The humor that Katie Stubblefield has shines through when she talks about her face transplant surgical experiences.
As she puts it, “It was the longest nap of my entire life.”
such who are not acquainted with Katie’s speech style, which is still growing, may not be able to readily understand such words; nevertheless, her parents are typically there to provide interpretation. Since Katie, who was 18 years old at the time, suffered serious face injuries and considerable problems as a result of a self-inflicted gunshot wound on March 25, 2014, Robb and Alesia Stubblefield have remained at her side, assisting her in “taking four steps forward, two steps back,” as Robb puts it.
Katie would be the recipient of the Cleveland Clinic’s third face transplant, as well as the institution’s first entire face transplant, which would need the participation of eleven surgeons and other specialists all working together. Having had a face transplant at the age of 21, Katie was the youngest person in the United States to have done so.
And it was indeed extensive: the surgery included transplantation of the scalp, the forehead, the upper and lower eyelids, the eye sockets, the nose, the upper cheeks, the upper jaw and half of the lower jaw, the upper teeth, the lower teeth, partial facial nerves, facial muscles, and skin. In addition, one hundred percent of her facial tissue was effectively replaced.
There is still a long way to go for Katie, despite the fact that the transplant was successful. Braille is something that Katie is studying since she is still unable to sight at the moment. Moreover, she has had additional surgical procedures in order to enhance the functionality of her jaw and tongue.
At long last, the way ahead seems to be within grasp. Katie’s aspiration is to attend college (she would want to be a counselor or a teacher), to achieve independence, and to be able to stroll down the street “and blend in,” as she puts it.
In her words, Alesia added, “Katie is given a second chance at life.”
During a meeting to ensure that she was prepared for her face transplant surgery, Katie herself gave the following statement to the Cleveland Clinic Ethics Committee: “I can’t go backward. I am required to go ahead.
As a result of her gunshot wound, Katie had sustained injuries that were both very traumatic and potentially fatal. In spite of this, when the paramedics came a few minutes later, one of them yelled out, “She is still alive.” There is a pulse here.”
It is a miracle that the single bullet merely managed to scratch her brain tissue, despite the fact that it penetrated her mouth and nasal canal and exited her skull between her eyebrows.
When Katie arrived at the hospital in Oxford, Mississippi, she was immediately intubated with an endotracheal tube and put on a ventilator. She was transported there by ambulance. Following the stabilization of her condition, she was transported by helicopter for the twenty-two minute journey to a hospital in Memphis that has a Level I trauma center.
Katie had already had surgery by the time Robb and Alesia arrived in their vehicle almost half an hour later; this would be the first of more than a dozen procedures that she would have over the course of the subsequent years.
The doctors spoke to us in a manner that was quite straightforward. If there is no gloom and doom, then there is also no peaches and cream. Robb said that one of them, an older guy, stated that it was the worst instance he had ever seen in his whole life.
After that, the doctor said a term that Robb had never previously encountered in his whole life.
When asked about it, he said, “Without a face transplant, I just don’t know.”
As I think about it, I’m thinking, ‘Face transplant? That is what it is,’”
Five weeks later, at the beginning of May 2014, Katie was transported by helicopter to Cleveland, Ohio, where she was brought into the Cleveland Clinic.
In addition, Robb and Alesia traveled with her to Cleveland, and they have not left the city up to this point.
Soon after Katie’s stay in Memphis, the possibility of her being moved to Cleveland Clinic, where she may eventually have a face transplant, became available to her. On a Sunday morning, the family had the opportunity to meet Brian Gastman, MD, who would go on to become Katie’s main plastic surgeon and a part of the team to perform the face transplant. His arrival at their meeting was accompanied by a three-dimensional representation of Katie’s head, which Robb referred to as a “ball of energy.”
The interior of my child’s skull is opening up to me. Every single thing. Specifically, the region of the incision and her bone structure. It captivated my attention.
An additional thing that they discovered was that face transplantation was the ultimate aim, but that it would be “way down the road somewhere,” as Robb put it. A number of preliminary treatments, such as a jaw reconstruction surgery, which would include the use of bone from Katie’s leg and a metal prosthesis, would be necessary in order to arrive at the destination.
