Face Transplant – PT and OT Are Part of Recovery at NYU Langone

Eduardo D. Rodriguez, MD, DDS, and Patrick Hardison.

By Frank Long

More than 100 specialists were called together at NYU Langone Medical Center and tasked with what is reported as the most extensive face transplant to date. The 26-hour surgery led by Eduardo D. Rodriguez, MD, DDS, was completed in the morning hours of August 15. Three months later, the procedure seems a clear success in a video released by NYU Langone Medical Center that chronicles the recovery of recipient Patrick Hardison.

First of Its Kind

The 41-year-old Hardison is a volunteer firefighter from Senatobia, Miss, who was fighting a house fire in 2001 when a roof collapsed on him, burning his full face and scalp. In the incident Hudson also lost his lips, ears, and most of his nose in addition to his eyelids. Losing his eyelids left Hardison unable to blink and properly hydrate his eyes, putting him at risk of losing his sight.

The procedure performed on Hardison included transplanting the donor’s eyelids and muscles that control blinking, which reportedly marked the first time such a procedure was performed on a seeing patient.

Patrick Hardison works to rebuild his strength and endurance after the face transplant procedure.

Recovery and Rehabilitation

The work performed on Hardison included transplantation of the ears and ear canals, and selective portions of bony structures of the chin and cheeks. The entire nose was also transplanted from the recipient to Hudson. The surgical procedure required precise placement of metal plates and screws designed to optimize the contour and symmetry of the transplanted face.

Three days into recovery, Hardison was able to blink with the transplanted eyelids and could sit up in a chair within 1 week. Hardison is reportedly making a quick return to his daily routines, but continues what is described as an “extensive rehabilitative therapy” program.

According to a media release from NYU Langone Medical Center, Hardison’s recovery included physical therapy to build strength and stamina, and occupational therapy directed at relearning activities of daily living such as shaving. Because the fire had destroyed all of Hardison’s hair, he had not had to shave in the preceding 14 years.

Comparison images of Patrick Hardison before and after suffering burns, and approximately 90 days after face transplant. (Image capture from NYU Langone Medical Center)

 Prognosis

Rodriguez told CBS News Hardison is “doing so well” in his recovery. He also noted that one of the things that made Hardison’s transplant such a landmark procedure was the amount of tissue that was transplanted. “More importantly,” Rodriguez tells CBS reporter Contessa Brewer, “[is] the ability to restore function with functioning eyelids. And Patrick today can blink normally like you and I do.”

According to Rodriguez, the last time a procedure of this magnitude was attempted the patient did not survive.

Facial Function

Since 2005 at least 20 face transplants have been performed worldwide, according to ABC News and the Johns Hopkins Comprehensive Transplant Center website. Rehabilitation after face transplant can last from 4 months to 6 months, with some aspects of rehabilitation ongoing for life.

Helping the patient regain function and movement to re-engage in daily activities are among the rehabilitation goals noted on the Johns Hopkins website. Speech, communication, smiling, eating and drinking, blinking, and emotional expression are among the functional duties ascribed to the face. Among therapy exercises that may be a part of rehabilitation after a face transplant, according to the Johns Hopkins website, are muscle relaxation or stimulation, mirror exercises, facial expression training, speech, and swallowing training.

David P. Rodebaugh

Hardison was given the face of registered organ donor David P. Rodebaugh, 26, described as an Ohio-born Brooklyn artist and bicycling enthusiast. Rodebaugh died from injuries sustained in an accident. According to a statement from NYU Langone Medical Center, Rodebaugh’s family also donated David’s heart, liver, and kidneys to other recipients and for research.

Frank Long is editorial director of Rehab Management and Physical Therapy Products.