Last fall, Cleveland Clinic performed its second near-total face transplant on a patient missing the middle of his face, forehead and eye sockets. The surgery, which lasted more than 24 hours, was a huge undertaking for the multidisciplinary teams, including plastic surgeons, head and neck surgeons, microvascular surgeons, immunologists, ophthalmologists, psychiatrists and bioethicists. More than 28 OR nurses and surgical technologists also contributed to the success of the procedure.
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Preparing ahead of time
When the OR nursing team received the call approximately 12 hours before the surgery, they were ready and willing to tackle this procedure. Throughout the previous year, the nursing team planned for a possible second face transplant. A coordinator from the Cleveland Clinic Transplant Center provided in-service training. “It was helpful to hear and understand all of the concerns of donors and recipients prior to coming to the operating room,” says Jackolyn Casanova, BSN, RN, Nurse Manager for ENT and Pediatric Surgery.
Casanova also created a “Face Transplant Playbook” – a binder containing important information for nurses. This included a list of volunteers willing to participate in the procedure, articles about the first face transplant performed at Cleveland Clinic and a list of the items and equipment required in the operating rooms.
Once the transplant was scheduled, the nursing team jumped into action. Many nurses and surgical technologists were sent home from work that morning to rest, understanding that the long surgery would begin around 3 p.m. and last well into the next day. Others prepared the operating rooms. “The face transplant was like a huge facial reconstruction,” says Casanova. “While it was similar to what this team does daily, the entire face is a large reconstruction. We made sure we had the proper instrument trays, and supplies were pulled and ready.”
Coordinating care during the surgery
The transplant lasted 24 hours, with multidisciplinary teams caring for both the donor and recipient patients through the night and into the next afternoon. “The teamwork among this group was stellar, and caregivers truly looked out for one another as much as they cared for the patients,” says Casanova. “It was crucial to have each discipline on the same page.”
The donor procedure began about an hour-and-a-half before the recipient’s surgery, so it was important that OR teams were in constant communication to make sure each portion of the complex procedure lined up properly. Throughout the surgery, nurses monitored the safety and stability of the patients and documented the procedure. (Details of the procedure are provided in this related post.)
“It was amazing to see what teamwork can produce!” says Casanova. “Every person was there that night to ensure this procedure went flawlessly. As a manager, I couldn’t ask for anything more than a team that truly cares for our patients and each other.” The result of the surgery: A face restored, and a life transformed.