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May 26, 2008 Families, soldiers and doctors grapple with an onslaught of facial injuries -- and go beyond call to try to heal scars
By E.A. Torriero, Tribune correspondent
NEW PALESTINE, Ind. -- Army Sgt. 1st Class Jeffrey Mittman was sitting behind the wheel of a Humvee when a roadside bomb exploded on a Baghdad street, shearing off Mittman's nose, lips and most of his teeth and blinding him in one eye.
Nearly three years later, and after more than two dozen surgeries, Mittman's face is a jigsaw of reconstructions. His nose is fashioned from his rib cartilage, a forearm flap and forehead skin. His jaw was rebuilt with wires; his cheeks with metal plates. Dental implants will add teeth.
Mittman is one of at least 300 American soldiers who have lost many of their facial features in the Iraq War, most from roadside and suicide bomb blasts. Thousands more suffered partial facial deformities: At least 60 percent of the 30,000-plus Americans wounded endured blows to the head.
American soldiers returning without parts of their faces will mark this Memorial Day grateful to be alive. Yet they and their families know they will never look the same again -- despite advanced surgical skills.
Facial injuries are not new to warfare, but the Iraq War is seeing an unprecedented rate of soldiers surviving facial blasts, according to military doctors treating the wounded.
"In another war, I wouldn't have survived," said Mittman, 38, a career military man who spends his time shuttling between his suburban Indianapolis home and Walter Reed Army Medical Center in Washington, D.C., where his surgeries continue. "And even if I did, the doctors wouldn't have been able to do the remarkable work done today."
Pentagon, patience helps
Facial injuries in Iraq have become so prevalent that the Pentagon last month dispensed $85 million to several universities for a nationwide program to develop regenerative bones, tissue and skin to more quickly repair soldiers' wounds, especially their faces. The experimental therapy -- it may become akin to a facial-parts hub -- is aimed at someday using a soldier's skin cells to grow implants for the face.
In addition to the Pentagon program, at least two volunteer groups -- including one funded by a donor at UCLA Medical Center in Los Angeles, in concert with the VA Greater Los Angeles Healthcare System -- are providing advanced reconstruction after preliminary surgeries. Those early operations are mostly performed at Walter Reed and at a burn unit at Brooke Army Medical Center in San Antonio.
The painstaking surgeries to rebuild faces take years. They require removing skin and bones from other parts of the body and attaching them to the face to shape features.
"If you lose a limb, there are devices in modern medicine to replace it," said Dr. Jeffrey Hollinger, a researcher from Carnegie Mellon University in Pittsburgh who will direct the craniofacial reconstruction part of the Pentagon's program.
"But if you lose your face, we can't put in a new one," he said. "It's hard to imagine the horror of being without your defining physical characteristic: a face. When you walk into a military hospital and see these guys walking around with these injured faces, it's just awful."
Facial injuries rose to prominence in World War I as soldiers sticking their heads out of trenches received weapons' blasts. The survivors were treated by doctors using skin flaps in what was the emergence of the modern-era plastic surgery field.
In Iraq, where soldiers are mostly covered in armor and gear, the exposed face and limbs are most vulnerable in the continuing run of bombings from improvised explosives.
Bleeding profusely from the face and elsewhere, the wounded usually are transported rapidly from the scene to emergency care in Iraq. Soldiers often receive preliminary surgeries, are stabilized and then evacuated to a military hospital in Germany. Within days they usually are back stateside, where they regain consciousness and often first learn of the extent of their facial deformities.
Scars draw stares
When retired Staff Sgt. Doug Szczepanski returned from Iraq in 2005 with a disfigured face from a suicide bombing, his father vomited after first seeing him. Even after surgeries to repair a torn right ear, broken jaw and flesh on his face, Szczepanski still deals with stares at his long scar from people in his hometown of Bay City, Mich.
Sometimes Szczepanski makes up stories of being in an accident because he wants to avoid discussion -- or possible arguments -- about the war.
