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Doctors Work to Restore Damaged Faces of Iraq War Soldiers

October 12, 2006 at 6:45 PM EST
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SUSAN DENTZER, NewsHour Health Correspondent: The face of
Jeffrey Mittman is the face of war. He has a large new nose and new lips,
thanks to his plastic surgeon.

JEFFREY MITTMAN, Injured in Iraq War: Hey, how are you?

SUSAN DENTZER: He did not have these a few, short months
ago. For that matter, he didn’t have much of a face, either. On duty in Iraq
in July 2005, Army Sergeant First Class Mittman was driving a Humvee when it
was attacked with an improvised explosive device.

JEFFREY MITTMAN: The IED blew. A projectile came through my
window, and that’s what caused my injuries. It knocked me out immediately,
obviously, and caused all my facial injuries, took my nose, my lips, most of my
teeth, and damaged my right arm.

SUSAN DENTZER: When he was flown back to the U.S.
and stitched hastily back together, he looked like this.

JEFFREY MITTMAN: What’s it say, cutie? You know I can’t read
it.

SUSAN DENTZER: Mittman is now back home with his wife and
two young daughters in Indiana.
He’s one of more than 100 Armed Forces personnel whose faces have been
seriously wounded or, in some cases, nearly obliterated in the war in Iraq.

The helmets and body armor they’ve worn while on duty
protected their brains and torsos, but those safeguards have still have left
faces vulnerable to IEDs or snipers’ bullets. Doctors who’ve treated these
faceless wounded say Mittman is one of the lucky ones since, after nearly 30
surgeries, his face is presentable enough to show on television.

And although he also lost his left eye in the attack, he
still has some peripheral vision in the right one.

JEFFREY MITTMAN: I can see to the right and down and to the
right. So to look at something, I have to actually look at the left, to the
left of it.

SUSAN DENTZER: So, with the help of special magnifying
equipment, he can read or use a computer by turning his head to the side.

A battle won step-by-step

CHRISTY MITTMAN, Wife of Injured Soldier: They called it aVSI, very seriously injured. They said that that was the worst category thatthey could classify him as except for being dead.

SUSAN DENTZER: Mittman's wife, Christy, recalls whathappened when she first saw her husband at the WalterReed ArmyMedical Centerin Washington, D.C.

CHRISTY MITTMAN: The nurse sat there with me the whole firstnight, and he told me -- he said "You know," he said, "30 yearsago, like in Vietnam,"he said, "more than likely your husband would not have made it off thebattlefield." He said, "But he's here," and he goes, "I'veseen it. They will get him looking almost perfectly the way that he did beforehe got hurt." And I called them liars.

SUSAN DENTZER: What would you call them today?

CHRISTY MITTMAN: Angels from God; that's what I would callthem, because, you know, he didn't have a nose three months ago, and he doesnow.

DR. JOE ROSEN, Plastic Surgeon: Look out into the futurewould be to readdress this area.

SUSAN DENTZER: One of those whom Christy considers an angelis Mittman's plastic surgeon, Joe Rosen. He normally practices at Dartmouth HitchcockMedical Centerin New Hampshirebut was called in by Walter Reed as a consultant on Mittman's and others'cases.

Rosen talked with Mittman before one recent surgery.

DR. JOE ROSEN: So when we approach someone like you, thereason it's complicated is because, not only do we have to make you a nose, butwe also have to build a foundation for the nose. So we needed a piece of bone,and you can feel down here that piece of bone so that we can rest your nose onit.

So where we got that piece of bone, in your case, was we gotit here from your forearm. And we took that piece of bone off, we actually cutit and put it in your face, and then wrapped the skin around it to createlining in your mouth and also a foundation, your upper lip, and also lining foryour nose.

SUSAN DENTZER: Rosen went on to describe how the surgicalteam actually crafted the new nose, from a leaf-shaped slice of Mittman'sforehead skin stretched over pieces from his ribs.

DR. JOE ROSEN: So if you imagine a tent that has struts init, and then the covering of the tent is the forehead skin, the covering goesdown on those struts.

JEFFREY MITTMAN: All this is from my forehead, so when Iactually touch here, it really feels like my forehead. It feels like I'mtouching here. You know, I've kind of cross-circuited all over. You can alsosee the hairline here which will be -- they'll correct that also during some ofthe procedures.

SUSAN DENTZER: Rosen told Mittman that, in future surgeries,he'd whittle down the nose to a more refined shape.

DR. JOE ROSEN: Plastic surgery is really a battle betweenbeauty and blood supply, so we can only do so much at each stage withoutendangering what we've done. But if we're willing to be patient, sort of atwo-year process, then each three months we can do another stage and make itbetter and better until you're satisfied. Now, one of the issues is that we cannever make you normal again, but we can make you appear very good.

The loss of interaction

JEFFREY MITTMAN: Did you call her?

