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.

Spring 2014

Initial Trauma

Mar 25, 2014 March 25, 2014
hospitalization

Self-inflicted gunshot wound with extensive damage to the face and intracranial injuries. Initially hospitalized at Oxford, Mississippi, then transferred to Memphis, Tennessee.

surgery

Tracheostomy

surgery

Put lower jaw, upper jaw, and cheekbones back in place, stabilized with plates. Surgically close eyelids to facilitate corneal healing.

surgery

Repair torn brain membrane.

Mar 31, 2014 March 31, 2014
surgery

Open skull to relieve bleeding in the brain.

Apr 15, 2014 April 15, 2014
surgery

Close open facial wound with tissue graft from stomach.

Apr 16, 2014 April 16, 2014
surgery

Tissue graft fails; remove graft.

surgery

Insert feeding tube, and exchange tracheostomy tube.

May 2, 2014 May 2, 2014
transfer

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.

Summer 2014

Operations and Complications

Jun 25, 2014 June 25, 2014
complication

Acute deep vein thrombosis

Jul 11, 2014 July 11, 2014
surgery

New tracheostomy

Jul 22, 2014 July 22, 2014
surgery

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

Aug 15, 2014 August 15, 2014
surgery

Insert a shunt to relieve swelling in the brain.

Aug 22, 2014 August 22, 2014
transfer

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.

Aug 14, 2015 August 14, 2015
surgery

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.

Oct 28, 2015 October 28, 2015
complication

Seizures related to low sodium levels; bacterial skin infection on cheek

Dec 11, 2015 December 11, 2015
hospitalization

Hospitalized for dizziness; starts oral iron therapy

Dec 17, 2015 December 17, 2015
complication

Intestinal ailment

Jan 11, 2016 January 11, 2016
evaluation

Evaluated as a good candidate for face transplant

Mar 15, 2016 March 15, 2016
listed

Listed for face transplant

Apr 6, 2016 April 6, 2016
surgery

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

Apr 15, 2016 April 15, 2016
surgery

Remove some facial tissue to address possible infection.

surgery

Remove tissue expander on left cheek.

Apr 18, 2016 April 18, 2016
surgery

Remove tissue expander on right cheek.

Apr 27, 2016 April 27, 2016
surgery

Adjust hardware shaping bones around eyes.

Jun 23, 2016 June 23, 2016
surgery

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.

May 4, 2017 May 4, 2017
transplant

Face transplant

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.

Last-Minute Change

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.

Connecting Nerves

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.

Summer 2017

Follow-Up Procedures

Jun 12, 2017 June 12, 2017
surgery

Advance base of the tongue; better align jaw.

Jul 17, 2017 July 17, 2017
surgery

Clean out sinuses; reshape eye sockets.

Aug 1, 2017 August 1, 2017
discharged

Discharged from Cleveland Clinic

Postsurgery Recovery

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.

May 6, 2014

Surgery

May 9, 2014

Surgery

May 23, 2014

Surgery

June 22, 2014

Surgery

April 6, 2016

Surgery

May 4, 2017

Face Transplant

Post-Transplant

Refinements

First Scan

May 8, 2014

Bone structure

Fasteners hold bones together

Thigh

skin

New

nasal

passage

Scan

of Katie’s

sister’s skull

Mandible

Jaw

model

Fibula

graft

Achilles

tendon

Titanium

mesh

Distraction

device

Original

plan for

transplant

Extent

of full

transplant

Original

plan for

transplant

Internal

carotid

artery

(to brain)

External

carotid

artery

(to face)

Facial

nerves

Titanium

fasteners

hold bones

together

Reinforce

orbital

walls

Move

jaw

back

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