"I don't think Americans know how to deal with it when they see someone like me," he said. "They would rather not see what we go through over there."
Szczepanski's disfigurements might have been worse had it not been for Air Force Maj. Manuel Lopez, a plastic surgeon, who operated on him in Iraq in 2005.
After arriving at the trauma unit in Balad, Lopez was taken aback by the number of facial injuries he saw. In five months beginning in May 2005, Lopez treated 52 Iraqi and American victims. He found that the rapid intervention not only cut down on rates of infection but helped speed recovery.
"The nature of this war is that we must be prepared for significant injuries to the face and be ready to do surgery right away," said Lopez, a military surgeon now back in Texas. "It's one of the war's signature injuries."
Szczepanski, 24, retired from the Michigan National Guard, still needed cosmetic operations later in Texas to smooth out his facial skin and make it possible for him to move the right side of his mouth. Shrapnel remains lodged in his brain, but he does not require more major surgeries.
But for many of those with facial injuries, reconstructive surgeries go on for years.
Sgt. Darron Mikeworth, 31, who suffered multiple face fractures in a suicide bombing in 2005 in Iraq, endured more than a dozen surgeries at Brooke military hospital in San Antonio.
In recent months, Mikeworth became one of a half-dozen soldiers operated on at UCLA Medical Center through the program Operation Mend sponsored by Los Angeles philanthropist Ronald Katz. Doctors are using skin flaps from Mikeworth's forehead to rebuild an eyelid and his nose.
"It's heartening to see these soldiers come in here with an attitude of 'Let's move on and let's get better,'" said Dr. Timothy Miller, chief of plastic surgery at UCLA, who is performing Mikeworth's surgeries. "There is no feeling sorry for themselves. They make me humble."
How long for healing?
Mikeworth hopes that the combination of federal and private partnerships will lead to a smoother route of medical care for facially injured soldiers. Even though the Iraq War is past its fifth anniversary, the Pentagon is still struggling with the scope of the wounded faces. Tallies of facial wounds are not complete and there is only a general protocol for treatment.
"The whole system isn't prepared for all of us living," he said. "It is overwhelmed with soldiers who have injuries like mine and want to get healed but have to figure out how to go about it."
No one is sure how long this healing will take. Outside Indianapolis, Mittman says his surgeries will end only when he decides it is enough.
Still, he has no sense of smell, no sensation on the tip of his tongue and no feeling on his cheeks. His sight out of the right eye is grainy and he is blind in his left. He walks mostly with his hand out in front of him or with the help of a walking stick. His wife, Christy, shuttles him around.
'Alive ... all that matters'
When he is recovering in Indiana after trips to Walter Reed, Mittman keeps his spirits up by monitoring news events on a computer system that enables him to read large type with the help of magnifying equipment.
Mittman says he never suffered depression and he cherishes the support of his wife and two children. After spending much of his adult life in the military -- he was on his second tour of duty in Iraq -- Mittman says his only regret is not being out with the troops.
"People expect me to be bitter but I'm not," he said. "No matter how people look at me, I'm alive and that's all that matters."
Many of the soldiers receiving facial wounds also suffered injuries elsewhere on their bodies that compound recovery.
Retired Marine Staff Sgt. Octavio Sanchez suffered third-degree burns over much of his face in a roadside bomb attack in 2005. Through a volunteer group, Iraq Star, that connects wounded soldiers with plastic surgeons, Sanchez contacted Dr. Miller, who reconstructed his nose.
But Sanchez lost his right hand in the blast. It was replaced with an artificial hand, but he also has little use of his left hand, which was injured as well.
"When it comes to my face, I usually don't see myself," he said. "I had the nose surgery so it would cut down on people staring at me -- which really affects my kids.
"Losing the use of my hands really sucks," said Sanchez, a stay-at-home father for his four children. "My face has been fixed. But I wish I had my hands."
