Is what we're doing in Iraq promoting democracy or promoting capitalism? Assuming, the latter, is promoting democracy worth getting your face blown off?
QUOTE
Doctors Work to Restore Damaged Faces of Iraq War Soldiers
As a result of the explosives and weapons used in Iraq, more than 100 soldiers have sustained severe injuries to their faces. But with the help of facial prosthetics and advanced plastic surgery, doctors can help repair the damage and their lives.
SUSAN DENTZER, NewsHour Health Correspondent: The face of Jeffrey Mittman is the face of war. He has a large new nose and new lips, thanks to his plastic surgeon.
JEFFREY MITTMAN, Injured in Iraq War: Hey, how are you?
SUSAN DENTZER: He did not have these a few, short months ago. For that matter, he didn't have much of a face, either. On duty in Iraq in July 2005, Army Sergeant First Class Mittman was driving a Humvee when it was attacked with an improvised explosive device.
JEFFREY MITTMAN: The IED blew. A projectile came through my window, and that's what caused my injuries. It knocked me out immediately, obviously, and caused all my facial injuries, took my nose, my lips, most of my teeth, and damaged my right arm.
SUSAN DENTZER: When he was flown back to the U.S. and stitched hastily back together, he looked like this.
JEFFREY MITTMAN: What's it say, cutie? You know I can't read it.
SUSAN DENTZER: Mittman is now back home with his wife and two young daughters in Indiana. He's one of more than 100 Armed Forces personnel whose faces have been seriously wounded or, in some cases, nearly obliterated in the war in Iraq.
The helmets and body armor they've worn while on duty protected their brains and torsos, but those safeguards have still have left faces vulnerable to IEDs or snipers' bullets. Doctors who've treated these faceless wounded say Mittman is one of the lucky ones since, after nearly 30 surgeries, his face is presentable enough to show on television.
And although he also lost his left eye in the attack, he still has some peripheral vision in the right one.
JEFFREY MITTMAN: I can see to the right and down and to the right. So to look at something, I have to actually look at the left, to the left of it.
SUSAN DENTZER: So, with the help of special magnifying equipment, he can read or use a computer by turning his head to the side.
A battle won step-by-step
CHRISTY MITTMAN, Wife of Injured Soldier: They called it a VSI, very seriously injured. They said that that was the worst category that they could classify him as except for being dead.
SUSAN DENTZER: Mittman's wife, Christy, recalls what happened when she first saw her husband at the Walter Reed Army Medical Center in Washington, D.C.
CHRISTY MITTMAN: The nurse sat there with me the whole first night, and he told me -- he said "You know," he said, "30 years ago, like in Vietnam," he said, "more than likely your husband would not have made it off the battlefield." He said, "But he's here," and he goes, "I've seen it. They will get him looking almost perfectly the way that he did before he got hurt." And I called them liars.
SUSAN DENTZER: What would you call them today?
CHRISTY MITTMAN: Angels from God; that's what I would call them, because, you know, he didn't have a nose three months ago, and he does now.
DR. JOE ROSEN, Plastic Surgeon: Look out into the future would be to readdress this area.
SUSAN DENTZER: One of those whom Christy considers an angel is Mittman's plastic surgeon, Joe Rosen. He normally practices at Dartmouth Hitchcock Medical Center in New Hampshire but was called in by Walter Reed as a consultant on Mittman's and others' cases.
Rosen talked with Mittman before one recent surgery.
DR. JOE ROSEN: So when we approach someone like you, the reason it's complicated is because, not only do we have to make you a nose, but we also have to build a foundation for the nose. So we needed a piece of bone, and you can feel down here that piece of bone so that we can rest your nose on it.
So where we got that piece of bone, in your case, was we got it here from your forearm. And we took that piece of bone off, we actually cut it and put it in your face, and then wrapped the skin around it to create lining in your mouth and also a foundation, your upper lip, and also lining for your nose.
SUSAN DENTZER: Rosen went on to describe how the surgical team actually crafted the new nose, from a leaf-shaped slice of Mittman's forehead skin stretched over pieces from his ribs.
DR. JOE ROSEN: So if you imagine a tent that has struts in it, and then the covering of the tent is the forehead skin, the covering goes down on those struts.
JEFFREY MITTMAN: All this is from my forehead, so when I actually touch here, it really feels like my forehead. It feels like I'm touching here. You know, I've kind of cross-circuited all over. You can also see the hairline here which will be -- they'll correct that also during some of the procedures.
SUSAN DENTZER: Rosen told Mittman that, in future surgeries, he'd whittle down the nose to a more refined shape.
DR. JOE ROSEN: Plastic surgery is really a battle between beauty and blood supply, so we can only do so much at each stage without endangering what we've done. But if we're willing to be patient, sort of a two-year process, then each three months we can do another stage and make it better and better until you're satisfied. Now, one of the issues is that we can never make you normal again, but we can make you appear very good.