Due to the fact that Katie had a multitude of more procedures over the course of time, hundreds of other doctors and professionals from many fields joined her life. Both Robb and Alesia have maintained a list of nutritionists in their possession. Individuals who specialize in physical therapy. Endocrinologists are present. Experts in infectious diseases expert. In the field of neurosurgery. Professionals who specialize in eye care. Social workers are employed. The bioethicists. These are psychiatrists. Those who specialize in anesthesia. The dentists. The pharmacists. Internal medicine experts are employed. Vascular surgeons are medical professionals. A large number of nurses, in the dozens. Also, there are plastic surgeons, of course.
Throughout the whole of this procedure, the psychiatrist Kathy Coffman, MD, of the Cleveland Clinic was an essential expert.
Counseling sessions with Dr. Coffman have been provided to all three of the face transplant patients at the Cleveland Clinic. These sessions normally begin one year before to the operation and continue for at least one full year following the procedure. According to what she has written, “Facial transplantation combined with the appropriate psychological care can enable (patients) to reclaim their identity, reestablish their social contacts, and ultimately get their life back.”
When Katie was getting closer and closer to the idea of having a complete face transplant, Dr. Coffman would gently push her with questions to be sure that this was what Katie really wanted.
Alesia had a clear and immediate recollection of one of those conversations: “Dr. Coffman was discussing all of the risks that were involved.” After she had finished, Katie said, “I still want to do this, Dr. Coffman.” Katie then allowed her to continue.
“I want to be able to go out into the world,” she had said. And not be regarded in such a manner at all.’”
In November of 2015, Katie went through the process of signing the permission documents for face transplant surgery. One more year and eighteen months would pass before she would be psychologically and physically ready, at which point the hunt for a prospective donor could start.
It was going to be a challenging procedure to get through. It was more difficult to find suitable donors for Katie because of her diminutive height and the fact that she was still quite young. This number is considerably lower due to the fact that the majority of donors that are available are male. Additionally, the donor’s other organs might potentially be utilized for other patients who are suffering from ailments that are more life-threatening, which would imply that they could take priority over a face transplant treatment.
During an interview that took place many months before to the transplant, Dr. Gastman expressed his anxiety by saying, “My greatest concern is getting her the right donor, one that is really appropriate for her.”
Katie’s team came together over the arduous months leading up to her surgical procedure. Maria Siemionow, MD, PhD, who was formerly the head of the Department of Plastic Surgery Research at the Cleveland Clinic, would be the co-director of the surgical team. Frank Papay, MD, who is the chairman of the Cleveland Clinic’s Dermatology & Plastic Surgery Institute, would also be co-directing the team.
Cleveland Ohio, Dermatology and Plastic Surgery Institute, DPSI
During the time that her main team was preparing her for surgery, the face transplant team performed a number of practice procedures. Some of these surgeries were performed with the use of a cutting-edge technology known as HoloLens, which was a self-contained mixed-reality computer headset that enabled the user to see holograms of three-dimensional representations of Katie’s head. Before entering the operating room, surgeons are able to virtually rehearse various components of the operation thanks to the invention of this technology.
The preoperative face transplant surgery planning for Katie Stubblefield’s procedure is carried out with the assistance of HoloLens, which is used by Kihyun Cho, M.D., a member of the face transplant surgical team at the Cleveland Clinic. (Image of Cleveland Clinic courtesy of)
According to Kihyun Cho, MD, a member of the face transplant surgical team at the Cleveland Clinic, HoloLens is used for the purpose of preoperative face transplant surgery planning in preparation for Katie Stubblefield’s procedure. (Image of Cleveland Clinic courtesy of)
When it comes to deciding what we ought to or ought not to do for Katie, we deliberate, debate, and dispute with a polite tone. “The process is extremely complicated, and each face transplant is one of a kind,” Dr. Gastman said. “We need to make a decision about whether or not it is truly worth it if something is going to increase the risk that the patient is exposed to.”
Facial reconstruction alone would not be sufficient to restore Katie’s facial deformities or enhance her quality of life; thus, the team had the final aim of face transplantation in mind from the minute that Katie arrived on the scene. As a result, the surgeons were able to protect any prospective blood arteries that may be utilized for the transplant while they were doing the preliminary repair surgery on her.
When asked about plastic surgery, Dr. Papay said that it is about restoring both form and function. According to the proverb, “function comes before form,” and prior to receiving a face transplant, Katie had severely poor function and form.