May 26, 2008 Families, soldiers and doctors grapple with an onslaught of facial injuries -- and go beyond call to try to heal scars
By E.A. Torriero, Tribune correspondent
NEW PALESTINE, Ind. -- Army Sgt. 1st Class Jeffrey Mittman was sitting behind the wheel of a Humvee when a roadside bomb exploded on a Baghdad street, shearing off Mittman's nose, lips and most of his teeth and blinding him in one eye.
Nearly three years later, and after more than two dozen surgeries, Mittman's face is a jigsaw of reconstructions. His nose is fashioned from his rib cartilage, a forearm flap and forehead skin. His jaw was rebuilt with wires; his cheeks with metal plates. Dental implants will add teeth.
Mittman is one of at least 300 American soldiers who have lost many of their facial features in the Iraq War, most from roadside and suicide bomb blasts. Thousands more suffered partial facial deformities: At least 60 percent of the 30,000-plus Americans wounded endured blows to the head.
American soldiers returning without parts of their faces will mark this Memorial Day grateful to be alive. Yet they and their families know they will never look the same again -- despite advanced surgical skills.
Facial injuries are not new to warfare, but the Iraq War is seeing an unprecedented rate of soldiers surviving facial blasts, according to military doctors treating the wounded.
"In another war, I wouldn't have survived," said Mittman, 38, a career military man who spends his time shuttling between his suburban Indianapolis home and Walter Reed Army Medical Center in Washington, D.C., where his surgeries continue. "And even if I did, the doctors wouldn't have been able to do the remarkable work done today."
Pentagon, patience helps
Facial injuries in Iraq have become so prevalent that the Pentagon last month dispensed $85 million to several universities for a nationwide program to develop regenerative bones, tissue and skin to more quickly repair soldiers' wounds, especially their faces. The experimental therapy -- it may become akin to a facial-parts hub -- is aimed at someday using a soldier's skin cells to grow implants for the face.
In addition to the Pentagon program, at least two volunteer groups -- including one funded by a donor at UCLA Medical Center in Los Angeles, in concert with the VA Greater Los Angeles Healthcare System -- are providing advanced reconstruction after preliminary surgeries. Those early operations are mostly performed at Walter Reed and at a burn unit at Brooke Army Medical Center in San Antonio.
The painstaking surgeries to rebuild faces take years. They require removing skin and bones from other parts of the body and attaching them to the face to shape features.
"If you lose a limb, there are devices in modern medicine to replace it," said Dr. Jeffrey Hollinger, a researcher from Carnegie Mellon University in Pittsburgh who will direct the craniofacial reconstruction part of the Pentagon's program.
"But if you lose your face, we can't put in a new one," he said. "It's hard to imagine the horror of being without your defining physical characteristic: a face. When you walk into a military hospital and see these guys walking around with these injured faces, it's just awful."
Facial injuries rose to prominence in World War I as soldiers sticking their heads out of trenches received weapons' blasts. The survivors were treated by doctors using skin flaps in what was the emergence of the modern-era plastic surgery field.
In Iraq, where soldiers are mostly covered in armor and gear, the exposed face and limbs are most vulnerable in the continuing run of bombings from improvised explosives.
Bleeding profusely from the face and elsewhere, the wounded usually are transported rapidly from the scene to emergency care in Iraq. Soldiers often receive preliminary surgeries, are stabilized and then evacuated to a military hospital in Germany. Within days they usually are back stateside, where they regain consciousness and often first learn of the extent of their facial deformities.
Scars draw stares
When retired Staff Sgt. Doug Szczepanski returned from Iraq in 2005 with a disfigured face from a suicide bombing, his father vomited after first seeing him. Even after surgeries to repair a torn right ear, broken jaw and flesh on his face, Szczepanski still deals with stares at his long scar from people in his hometown of Bay City, Mich.
Sometimes Szczepanski makes up stories of being in an accident because he wants to avoid discussion -- or possible arguments -- about the war.
