh implant that closely fits Katie’s anatomy is added to help prevent exposure and infection.
Summer 2014 - Spring 2016
Operations and Complications
Insert a shunt to relieve swelling in the brain.
Discharged to rehab unit
Katie’s pituitary gland, which helps regulate metabolism, remains damaged and is a possible factor leading to seizures. Katie has physical, occupational, speech, and vision therapy and undergoes evaluation for face transplant candidacy.
Enhance soft-tissue coverage over cranial plate, and prevent erosion and exposure of plate and brain.
At the end of summer and into the fall, Katie continues with outpatient rehab, including physical and occupational therapy and speech and visual rehab. She also undergoes multidisciplinary evaluation for possible face transplant.
Seizures related to low sodium levels; bacterial skin infection on cheek
Hospitalized for dizziness; starts oral iron therapy
Evaluated as a good candidate for face transplant
Listed for face transplant
Attach distraction device.
Reposition Her Eyes
Katie’s eyes are misaligned and too far apart. To prepare her skull to fit a donor face, surgeons employ a method called distraction osteogenesis. Surgeons reshape bone by cutting through it with a saw and controlling for shape and length as it regrows.
Break and Shape Bone
Doctors make surgical cuts to the bones around Katie’s eyes. As a distraction device is adjusted, the cuts widen a millimeter a day, filling in with new growth.
Spring 2016 - Spring 2017
More Operations and Transplant
Remove some facial tissue to address possible infection.
Remove tissue expander on left cheek.
Remove tissue expander on right cheek.
Adjust hardware shaping bones around eyes.
Remove distraction device.
After 14 months a donor is found. During this time, Katie’s condition is stable and surgeons practice regularly on cadavers and 3D-printed models of faces.
Transplant the Face
A donor with matching tissue type and sex, as well as similar face size, becomes available. In an operating room adjacent to Katie’s, surgeons remove the donor’s face along with the lower portion of her skull.
Surgeons expect to use only part of the donor’s face, but the darker skin tone—meaning more obvious scarring—and larger size lead to the switch to a riskier, full-face transplant. They also cut away much of Katie’s reconstructed face, shown in previous stages.
Connecting Blood Vessels
In a critical step in the surgery, blood vessels are quickly attached to limit the time the donor face lacks access to oxygenated blood. Katie’s new face then flushes pink.
Once the blood vessels are joined, Katie’s facial nerve trunks are connected to the donor face, one on each side. Nerves to her eye muscles are preserved. Katie can still control those muscles.
Layering the Eyes
Because Katie’s eyelid muscles still work, the team decides to overlay the donor’s eye muscles on Katie’s, increasing her chances of being able to make facial expressions.
What Is Donated
Transplanted parts of the face include the donor’s skin, muscle, upper and lower jaws, teeth, cartilage, soft palate, blood vessels, and nerves.
Advance base of the tongue; better align jaw.
Clean out sinuses; reshape eye sockets.
Discharged from Cleveland Clinic
Her cognitive abilities intact, Katie continues her physical and occupational therapy after the transplant. She also works with a speech therapist and takes Braille lessons. Doctors closely monitor her for signs of rejection. Her nerves need more than a year to recover.
Fine-Tune the Transplant
After the transplant, Katie’s tongue can’t touch her teeth or the roof of her mouth, making it impossible to produce th, d, n, l, t, and s sounds. P and b are also difficult for her. Post-transplant surgeries seek to bring her tongue closer to her teeth, better align her jaw, and reshape her eye sockets to keep her eyes properly placed in her skull.
Told by her surgeons she’d now be a “professional patient,” Katie takes immunosuppressive drugs and her hormone levels are monitored. She’s learning to use her new face as she regains the ability to eat and speak.
By Jason Treat, Ryan T. Williams, and Brian T. Jacobs, NGM Staff. Art: Bryan Christie. Source: Cleveland Clinic
Dive Deeper into The Story of a Face
May 6, 2014
May 9, 2014
May 23, 2014
June 22, 2014
April 6, 2016
May 4, 2017
May 8, 2014
Fasteners hold bones together