Earlier this year, inside an operating room in New York City, a man’s life was transformed.
When a horrific workplace accident occurred two years ago, electrical lineman Aaron James received a fatal shock of 7,200 volts when his face accidentally touched a live wire.
James, 46, suffered massive injuries, including the loss of his left eye, his dominant left arm from above the elbow, his entire nose and lips, his front teeth, his left cheek area and his chin down to the bone.
The outlook for James, a military veteran living in Arkansas, was decidedly bleak.
But NYU Langone Health surgeons made medical history in May with an unprecedented operation: the first full eye transplant in a human and the only successful full eye and partial face transplant ever performed.
The complex surgical procedure involved a team of more than 140 surgeons, nurses and other healthcare professionals led by Dr. Eduardo D. Rodríguez, director of the Face Transplant Program and chair of the Department of Plastic Surgery at NYU Langone.
“We couldn’t have asked for a more perfect patient,” Rodriguez said in a news release. “Aaron has been extremely motivated to regain the function and independence he lost after his injury.”
Aaron James, pictured here with his wife Meagan, served in the Army National Guard for 10 years.
Weigh the risks against the rewards
James received early treatment at a Texas medical center and the NYU Langone team heard about his case two months after his accident. Last year, James was evaluated for a face transplant.
But due to severe pain, Texas surgeons were forced to remove his injured left eye. Rodríguez recommended that surgeons leave as much of the optic nerve as possible, in the hope of a transplant that can restore some level of vision.
That opened a discussion about the possibility of transplanting an eye to a face, something that had never been attempted anywhere before.
The unprecedented operation was fraught with risk and, beyond some cosmetic improvement for James, the outcome was uncertain.
But the James family and the NYU Langone surgical team decided to move forward.
“Since James needed a face transplant and will take immunosuppressive medications anyway, the risk-reward ratio of the eye transplant was very low. Even though the eye was successfully transplanted, from an aesthetic point of view, it would still be a notable achievement,” Rodríguez said.
James was working as a power lineman at Arkansas at the time of his injury.
The ‘donor hero’ is found
A major stroke of luck came when LiveOnNY, an organ procurement organization for the New York metropolitan area, quickly identified a potential donor at another New York City hospital.
“The hero donor was a young man in his 30s who came from a family that strongly supports organ donation,” said Leonard Achan, president and CEO of LiveOnNY.
“He generously donated tissues that enabled this successful face and eye transplant, but he also saved three other people between the ages of 20 and 70, donating their kidneys, liver and pancreas,” Achan added.
Aaron James, pictured here with his daughter Allie, after his injury and before the operation. COURTESY OF THE JAMES FAMILY
Challenges of eye transplant
Transplanting a human eye is a very complex process due to the challenges associated with optic nerve regeneration, blood flow to the retina, and the possibility of your immune system rejecting any new organs or body tissues.
Rodriguez and the team at NYU Langone Cell Therapy and Transplant Center made the decision to combine the donor eye with stem cells derived from the donor.
Transplanted stem cells can function as a natural “repair kit,” dividing again and again to create healthy cells that replace damaged or dysfunctional tissue.
“This is the first attempt to inject adult stem cells into a human optic nerve during a transplant in the hopes of improving nerve regeneration,” said Dr. Samer Al-Homsi, executive director of the NYU Center for Transplantation and Cell Therapy. Langone.
The complex surgical procedure involved a team of more than 140 surgeons, nurses and other healthcare professionals.NYU Langone Health
A carefully rehearsed operation
The 21-hour surgery took place at NYU Langone’s Kimmel Pavilion, where two different surgical teams operated simultaneously in the donor and recipient rooms.
Each team followed a carefully planned schedule, which had been rehearsed several times over the past year, to integrate the donor’s face and eye into James as quickly as possible.
The face transplant included the nose, left eyelid and eyebrow, lips and underlying bone segments of the skull, cheeks, nose and chin, as well as underlying muscles, blood vessels and nerves.
The simultaneous eye transplant included the entire left eye and its orbit, plus the orbital bone and all surrounding tissue, including the optic nerve.
The transplanted left eye currently has no vision, but over the past six months his eye has shown notable signs of health, including strong blood flow to the retina. If the organ remains healthy, there is a chance it can restore some sight, but all they can do is hope.
Dr. Eduardo Rodríguez examines Aaron James after his operation.AP
The result “far exceeds our initial expectations”
The successful outcome of the complex surgical procedure has even exceeded the great hopes of the healthcare team.
“The progress we have seen in the eye is exceptional, especially considering that we have a viable cornea combined with a retina that shows great blood flow five months after the procedure,” said Dr. Bruce Gelb, transplant surgeon at the Transplant Institute. Langone of New York University. .
“This far exceeds our initial expectations, as our best hope was that the eye would survive at least 90 days,” Gelb added.
Rodriguez agreed: “Beyond what you see, the quality of Aaron’s face transplant results is special. You would never think he underwent a procedure like that so recently. “He looks very good.”
A twist: the donor’s eye was brown and James’ eye is blue, giving him heterochromia (different colored eyes in the same person).
Aaron James before his injury (left) and after the successful operation.
A ‘second chance at life’
After surgery, James spent just 17 days in the Intensive Care Unit at NYU Langone, one of the shortest recoveries among Rodriguez face transplant recipients.
James is now back in Arkansas, where he hopes to spend Thanksgiving with his family and eat a holiday meal for the first time since his injury in 2021.
“I am beyond words to thank the donor and his family, who have given me a second chance at life during their time of great difficulty,” James said.
“I will also be eternally grateful to Dr. Rodríguez and his team for changing my life. My family and I would not have been able to navigate this difficult journey without their expertise and support.”
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Source: vtt.edu.vn