Doctor Discusses Complexity of Rebuilding Faces of Injured Soldiers

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• SUSAN DENTZER:

  Let's start off by talking about Jeffrey. When you first saw him, what did he look like?

• DR. JOE ROSEN:

  In late 2005 I was asked to look at him and provide suggestions. I was working with a team of plastic surgeons at Walter Reed that included Dr. Roy Harshbarger and Dr. Andy Friedman, as an outside consultant.

  Jeffrey is somebody who fits a classical pattern, where he lost his mid-face and all the associated structures, so he has injuries to the lower jaw, upper jaw and nose. He also had additional injuries to his eyes.

  We have to think about how to reconstruct it. So we think about what are all the things that are missing, what are all the things that are available to us around the body that we can borrow and move there, and what's the approach?

  He already had an injury to his right arm, so we looked at his left arm where you can take the forearm skin, part of the underlying bone. If you want you can take nerves with it, and you can take skin and bone, and then you can take this and transpose it up to the face. In this case we hooked it into arteries in his neck, so we find the artery and vein in the arm. There's two of them that go to the hand, so you can steal one, which is a radial artery. You can test first to make sure that the hand can survive without the artery. And you bring it up and you attach it using microsurgery, very tiny needles and sutures, small enough that you can pass the needle through a hair on your head.

  We bring this flap up and hook it into the neck and put it into the face and hook the bone from cheek to cheek with the soft tissue. We brought up extra soft tissue so some of that can end up being the lining for the eventual nose that we're going to bring down. And we let that all heal.

  So we did that back in March. It was about an 8 to 10 hour operation with two teams working, Dr. Friedman with someone else was working on the forearm, and Dr. Roy Harshbarger and myself were working on the face. The flap was then brought up from the arm to the face. We attached it, reestablished the blood supply. And again, it's difficult because there's a lot of injury to the face so you're working through a scar. So once we have that established that provided our foundation for the later surgeries.

• SUSAN DENTZER:

  Now let's pull out some of the photos of the, of Jeffrey as he after he was brought back from Baghdad. A lot of preliminary work has been done just to stitch him back up, but this was before you got going.

• DR. ROSEN:

  We had a photograph of his face and what we do is we sketch on the photograph where we think the tissue was before. We kind of zoom in on it, we start thinking about the lower lip, the upper lip, the nose, which are what we call cosmetic units, the segments you see as you look at a face. I think about the lower chin as one unit, the upper chin and lip as one unit, the nose as a unit. And I want to replace them as a solid unit so that when people see him afterwards it makes sense in terms of how the face it put together. And we work on all that and try to figure out how all that fits together.

  We create models. We have a computer generated model from the CT scan we did of the head. So we have the data set, the real digital data. We can generate an image of the part that's missing. A lot of emails go back and forth with suggestions back and forth as we as a consensus try to decide what's best, what do we need to do to get him back to as close as possible to the original Jeffrey.