Images of a nose implanted on a man’s forehead have been all over the Internet, like ads for some creepy horror film you probably don’t want to see. Almost as jarring are pictures of an ear protruding from a woman’s inner arm.
They’re not from some horror movie—they’re real science. The nose-on-the-forehead photo depicts a nose repair in progress in China. The photo of the ear on an arm was published in the September 19 issue of the New England Journal of Medicine. Such surgeries are examples of new approaches to standard reconstructive techniques that may cost patients a few months of psychological discomfort but will eventually allow their facial features to be repaired.
Patrick Byrne, director of facial plastic and reconstructive surgery at Johns Hopkins Health Care and Surgery Center in Green Spring Station, Maryland, believes his innovative ear reconstruction pictured in the NEJM was one of the first performed in the world. Growing noses on foreheads or ears on arms before transplanting them to the conventional locations is based on surgical reconstruction techniques going back hundreds of years. But modern-day applications are truly revolutionary, as Byrne explained in an interview with National Geographic News.
The photographs look like some sort of cruel joke. Is this a serious procedure?
Yes, it certainly is. It’s called prelamination: Tissue that’s going to be used to rebuild an area is constructed in multiple layers. In the case of the ear, I was trying to solve a difficult problem. [The woman had advanced basal cell carcinoma, a skin cancer. Treatment, including radiation, damaged the area too much to allow for a more traditional reconstruction.]
What are the layers, and why is each layer important?
Take the nose, for example. If the damage from disease or injury goes all the way through, then all three layers must be replaced: the skin on the outside, the cartilage, and the soft lining inside. The forehead skin tends to be the best match for the outside skin from an area called the paramedian forehead flap, described in medicine as early as 700 B.C. [Reconstructive surgeons have been using skin from this area of the forehead for nasal reconstruction for centuries.] Cartilage creates a three-dimensional form that will resemble a nose, and the choice to take it from the rib cage is pretty straightforward. A lot of nuance and challenge comes from the internal layer, the lining of the nose. If you don’t have a pretty good blood supply nourishing the nose from the inside, over time it will fail. You’ll be left with a mess of tissue that could be a deformity worse than the one you started with.
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