To genuinely improve her life, the only option available to her was to have a face transplant.
The Cleveland Clinic physicians would get a call for a prospective donor exactly three years after Katie arrived in Cleveland. This would be the day that the call would be received. In the end, Katie would be the recipient of that donor. Katie was prepared for the day of the operation when it finally came. Her “longest nap ever” started at that moment.
Throughout the course of the 31-hour process, Drs. Papay and Gastman would leave the operating room with photographs that had been taken throughout the procedure in order to have conversations with Robb and Alesia about the subsequent stages and alternatives that were available to them.
What Dr. Papay had to say about it was that “We were well prepared.” In the midst of the operation, however, we were aware that our game plan may be altered. And that is exactly what took place. We ultimately decided to use a greater portion of the donor’s face than we had first anticipated, and we switched to option B around midway through the operation. This would result in an increase in risk, but it would also enhance the shape and function of her face.
Alesia said that at first, she was taken aback by the fact that the medical professionals required her input. However, in the end, she realized that she and Robb had a part to play in evaluating the available alternatives and making some of the judgments. This was due to the fact that the choices would have aesthetic consequences that would also raise the risks associated with the surgical procedure.
Alesia said, “I couldn’t stop thinking about what we think Katie would have wanted to do,” and she was right. Rob continued by saying, “At some point, somebody came up and said, ‘Katie would want us to go all the way.’” And it was a perfect fit. We were aware of the actions that we needed to take.
After everything was said and done, the physicians used option B to essentially replace one hundred percent of Katie’s face tissue with the donor’s, beginning at the middle of her skull and continuing all the way down to her chin and neckline. A further two-thirds of her lower jaw, as well as her upper jaw and the region under her orbital floors, are made up of bone that was donated by the donor. Her vascularity was one of the most challenging aspects of the operation, since it required ensuring that her blood vessels continued to operate properly and that they delivered a enough amount of blood throughout her body.
A total of more than seventeen procedures have been performed on Katie at the Cleveland Clinic, including her face transplant. She is now able to breathe, chew, and swallow more successfully as a result of the cumulative effects of those treatments. Additionally, she is able to effectively convey her feelings via the use of her face. Katie’s physiological, psychological, and social functions are all on the verge of being greatly better, in addition to the major improvement in her actual physical function.
After a year has passed, Dr. Papay considers Katie’s transplant to have been a successful procedure. A number of following procedures to fine-tune particular regions (including her tongue in order to enhance speech) have gone according to plan, and she has not had any symptoms of rejection or negative effects as a result of being on immunosuppressant medicines.
He is positive that Katie would not be on the edge of a new life if it were not for the unwavering support of her parents, siblings, and extended family. This is in addition to the advances that have been made in medical treatment. Dr. Papay made the following statement: “In addition to the physical trauma that Katie went through, they all additionally suffered from the emotional trauma.” “I am proud of them just as much as I am proud of Katie, and they are about as resilient as it is possible to be,” said the speaker.
When it comes to face transplants, medical professionals are uncertain about the future of these kinds of surgical procedures, which may also include the prospect of hand transplants and uterus transplants. The Armed Forces Institute of Regenerative Medicine I (AFIRM I) funding program, which is meant to assist in improving the care of United States service personnel who have been injured on the battlefield, has been responsible for paying for the majority of face transplants performed in the United States up to this point.
The question is, “Will these patients who are in desperate need of a transplant receive support from third-party payers, including the government and private payers?” The question was posed by Dr. Papay. “In these situations, the source of financial support is the most important factor in determining the future.”
Katie expressed her thanks to all of those who were involved in her face transplant procedure in a statement that she wrote for the media after the procedure was over. On her path toward rehabilitation and healing, she expressed her gratitude by saying, “I will be eternally grateful for the care that this hospital has provided me with and continues to provide.” There are no words that can adequately explain the gratitude I feel for my donor and her family for the great gift they have given me. From the bottom of my heart, I would want to express my gratitude to everyone who has helped me achieve my goal.
Katie is only starting out on her adventure, according to Alesia, who feels that in many regards. There is no way I can say for certain, but I am certain that Katie will assist others. She will, as a mother, I have a feeling in my heart. I just want Katie to enjoy life and make a difference in society. And I want her to be able to be independent.”
Rob added, “We have a road to go yet. But we’re thankful that we have a road.”