I'm a pediatric plastic surgeon—a craniofacial surgeon—working with kids with cleft lip and palate, and with other congenital syndromes like Treacher Collins syndrome, which is what Brad had. One of the problems craniofacial surgeons have is that we need more bone. We have some ways of reconstructing bone: We can split a bone in half or we can harvest bones from other places in the body. There are certain instances where those techniques don’t work well, though. And there are instances where we need such a large volume of bone that we have to use metal or plastic, which doesn’t grow with the patient.
So the question for me is: Can we engineer something from scratch? We used small animals—rats—first, to see what worked and what didn’t. Then we moved on to the pig, because the pig is very similar to a human from an immunological standpoint. Once we felt comfortable, we chose a human patient.
Treacher Collins syndrome is a craniofacial disorder. You have very severe facial dysmorphism—“different looks”—that revolves around the lack of cheekbones. Surgeons have tried just about everything to reconstruct Treacher Collins and it hasn’t worked well. I’m basically taking a femur bone—a straight bone with very little architecture—and figuring out how to sculpt it into cheekbones. We’re robbing a little fat [for stem cells, which are injected into the donor bone along with growth factor], and one of the coverings of one of the patient’s bones, the periosteium [to provide blood supply]. I knew how it worked on a pig and a rat, but I had to tell Brad, “This may not work, man. I need you to tell me you understand that and you’re OK with that or we can’t go forward.” And he was able to voice that.
The surgery took almost eight hours. When you put this growth factor—it’s called BMP-2—in the body, it causes inflammation. So Brad blew up like a balloon. He couldn’t open his eyes for five days after surgery; they were swollen shut. Brad was unfazed.
The first time I saw Brad after the swelling went down, I was like, “Wow, this is amazing.” And I had to say to myself, “Jesse, this could still fail, temper your enthusiasm.” Three months after surgery, we got our first CAT scan. At that point I could tell that this bone had incorporated into Brad’s native bone. It was definitely an emotional moment. In all of our lives we probably get the chance to do that only once or twice. So it was pretty cool.
Photograph by Ryan KurtzOriginally published in the January 2010 issue.
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