JEFFREY MITTMAN'S DAUGHTER: Yes.

SUSAN DENTZER: Aside from looks, we asked Mittman how muchof his facial function has been restored, given the overwhelming damage to themany nerves and more than 50 muscles that make up the normal human face.

JEFFREY MITTMAN: My lower lip is numb, and my upper lip Idon't have, you know, total control over. It makes it a little hard to eat anda little hard to drink. So I drink through a straw; everything I drink isthrough a straw.

My sense of taste is also affected. I really don't tastesweets, so I don't taste, you know, candy. I don't have any taste -- I tastesalt with it.

How much do you love Daddy?

SUSAN DENTZER: Most of all, of course, he can't smile orfrown, the basic facial expressions that make up so much human interaction.

JEFFREY MITTMAN: It's not the end of the world. You have tokeep going. You know, you take from my experience what you can and realizethat, you know, there's always tomorrow, so...

CHRISTY MITTMAN: You know, it could be worse. You know, hecould be in the ground. So, you know, we'll take what we can get, and they'llfix it slowly but surely.

Innovations in saving a face

SUSAN DENTZER: Military health experts worry there may bemany more Armed Forces personnel with devastating facial wounds in the futurecoming out of Iraqor other conflicts. Yet they're frustrated that even the innovative surgicaltechniques, like those used on Jeffrey Mittman, will only get them so far.

So recently, the Defense Advanced Research Projects Agency,or DARPA, brought together a range of physicians and scientists to explorefuturistic options for restoring a human face.

DR. ANTHONY ATALA, Director, Institute for RegenerativeMedicine: So here are actually the incubators, which are in the same conditionsas the human body.

SUSAN DENTZER: One of those who attended the DARPA workshopwas Dr. Anthony Atala of Wake Forest Universityin North Carolina.He's a pioneer in a field called tissue engineering.

DR. ANTHONY ATALA: And these are the molds that will be usedfor cell seeding, so the cells will be seeded in these molds.

SUSAN DENTZER: In their lab, Atala and his research team areactually taking bone, muscle and blood vessel cells from individuals, thengrowing them into tissues to put back into the same people. They say thesetechniques could help future Jeffrey Mittmans.

DR. ANTHONY ATALA: We would first start by growing a pieceof bone for his face, and then a pieces of muscle for his face, and then a skinfor that particular area. And then we'd just really build upon the wholeconstruct one step at a time.

All we really need to bring these technologies faster toreality is a concerted national effort to be able to invest in thesetechnologies that we know have a high potential of benefiting patientsthroughout the world.

SUSAN DENTZER: Another possibility discussed at the DARPAworkshop was an advanced facial prosthesis, along the lines of a robot namedJules. It's now being built in the Dallas, Texas, lab of engineer DavidHanson.

Hi, Jules, how are you doing today?

JULES, Robot: I'm fine, Susan, how are you? How's Jim Lehrerdoing?

SUSAN DENTZER: Hanson and his colleagues built Jules out ofa sophisticated skin-like material they developed, dubbed "Frubber." Anetwork of tiny motors powered by a nine-volt battery stands in for facialmuscles, changing the robot's expressions.

Hanson says a robotic prosthetic could be combined withtissue engineering techniques to build a composite face that could even smile,frown, or chew.

DAVID HANSON, Hanson Robotics: If we can create thesetechnologies to address our combat injuries, then we can alleviate so muchmisery in the world. We're at a time in history where these things arepossible.

Looking to the future

SUSAN DENTZER: It isn't clear whether DARPA will ultimatelyproceed with a so-called Virtual Face Project, into which it would pumpmillions of dollars to try to advance these technologies. But Doctors Rosen andAtala hope it will.

DR. JOE ROSEN: We have the need with these patients, and weneed to sort of start looking at: How do we make this happen, not 10 years fromnow or 20 years from now, but what can we do tomorrow? They certainlysacrificed for the country, for freedom, for all the things we believe in; whyshouldn't we do as much as possible?

DR. ANTHONY ATALA: Obviously, losing a face is an absolutelydevastating thing. And it is not just the ability to function that you'relosing, but it's also the ability to interact. And in a way, that's what humansare about: interaction. You take that away, you take away a bit of somebody'ssoul.

JEFFREY MITTMAN: She speaks Spanish and dances? Well, she'stwo up on daddy.

SUSAN DENTZER: For now, Mittman's soul seems intact, surroundedas he is by his loving family.

LEARNING TOY: The color of my shirt is rosado. Rosado.

JEFFREY MITTMAN: What's that mean?

LEARNING TOY: Pink.

JEFFREY MITTMAN: Green?

SUSAN DENTZER: And bit by bit, over the next several years,his new face will come together, too.

LEARNING TOY: We did it. We did it. Yay!

JEFFREY MITTMAN: Can you dance?