Plastic Surgeons Face War Injuries From Iraq To Inner-city Violence

At the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2008 conference, Oct. 31 – Nov. 5, in Chicago, civilian and military plastic surgeons will participate in a panel discussion about the challenges created by today's high-powered weaponry and the advances in facial reconstruction accelerated by wartime.

"Plastic surgery is a specialty that, unfortunately, always makes significant advances in wartime," said Colonel Thomas Crabtree, MD, ASPS Member Surgeon and panel moderator.

"The surgical problems we face from the frontlines to stateside military hospitals are challenging to say the least, but the advances made benefit both wounded warriors and civilians hurt in inner-city violence or trauma."

Plastic surgeons specialize in bone and soft tissue reconstruction of the face and skull. From the war in Iraq and Afghanistan, ASPS Member Surgeons face patients who have suffered large scale blast trauma wounds from high explosive detonations or high velocity missiles.

At Walter Reed Army Medical Center, Lieutenant Colonel Raymond Harshbarger, MD, ASPS Member Surgeon and panel participant, treats soldiers with facial and skull injuries with a 3-D model of their skull, created from CT scans. These models help in pre-operative planning and surgery.

"From these models, we can help soldiers who are missing half their skull or the upper part of their face by fashioning an innovative prefabricated, patient-specific implant to remodel their lost bone," said Dr. Harshbarger. "We also use special woven titanium as implants for the skull on soldiers who have large-scale defects of missing bone and tissue."

Dr. Harshbarger added they are working toward bridging these innovative technologies – modeling and implants – with tissue engineering. "In the future we hope to produce an implant that is biodegradable and will induce bone formation so that the implant (in the shape of the deformity) will absorb over time and new bone will be created. We're moving down this pathway, but it will be years before it becomes reality."

Back on the streets of America, Eduardo Rodriguez, MD, ASPS Member Surgeon and panel participant, treats injuries from gun shots and high-speed auto and motorcycle accidents. "I treated a young woman from the inner-city who was protecting her sleeping child by covering him with her body when high velocity gunshots blew off one of her arms and she lost a large part of her cheek. Many of the bones in her face were fractured and there was major tissue missing."

Reconstruction of these types of injuries involves free tissue transfer where Dr. Rodriguez takes tissue from a different area of the body like the hip with its blood vessels, and reconnects it to the missing area of the face.

"These cases are incredibly difficult to perform, often taking up to 10 hours," said Dr. Rodriguez. "But you get so committed to these cases. This young lady saved her baby's life, now I wanted to help her. The pressure is incredible, it's like you are in the SuperBowl and its 4th and goal. But the rewards are amazing. We can do so much to help these patients now, where they previously would be left with devastating injuries."