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

hink he would go through it. But he did not want to wear a prosthesis. He wanted his nose rebuilt, even if all the world was going to see his scars.

And there was significant risk that any transferred tissue would not survive. It could get infected and have to be removed, adding scar tissue and leaving us back where we started, he says, recalling the courage of his patient.

Hospital records show that Fletchers new nose involved more than 40 Hopkins clinical staff. Among them are an anaplastologist, who helped design the shape and look of the new nose, several anesthesiologists, operating room nurses, schedulers, and home care assistants, as well as a team of surgeons from the United States military who initially treated Fletcher in Kuwait and then at Walter Reed Army Medical Center, in suburban Washington, D.C.

A Walter Reed surgeon who had trained in facial plastic surgery at Hopkins, and who was familiar with Byrnes recent work with cancer patients, referred Fletcher to Hopkins in January 2006 for the reconstruction.

The plan to rebuild Fletchers nose was based on techniques already used to help survivors of nasal cancers resume a normal life without disfigurement. Though rare, these cancers are often fatal without surgery to remove tumors. Some cases require total removal of the nose.

Complicating Fletchers case was the soldiers damaged facial skeleton, which had little bone structure to support a new nose, and a sparse network of facial arteries to sustain the highly vascularized nasal tissues. Arteries supplying blood to the forehead had been slashed in Iraq, potentially compromising the suitability of the skin for subsequent transplant to the nose. The accident had also fractured Fletchers skull, blinded his left eye, and widened the gap between his eyes, something surgeons had to correct to properly place the nose. Fletcher is also African American, so surgeons were compelled to minimize
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