Saving Face

Col. Robert Hale, U.S. Army Institute of Surgical Research Dr. Eduardo Rodriquez, University of Maryland,  and Col. Dallas Hack, director of Combat Casualty Care Research Program.

Col. Robert Hale, U.S. Army Institute of Surgical Research; Dr. Eduardo Rodriquez, University of Maryland; and Col. Dallas Hack, director of the USAMRMC Combat Casualty Care Research Program.

At the 2012 Medical Health System Research Symposium in Fort Lauderdale, Fla., high-tech programs and products are being discussed by a multitude of researchers focused on translating futuristic technology into modern-day practice.

In the 1990 Sci-Fi film Total Recall, Arnold Schwarzenegger's character receives a new face via high-tech methods, so that he can elude pursuers. The image, at once both intriguing and disturbing, causes viewers to imagine a world where something such as this is not only possible, but typical. Today, thanks to the work of researchers such as Dr. Eduardo Rodriquez of the University of Maryland, providing a new face to someone in need is on its way to becoming "typical."

In his presentation, Aug. 14, "Comprehensive Facial Transplantation," Rodriquez conveyed how he and his massive surgical team at Maryland used every resource available during a 36-hour surgery to attach a healthy donor face to a 37-year-old gunshot victim whose own face was disfigured. The procedure is considered to be the most extensive operation of its kind ever performed.

And the results are both surprising and remarkable.

Although this particular patient, Richard Lee Norris, was a civilian from rural Virginia, Rodriquez's initial plan was to treat the extreme facial wounds inflicted upon warfighters on the battlefield.

"The ultimate goal of this project was to treat the wounded warrior," said Rodriquez. "We wanted to develop a strategy that would essentially reconstruct the massive disfigurement of the face of these Soldiers [wounded in battle]."

"If you look at our data at the [R. A. Cowley] Shock Trauma Unit, approximately 15% of the patients that come through have some form of facial injury, and in the data from the Journal of Trauma, approximately 30% of all wounded warriors have some form of facial injury," he said. "The ultimate goal is not only to make these patients and Soldiers appear well, but to also ensure that they function normally."

Rodriquez said that many of massive facial injuries have been the result of today's improvised explosive devices, used frequently by rebels in combat scenarios, and from the high energy ballistic injuries that, unfortunately, these Soldiers or patients suffer.

"As injuries between the lower face and upper face are considered very difficult injuries to treat, the operation to repair these injuries must be proportionate to the problem in order to take these patients to the next level," said Rodriquez.

Working within the Shock Trauma Center in Baltimore, Md., Rodriquez and his team -- specialists in craniofacial surgery and microsurgery -- spent hundreds of hours in rigorous training and rehearsal before the patient ever entered the operating room. In a procedure of this magnitude, no margin of error could be tolerated by the surgical team. They studied the underlying relevant clinical anatomy to ensure proper transplantation, and they also considered the procedure from an aesthetic perspective, to see where incisions could be placed in order to go undetected.

The team used computerized surgical planning to ensure the exact transfer of the donor face to the patient, and they were extremely thorough in aligning the oral/dental/tongue configuration during the transfer to ensure that the patient could chew and speak correctly.

Considering the magnitude of this procedure, it is nothing short of amazing that the patient is recovering on schedule at this time. In fact, upon showing a comparison photo of Norris prior to and following the extensive surgery, Rodriquez himself appeared a bit surprised -- and pleased -- about the recovery.

"You can appreciate the dramatic change in this individual's not only appearance but also function," said Rodriquez. "This would not have been possible with conventional measures."

Most would agree that this is an understatement.

The doctor and his team hope to continue with the state-of-the-art craniofacial reconstruction they provide from their facility in Maryland, and Rodriquez looks to maintain, ideally, a goal of 3-5 facial transplantation surgeries per year.

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Last Modified Date: 15-Aug-2012