"I don't think Americans know how to deal with it when they see someone like me," he said. "They would rather not see what we go through over there."
Szczepanski's disfigurements might have been worse had it not been for Air Force Maj. Manuel Lopez, a plastic surgeon, who operated on him in Iraq in 2005.
After arriving at the trauma unit in Balad, Lopez was taken aback by the number of facial injuries he saw. In five months beginning in May 2005, Lopez treated 52 Iraqi and American victims. He found that the rapid intervention not only cut down on rates of infection but helped speed recovery.
"The nature of this war is that we must be prepared for significant injuries to the face and be ready to do surgery right away," said Lopez, a military surgeon now back in Texas. "It's one of the war's signature injuries."
Szczepanski, 24, retired from the Michigan National Guard, still needed cosmetic operations later in Texas to smooth out his facial skin and make it possible for him to move the right side of his mouth. Shrapnel remains lodged in his brain, but he does not require more major surgeries.
But for many of those with facial injuries, reconstructive surgeries go on for years.
Sgt. Darron Mikeworth, 31, who suffered multiple face fractures in a suicide bombing in 2005 in Iraq, endured more than a dozen surgeries at Brooke military hospital in San Antonio.
In recent months, Mikeworth became one of a half-dozen soldiers operated on at UCLA Medical Center through the program Operation Mend sponsored by Los Angeles philanthropist Ronald Katz. Doctors are using skin flaps from Mikeworth's forehead to rebuild an eyelid and his nose.
"It's heartening to see these soldiers come in here with an attitude of 'Let's move on and let's get better,'" said Dr. Timothy Miller, chief of plastic surgery at UCLA, who is performing Mikeworth's surgeries. "There is no feeling sorry for themselves. They make me humble."
How long for healing?
Mikeworth hopes that the combination of federal and private partnerships will lead to a smoother route of medical care for facially injured soldiers. Even though the Iraq War is past its fifth anniversary, the Pentagon is still struggling with the scope of the wounded faces. Tallies of facial wounds are not complete and there is only a general protocol for treatment.
"The whole system isn't prepared for all of us living," he said. "It is overwhelmed with soldiers who have injuries like mine and want to get healed but have to figure out how to go about it."
No one is sure how long this healing will take. Outside Indianapolis, Mittman says his surgeries will end only when he decides it is enough.
Still, he has no sense of smell, no sensation on the tip of his tongue and no feeling on his cheeks. His sight out of the right eye is grainy and he is blind in his left. He walks mostly with his hand out in front of him or with the help of a walking stick. His wife, Christy, shuttles him around.
'Alive ... all that matters'
When he is recovering in Indiana after trips to Walter Reed, Mittman keeps his spirits up by monitoring news events on a computer system that enables him to read large type with the help of magnifying equipment.
Mittman says he never suffered depression and he cherishes the support of his wife and two children. After spending much of his adult life in the military -- he was on his second tour of duty in Iraq -- Mittman says his only regret is not being out with the troops.
"People expect me to be bitter but I'm not," he said. "No matter how people look at me, I'm alive and that's all that matters."
Many of the soldiers receiving facial wounds also suffered injuries elsewhere on their bodies that compound recovery.
Retired Marine Staff Sgt. Octavio Sanchez suffered third-degree burns over much of his face in a roadside bomb attack in 2005. Through a volunteer group, Iraq Star, that connects wounded soldiers with plastic surgeons, Sanchez contacted Dr. Miller, who reconstructed his nose.
But Sanchez lost his right hand in the blast. It was replaced with an artificial hand, but he also has little use of his left hand, which was injured as well.
"When it comes to my face, I usually don't see myself," he said. "I had the nose surgery so it would cut down on people staring at me -- which really affects my kids.
"Losing the use of my hands really sucks," said Sanchez, a stay-at-home father for his four children. "My face has been fixed. But I wish I had my hands."