The loss of interaction
JEFFREY MITTMAN: Did you call her?
JEFFREY MITTMAN'S DAUGHTER: Yes.
SUSAN DENTZER: Aside from looks, we asked Mittman how much of his facial function has been restored, given the overwhelming damage to the many nerves and more than 50 muscles that make up the normal human face.
JEFFREY MITTMAN: My lower lip is numb, and my upper lip I don't have, you know, total control over. It makes it a little hard to eat and a little hard to drink. So I drink through a straw; everything I drink is through a straw.
My sense of taste is also affected. I really don't taste sweets, so I don't taste, you know, candy. I don't have any taste -- I taste salt with it.
How much do you love Daddy?
SUSAN DENTZER: Most of all, of course, he can't smile or frown, the basic facial expressions that make up so much human interaction.
JEFFREY MITTMAN: It's not the end of the world. You have to keep going. You know, you take from my experience what you can and realize that, you know, there's always tomorrow, so...
CHRISTY MITTMAN: You know, it could be worse. You know, he could be in the ground. So, you know, we'll take what we can get, and they'll fix it slowly but surely.
Innovations in saving a face
SUSAN DENTZER: Military health experts worry there may be many more Armed Forces personnel with devastating facial wounds in the future coming out of Iraq or other conflicts. Yet they're frustrated that even the innovative surgical techniques, like those used on Jeffrey Mittman, will only get them so far.
So recently, the Defense Advanced Research Projects Agency, or DARPA, brought together a range of physicians and scientists to explore futuristic options for restoring a human face.
DR. ANTHONY ATALA, Director, Institute for Regenerative Medicine: So here are actually the incubators, which are in the same conditions as the human body.
SUSAN DENTZER: One of those who attended the DARPA workshop was Dr. Anthony Atala of Wake Forest University in North Carolina. He's a pioneer in a field called tissue engineering.
DR. ANTHONY ATALA: And these are the molds that will be used for cell seeding, so the cells will be seeded in these molds.
SUSAN DENTZER: In their lab, Atala and his research team are actually taking bone, muscle and blood vessel cells from individuals, then growing them into tissues to put back into the same people. They say these techniques could help future Jeffrey Mittmans.
DR. ANTHONY ATALA: We would first start by growing a piece of bone for his face, and then a pieces of muscle for his face, and then a skin for that particular area. And then we'd just really build upon the whole construct one step at a time.
All we really need to bring these technologies faster to reality is a concerted national effort to be able to invest in these technologies that we know have a high potential of benefiting patients throughout the world.
SUSAN DENTZER: Another possibility discussed at the DARPA workshop was an advanced facial prosthesis, along the lines of a robot named Jules. It's now being built in the Dallas, Texas, lab of engineer David Hanson.
Hi, Jules, how are you doing today?
JULES, Robot: I'm fine, Susan, how are you? How's Jim Lehrer doing?
SUSAN DENTZER: Hanson and his colleagues built Jules out of a sophisticated skin-like material they developed, dubbed "Frubber." A network of tiny motors powered by a nine-volt battery stands in for facial muscles, changing the robot's expressions.
Hanson says a robotic prosthetic could be combined with tissue engineering techniques to build a composite face that could even smile, frown, or chew.
DAVID HANSON, Hanson Robotics: If we can create these technologies to address our combat injuries, then we can alleviate so much misery in the world. We're at a time in history where these things are possible.
Looking to the future
SUSAN DENTZER: It isn't clear whether DARPA will ultimately proceed with a so-called Virtual Face Project, into which it would pump millions of dollars to try to advance these technologies. But Doctors Rosen and Atala hope it will.
DR. JOE ROSEN: We have the need with these patients, and we need to sort of start looking at: How do we make this happen, not 10 years from now or 20 years from now, but what can we do tomorrow? They certainly sacrificed for the country, for freedom, for all the things we believe in; why shouldn't we do as much as possible?
DR. ANTHONY ATALA: Obviously, losing a face is an absolutely devastating thing. And it is not just the ability to function that you're losing, but it's also the ability to interact. And in a way, that's what humans are about: interaction. You take that away, you take away a bit of somebody's soul.
JEFFREY MITTMAN: She speaks Spanish and dances? Well, she's two up on daddy.
SUSAN DENTZER: For now, Mittman's soul seems intact, surrounded as he is by his loving family.
LEARNING TOY: The color of my shirt is rosado. Rosado.
JEFFREY MITTMAN: What's that mean?
LEARNING TOY: Pink.
JEFFREY MITTMAN: Green?
SUSAN DENTZER: And bit by bit, over the next several years, his new face will come together, too.
LEARNING TOY: We did it. We did it. Yay!
