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

Fletchers first surgery.

Hopkins anaplastologist Juan Garcia, M.A., a trained medical illustrator who specializes in facial prosthetics, met with Fletcher and, together, using old pictures of the soldier taken before his accident as a reference, they designed his new nose.

Garcia, an assistant professor in art as applied to medicine, at Hopkins, also took a silicone impression of Fletchers damaged midface and created a stone model of the damaged terrain on which his new nose would be built. On to this base, the artist applied hot wax and sculpted a replica of the soldiers nose, something he has done many times before when making prosthetic noses, ears, and even eyes. The modeling process took more than two hours and required dozens of minute touch ups.

Once fitted, Fletchers wax replica and stone model were each scanned by a computer to create a 3-D image needed to produce the plastic guide. The methods for using laser scanning and computer software necessary to produce the surgical tool were developed by Byrne and Garcia with a local digital imaging firm, Direct Dimensions of Owings Mills, Md.

After making the computerized version of the surgical guide, the resulting 3-D image was sent to the Berger laboratory at the United States Armys Aberdeen Proving Ground, in Gunpowder, Md., for fabrication into a plastic version. The lab specializes in manufacturing precision plastics for the military and private industry, including the kinds of clear plastic molds that Byrne has used to reconstruct noses for a half-dozen cancer patients.

We know that our part in his recovery is just a single step forward, says Garcia. But we are grateful to have been able to help and wish him well. He is someone with a tremendous amount of courage.


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