RESTORING HOPE - Medical team uses prosthetics to bring normalcy to wounded warriors

Published Sept. 26, 2012
By Desiree N. Palacios & Senior Airman Zach Lopez

San Antonio -- Editors Note: A story about changing the lives and restoring hope of our wounded warriors, thanks to Col. (Dr) Alan Sutton and his team at SAMMC. This is another feature produced by DMA during their recent visit .

http://airman.dodlive.mil/2012/09/restoring-hope/

For Army Spc. Mario Lopez, who was severely injured while on duty in Afghanistan, the rehabilitation process continued even after surgeries had ended and a number of wounds healed. As part of a routine convoy, Lopez was strapped into his Humvee and headed to his next mission when a 300-pound roadside bomb exploded, creating a blast that sent the Humvee's door hurtling into him and pinning him inside the burning vehicle. As a result of the blast, he sustained burns on more than 40 percent of his body and lost his right arm, right ear, right eye and the fingers on his left hand.

It was a tragedy that could have left Lopez completely disfigured just a few years ago. However, tucked away in nondescript offices on the third floor of the San Antonio Military Medical Center is a small team of four medical professionals and technicians who are using a combination of technology and artistry to bring a sense of normalcy to people like Lopez.

Called the Maxillofacial Prosthetics department, it is the phase of rehabilitation "when surgeons get done trying to fix somebody with tissue and bone issues," according to the department chief, Col. (Dr.) Alan Sutton. "If they can't fix the facial structures, then it's our turn. We replace facial structures with synthetic materials, prosthetic materials to a life-like condition."

For patients, the process begins with a series of CT scans and stereophotogrammetry that helps the staff determine the areas needing reconstruction. According to Tech. Sgt. Jay Schaefer, the NCO in charge of the stereolithography dental laboratory, the process consists of 3-D imaging technology. "Here, we do the treatment planning, design, surgical placement of the craniofacial implants and the fabrication of facial prostheses," said Schaefer.

Schaefer explained that these procedures helped dramatically with accurate replication of the anatomical form, the proper position of the implants under the underlying bone, the accurate placement of craniofacial implants during surgery, and improved efficiency and turnaround time.

In Lopez's case, the team's focus was to replace his right ear. The first step was making an impression and beginning the more artistic part of the process.

Nancy Hansen is a certified anaplastologist and a retired master sergeant, who took the construction of Lopez's ear to the next level. "We'll make a moulage, or an impression of the ear using wax or clay, and, at this point, we'll get the patient involved with the process," said Hansen.

Sutton said he then sat down with Lopez to learn more about his medical history and injury. He established a rapport with Lopez that allowed him to get a sense of what he wanted his ear to look like.

"Mario was allowed to go 'ear shopping,' in a sense, picking out the size and shape of the ear he would like to have and becoming an actual participant in his recovery," said Sutton.

Using handmade tools, paintbrushes, a colorimeter and laser-leveling device, Hansen said she molds the body part according to the patient's wishes. "We'll sculpt, redefine, resculpt, and adjust, adjust and adjust until it's right," Hansen said.

She said that once the piece is perfect, she makes a stone mold, cleans out the sculpting, selects the type and tint of silicone to match the patient's skin tone, and lets the piece cure from an hour to overnight.

Hansen explained that when the patient returns, there will be another evaluation, last-minute color matching, then sealing and finally attaching, in this case, Lopez's right ear. "This is a multi-appointment process that can take anywhere from one to three weeks, depending on how far the patient has to travel to get here."

During a recent visit, Lopez was in the process of matching the prosthetic ear to his skin color. "If it's wintertime, I need a light one, and during the summertime, I need a really dark one."

Sutton said this is an area where he likes to tease his patients, often asking them whether or not they'd like large, Dumbo-like ears or something smaller. "I like to add a little humor to their routine appointments because it helps them focus on something besides their problems and injuries."

While the prosthetic ear's function could be considered primarily cosmetic, it has aided Lopez's emotional healing from the self-consciousness that stemmed from his injuries. "Before I ever had it, I would always wear my hat to the side," Lopez said. "Not having an ear was always an issue for me."

Having the ear has also affected Lopez's physical well-being. His wife owns a convertible and drives it with the top down. The ear protects him from wind that could blow into that wound.

"The fact of the matter is I feel more normal in public (with the prosthetic ear) because it's not noticeable that it's a fake ear," he said. "I feel more confident. I appreciate what they do."

Lopez said his recovery has been hard, but he knows things could have been a lot worse. Despite his injuries, he has become an accomplished artist. "I started doing artwork as a child and really loved it," he said. "When I had my son and daughter at a young age, I put the paintbrush down for a while to support my family."

Lopez has picked up the brush again, this time with his left hand, minus some fingers, and, according to Sutton, has turned into quite an accomplished artist.

"He's shown me his paintings, and I saw one that I said, 'I've got to have that one,'" Sutton said. "Come to find out, he was right-handed, and he only has two knuckles. He's a hero to be able to paint. He can paint better than I can paint with my normal hand."

According to Lopez, the painting is entitled "A Journey Begins," and includes the Wounded Warrior Project logo. "But it's not just for the Soldiers that the journey begins. It's for everyone around them too. Sometimes roads are rocky and high, but anything can be accomplished."

Accomplishing those goals has been a little easier for Lopez, thanks to Sutton and his team.

"You couldn't ask for anything better," Lopez said. "Anything I need, if they don't know how to do it, they bring someone in who does. In the military, the medical field has an important purpose, and, to me, they're the best in the world."