JEFFREY MITTMAN: Can you dance?
http://www.pbs.org/newshour/bb/health/july...face_10-12.html
As a result of the explosives and weapons used in Iraq, more than 100 soldiers have sustained severe injuries to their faces. But with the help of facial prosthetics and advanced plastic surgery, doctors can help repair the damage and their lives.
SUSAN DENTZER, NewsHour Health Correspondent: The face of Jeffrey Mittman is the face of war. He has a large new nose and new lips, thanks to his plastic surgeon.
JEFFREY MITTMAN, Injured in Iraq War: Hey, how are you?
SUSAN DENTZER: He did not have these a few, short months ago. For that matter, he didn't have much of a face, either. On duty in Iraq in July 2005, Army Sergeant First Class Mittman was driving a Humvee when it was attacked with an improvised explosive device.
JEFFREY MITTMAN: The IED blew. A projectile came through my window, and that's what caused my injuries. It knocked me out immediately, obviously, and caused all my facial injuries, took my nose, my lips, most of my teeth, and damaged my right arm.
SUSAN DENTZER: When he was flown back to the U.S. and stitched hastily back together, he looked like this.
JEFFREY MITTMAN: What's it say, cutie? You know I can't read it.
SUSAN DENTZER: Mittman is now back home with his wife and two young daughters in Indiana. He's one of more than 100 Armed Forces personnel whose faces have been seriously wounded or, in some cases, nearly obliterated in the war in Iraq.
The helmets and body armor they've worn while on duty protected their brains and torsos, but those safeguards have still have left faces vulnerable to IEDs or snipers' bullets. Doctors who've treated these faceless wounded say Mittman is one of the lucky ones since, after nearly 30 surgeries, his face is presentable enough to show on television.
And although he also lost his left eye in the attack, he still has some peripheral vision in the right one.
JEFFREY MITTMAN: I can see to the right and down and to the right. So to look at something, I have to actually look at the left, to the left of it.
SUSAN DENTZER: So, with the help of special magnifying equipment, he can read or use a computer by turning his head to the side.
A battle won step-by-step
CHRISTY MITTMAN, Wife of Injured Soldier: They called it a VSI, very seriously injured. They said that that was the worst category that they could classify him as except for being dead.
SUSAN DENTZER: Mittman's wife, Christy, recalls what happened when she first saw her husband at the Walter Reed Army Medical Center in Washington, D.C.
CHRISTY MITTMAN: The nurse sat there with me the whole first night, and he told me -- he said "You know," he said, "30 years ago, like in Vietnam," he said, "more than likely your husband would not have made it off the battlefield." He said, "But he's here," and he goes, "I've seen it. They will get him looking almost perfectly the way that he did before he got hurt." And I called them liars.
SUSAN DENTZER: What would you call them today?
CHRISTY MITTMAN: Angels from God; that's what I would call them, because, you know, he didn't have a nose three months ago, and he does now.
DR. JOE ROSEN, Plastic Surgeon: Look out into the future would be to readdress this area.
SUSAN DENTZER: One of those whom Christy considers an angel is Mittman's plastic surgeon, Joe Rosen. He normally practices at Dartmouth Hitchcock Medical Center in New Hampshire but was called in by Walter Reed as a consultant on Mittman's and others' cases.
Rosen talked with Mittman before one recent surgery.
DR. JOE ROSEN: So when we approach someone like you, the reason it's complicated is because, not only do we have to make you a nose, but we also have to build a foundation for the nose. So we needed a piece of bone, and you can feel down here that piece of bone so that we can rest your nose on it.
So where we got that piece of bone, in your case, was we got it here from your forearm. And we took that piece of bone off, we actually cut it and put it in your face, and then wrapped the skin around it to create lining in your mouth and also a foundation, your upper lip, and also lining for your nose.
SUSAN DENTZER: Rosen went on to describe how the surgical team actually crafted the new nose, from a leaf-shaped slice of Mittman's forehead skin stretched over pieces from his ribs.
DR. JOE ROSEN: So if you imagine a tent that has struts in it, and then the covering of the tent is the forehead skin, the covering goes down on those struts.
JEFFREY MITTMAN: All this is from my forehead, so when I actually touch here, it really feels like my forehead. It feels like I'm touching here. You know, I've kind of cross-circuited all over. You can also see the hairline here which will be -- they'll correct that also during some of the procedures.
SUSAN DENTZER: Rosen told Mittman that, in future surgeries, he'd whittle down the nose to a more refined shape.
DR. JOE ROSEN: Plastic surgery is really a battle between beauty and blood supply, so we can only do so much at each stage without endangering what we've done. But if we're willing to be patient, sort of a two-year process, then each three months we can do another stage and make it better and better until you're satisfied. Now, one of the issues is that we can never make you normal again, but we can make you appear very good.
