Lack­land Air Force Base pro­gram gives new hope to sol­diers whose faces have been dis­fig­ured

iraq, Afghan wars bring new pa­tients to Lack­land lab

Austin American-Statesman - - METRO &STATE - By Michelle Roberts

SAN AN­TO­NIO — Mas­ter Sgt. Todd Nel­son lost his right eye and ear when a car bomb in Afghanistan ex­ploded, send­ing fire up his arm and over his head.

Al­though it’s taken years of painstak­ing work, the mil­i­tary has given him a bright blue eye and an ear lightly freck­led and pinked from sum­mer sun. They’re not flesh and blood, but the glass and silicone repli­cas are so re­al­is­tic, so per­fectly cus­tom­ized, that they’ve given Nel­son some­thing else: the abil­ity to face the world with­out shock­ing it.

“Hon­estly, peo­ple re­ally don’t know it’s ar­ti­fi­cial,” said Nel­son, whose in­juries three years ago in­cluded third-de­gree burns, a skull frac­ture and a bro­ken jaw.

The wars in Iraq and Afghanistan have brought a new kind of pa­tient to the fa­cial pros­thet­ics lab at Lack­land Air Force Base: wounded war­riors who have re­cently suf­fered heavy burns and mul­ti­ple trau­mas. The lab is one of two ma­jor fa­cial pros­thetic pro­grams in the De­fense Depart­ment, and it has seen an un­prece­dented new stream of wounded sol­diers.

Be­fore the wars, the 26-yearold lab’s pa­tients were al­most ex­clu­sively can­cer and civil­ian Mas­ter Sgt. Todd Nel­son, who lost an eye and an ear in Afghanistan, said the loss of his ear both­ered him the most aes­thet­i­cally. trauma sur­vivors, but “all of that pre­pared us for wartime, and that’s re­ally why our depart­ment is here,” said Dr. Joe Vil­lalo­bos, the lab di­rec­tor.

The lab doesn’t track how many sol­diers wounded in war it’s treated. How­ever, be­fore the wars be­gan in 2001 and 2003, the fa­cil­ity rarely saw com­bat­re­lated in­juries — only an oc­ca­sional Viet­nam-era vet­eran look­ing for a new pros­the­sis. Now, partly be­cause the lab is across town from the Army’s only burn cen­ter, wounded war­riors make up about one­fifth of the roughly 425 pa­tients treated each year.

Though the technology and ca­pa­bil­i­ties at the Lack­land lab are avail­able in the civil­ian world, the lab has the ex­per­tise and re­sources to give sol­diers the best pos­si­ble care with lit­tle con­cern about the fi­nan­cial bur­dens that civil­ian trauma pa­tients might face, he said.

“Our goal is to give them the best of the best,” Vil­lalo­bos said. “We’re go­ing to give them the ideal treat­ment.”

Pa­tients at Lack­land are treated with a com­bi­na­tion of cut­ting-edge technology and care­fully hand-hewed pros­thet­ics.

Us­ing spe­cially de­signed com­puter equip­ment, tech­ni­cians can turn an MRI into three-di­men­sional molds and cre­ate cus­tom-fit pieces to re­place missing jaw­bones or sec­tions of skull for im­plant.

The lab has even done it re­motely, cre­at­ing a per­fectly fit­ting re­place­ment for onethird of a pa­tient’s skull at a hos­pi­tal in Balad, Iraq, Vil­lalo­bos said.

Some­times, af­ter pa­tients have un­der­gone life-sav­ing surg­eries and re­con­struc­tion work for ba­sic func­tion­al­ity, aes­thet­ics start to mat­ter. Sol­diers tire of stares and flashes of shock on the faces of peo­ple un­ac­cus­tomed to se­vere burn in­juries.

Not ev­ery­one who loses an ear, eye or nose tip is in­ter­ested in get­ting a new one. Af­ter the me­mory of what you used to look like be­gins to fade, “you start to ac­cept who you are,” said Nel­son, a 37-year-old Army me­chanic from Ev­er­green, Colo. And be­cause burn pa­tients typ­i­cally un­dergo dozens of surg­eries (Nel­son is at 43 and count­ing), At the fa­cial pros­thet­ics lab at Lack­land Air Force Base, threads are used to mimic veins. many are sim­ply too pro­ce­dure-weary to seek pros­thetic ears or noses.

But Nel­son said for him, “one of the things that both­ered me the most aes­thet­i­cally was the missing ear.”

He knew get­ting a pros­thetic right ear wouldn’t make a func­tional dif­fer­ence. If any­thing, the pros­thetic has slightly damp­ened noises.

“It was for form, but I couldn’t help but want some of my form back,” said Nel­son, who some­times wears a hair­piece to cover his burned scalp.

To cre­ate pros­thetic ears, the lab uses cam­eras that gen­er­ate 3-D im­ages for tech­ni­cians to make molds. Though ad­he­sive can be used to keep pros­thetic ears in place, younger pa­tients like Nel­son of­ten opt for ti­ta­nium implants that al­low the pros­thetic to at­tach with a mag­net.

When a pa­tient has one ear re­main­ing, a mir­ror-im­age ear is cre­ated. Two missing ears are more dif­fi­cult, said Vil­lalo­bos, but the lab has cre­ated ears us­ing fam­ily mem­bers as mod­els.

“It’s eas­ier to cre­ate a sec­ond ear if they have one al­ready, but if some­one comes in and says, ‘I want Clint East­wood ears,’ we can do that,” he said, grin­ning.

Nancy Han­son, the lab’s clin­i­cal anaplas­tol­o­gist, care­fully matches skin tone us­ing pow­dered pig­ment and tiny red and blue em­broi­dery threads to cre­ate the vis­ual ef­fect of veins. Freck­les are painted on, and tops of ears are pinked to mimic sun ex­po­sure. Some sol­diers get “sum­mer ears” and “win­ter ears” to ac­count for skin tone vari­a­tion.

“It’s a com­bi­na­tion of a lit­tle bit of sci­ence, art and in­ge­nu­ity,” said Han­son. “We deal with very unique sit­u­a­tions.”

Eric Gay pho­tos

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