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Surgeons Perform Nasal Reconstruction for War Veteran Using His Own Body Parts

Fletcher remembers little of the disfiguring accident that nearly killed him, but he likes to recall shopping in January 2007 near his home on Andrews Air Force Base in Maryland.

Nobody stared at his torn face, he says. Not anymore, that is, because of his brand-new nose.

In a series of six operations over a year-long period that ended with removal of the last sutures on May 2 - and that rank as one of the most complicated nasal reconstructions ever performed at Johns Hopkins - facial plastic and reconstructive surgeons have pieced together more than a dozen bits of bone, cartilage, skin, arteries and veins to rebuild Fletchers nose. All materials were taken from spare or renewable parts of his own body.

Fletchers new nose is completely functional. He can breathe and sneeze through it, and expectations are that he will soon be sensitive to smell and touch, his surgeons say.

Scarring and swelling will naturally reduce for a year, while minor sculpting and contouring procedures are done at an outpatient clinic, but his long days recuperating in the hospital are done, says lead surgeon Patrick J. Byrne, M.D.

Aided by new advances in instrumentation by biomedical engineers, and computer-assisted design of precision plastics for use as templates, Byrnes team and the patient logged more than 40 hours in surgery, with the first operation, July 18, lasting eight hours. With his wife, Yolanda, by his side the entire time, Fletcher had more than 60 hospital check-ups and tests and needed three hospital stays, including a 16-hour emergency operation to deal with a wound infection.

This soldier is fearless, says Byrne, an assistant professor in otolaryngology - head and neck surgery at The Johns Hopkins University School of Medicine. From the beginning, his nasal reconstruction was not straightforward. He had tremendous scarring all over his face and head injuries so severe that I did not t
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