The loss of interaction
JEFFREY MITTMAN: Did you call her?
JEFFREY MITTMAN'S DAUGHTER: Yes.
SUSAN DENTZER: Aside from looks, we asked Mittman how much of his facial function has been restored, given the overwhelming damage to the many nerves and more than 50 muscles that make up the normal human face.
JEFFREY MITTMAN: My lower lip is numb, and my upper lip I don't have, you know, total control over. It makes it a little hard to eat and a little hard to drink. So I drink through a straw; everything I drink is through a straw.
My sense of taste is also affected. I really don't taste sweets, so I don't taste, you know, candy. I don't have any taste -- I taste salt with it.
How much do you love Daddy?
SUSAN DENTZER: Most of all, of course, he can't smile or frown, the basic facial expressions that make up so much human interaction.
JEFFREY MITTMAN: It's not the end of the world. You have to keep going. You know, you take from my experience what you can and realize that, you know, there's always tomorrow, so...
CHRISTY MITTMAN: You know, it could be worse. You know, he could be in the ground. So, you know, we'll take what we can get, and they'll fix it slowly but surely.
Innovations in saving a face
SUSAN DENTZER: Military health experts worry there may be many more Armed Forces personnel with devastating facial wounds in the future coming out of Iraq or other conflicts. Yet they're frustrated that even the innovative surgical techniques, like those used on Jeffrey Mittman, will only get them so far.
So recently, the Defense Advanced Research Projects Agency, or DARPA, brought together a range of physicians and scientists to explore futuristic options for restoring a human face.
DR. ANTHONY ATALA, Director, Institute for Regenerative Medicine: So here are actually the incubators, which are in the same conditions as the human body.
SUSAN DENTZER: One of those who attended the DARPA workshop was Dr. Anthony Atala of Wake Forest University in North Carolina. He's a pioneer in a field called tissue engineering.
DR. ANTHONY ATALA: And these are the molds that will be used for cell seeding, so the cells will be seeded in these molds.
SUSAN DENTZER: In their lab, Atala and his research team are actually taking bone, muscle and blood vessel cells from individuals, then growing them into tissues to put back into the same people. They say these techniques could help future Jeffrey Mittmans.
DR. ANTHONY ATALA: We would first start by growing a piece of bone for his face, and then a pieces of muscle for his face, and then a skin for that particular area. And then we'd just really build upon the whole construct one step at a time.
All we really need to bring these technologies faster to reality is a concerted national effort to be able to invest in these technologies that we know have a high potential of benefiting patients throughout the world.
SUSAN DENTZER: Another possibility discussed at the DARPA workshop was an advanced facial prosthesis, along the lines of a robot named Jules. It's now being built in the Dallas, Texas, lab of engineer David Hanson.
Hi, Jules, how are you doing today?
JULES, Robot: I'm fine, Susan, how are you? How's Jim Lehrer doing?
SUSAN DENTZER: Hanson and his colleagues built Jules out of a sophisticated skin-like material they developed, dubbed "Frubber." A network of tiny motors powered by a nine-volt battery stands in for facial muscles, changing the robot's expressions.
Hanson says a robotic prosthetic could be combined with tissue engineering techniques to build a composite face that could even smile, frown, or chew.
DAVID HANSON, Hanson Robotics: If we can create these technologies to address our combat injuries, then we can alleviate so much misery in the world. We're at a time in history where these things are possible.
Looking to the future
SUSAN DENTZER: It isn't clear whether DARPA will ultimately proceed with a so-called Virtual Face Project, into which it would pump millions of dollars to try to advance these technologies. But Doctors Rosen and Atala hope it will.
DR. JOE ROSEN: We have the need with these patients, and we need to sort of start looking at: How do we make this happen, not 10 years from now or 20 years from now, but what can we do tomorrow? They certainly sacrificed for the country, for freedom, for all the things we believe in; why shouldn't we do as much as possible?
DR. ANTHONY ATALA: Obviously, losing a face is an absolutely devastating thing. And it is not just the ability to function that you're losing, but it's also the ability to interact. And in a way, that's what humans are about: interaction. You take that away, you take away a bit of somebody's soul.
JEFFREY MITTMAN: She speaks Spanish and dances? Well, she's two up on daddy.
SUSAN DENTZER: For now, Mittman's soul seems intact, surrounded as he is by his loving family.
LEARNING TOY: The color of my shirt is rosado. Rosado.
JEFFREY MITTMAN: What's that mean?
LEARNING TOY: Pink.
JEFFREY MITTMAN: Green?
SUSAN DENTZER: And bit by bit, over the next several years, his new face will come together, too.
LEARNING TOY: We did it. We did it. Yay!
JEFFREY MITTMAN: Can you dance?
http://www.pbs.org/newshour/bb/health/july...face_10-12.html