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

risk of scarring, as any scar tissue would contrast sharply with his dark skin.

Among the many procedures was the detachment on Dec. 20 of a forehead flap of skin that now makes up the outer skin of the new nose. The flap was first carved in upside-down profile on the center of his forehead, with the top portion then cut out, turned around clockwise, and laid over the newly rebuilt nose.

The outer skin covering was left attached to the center spot of the forehead, right between Fletchers eyes, for six weeks to secure its blood supply during recovery. While attached, the forehead flap was covered with a protective bandage to prevent infection. Surgeons had earlier made small incisions across the skin graft to promote new blood vessel formation, and to improve the coverings arterial network before transplant.

The inside nasal components were assembled in two operations, with nostrils and tip, using skin transplanted from his arm and neck, bone and cartilage came from rib and ear.

One of the more complex procedures involved transfer of soft skin from the underside of Fletchers arm to create an inside nasal lining. Arteries in his neck had to be rerouted to keep sufficient blood flowing to this part of the nose.

Weeks before the first operation, the surgical team fully mapped out Fletchers interior and exterior skull, including his nasal passage, by CT scan and nasal endoscopy.

Unique to the Hopkins approach is the additional use of clear plastic molds that are custom-made to help surgeons shape the skin flap, build up supporting cartilage, and construct the nose. (A mesh made of different plastic is also often used as an alternative support structure in cancer patients. Sometimes left inside the body, the mesh is resorbed - chemically broken down and disposed of naturally, over time.)

Design and production of the nasal surgical guide began more than three months before
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