Regulatory Intelligence Data
WASHINGTON (Army News Service, Aug. 24, 2004) -- The Army is not
offering free face-lifts, tummy tucks and breast enhancements to everyone
in uniform, medical officials said, adding that recent articles in national
publications may be misleading. "The spectrum of plastic surgery most people
see are the shows on TV, extreme makeover shows, and they think that's
plastic surgery," said Lt. Col. Joseph Kolb, Walter Reed Army Medical Center's
Plastic Surgery Service chief. "We are primarily a reconstructive service."
Less than 20 percent of the plastic surgery cases at Walter Reed are for
elective cosmetic procedures, Kolb said. The entire Army has only about
a dozen plastic surgeons, Kolb said, adding that plastic surgery is far
from a luxury service offered to military beneficiaries. "The Army keeps
us around for reconstructive procedures," Kolb said. "In addition, we operate
on children with congenital defects like cleft lip, cleft palate and other
defects to the head and neck." Kolb said Walter Reed's four plastic surgeons
are very intimately and actively involved in treating wounded from the
war in Iraq. One, Lt. Col. Andrew Friedman, is currently deployed to Iraq
as a general surgeon. "He ends up doing a lot of acute hand injuries over
there." "Hand function is really very dependent on the timeliness of repair,"
Kolb explained. "So having a hand surgeon in Iraq can make a difference
in having a functional hand after an injury, and not having a functional
hand. It's that important." "We also have nasal reconstruction patients
- people who have part or all of their nose blown away," he said. And we've
all been involved in some very difficult head and neck traumas with Iraq
going on. Those are always very difficult to do because of the complexity."
"There are some injuries where you're never going to make a person look
normal again. And unfortunately, some of the injuries we've seen [from
Iraq] are in that category. But we make them function, obviously saving
the patient's life is important. Functional considerations are much more
important than cosmetic," Kolb explained. "Luckily, we've had some good
results with the reconstruction, and I think it will return people to certain
levels of duty in some cases." "The spectrum of plastic surgery goes from
the very simple, purely cosmetic things up to the very complex micro-vascular
surgery," Kolb said. "Using micro-vascular techniques, surgeons can move
a piece of tissue with its artery and vein to another part of a patient's
body and hook into a different artery and vein. This is something Walter
Reed plastic surgeons perform regularly. Despite supporting deployments
and spending long hours in the operating room to treat the war wounded,
"We have maintained our support of the Breast Center and of cleft lip,
cleft pallet and cancer surgery in general," he said. "We've been in a
little bit of a squeeze and our ability to do cosmetic surgery has been
compromised a certain bit. But, we're still offering most every service
we've always offered - certainly the waiting times have increased though."
Walter Reed plastic surgeons also find time for research. "We are on a
[Food and Drug Administration] protocol for using silicone-gel implants
for breast reconstructive work," Kolb said. This allows doctors in the
Walter Reed Comprehensive Breast Center to send their breast cancer patients
to plastic surgery for a consult for breast implantation. To help maintain
the surgeons' skills in all areas of plastic surgery, Kolb said services
are sometimes provided in other areas. Walter Reed gets thousands of plastic
surgery consults for beneficiaries wanting some type of cosmetic surgery.
"The demand is tremendous and we don't have the OR time to devote to all
of them," he said. "Because of that, I personally have to go through all
of the consults, that go to the service, and prioritize them." Kids and
patients with cancer who need reconstructive surgery come first. Because
of Walter Reed's vast expertise in plastic surgery, medical students from
the Uniformed Services University of Health Sciences come to the hospital's
Plastic Surgery Service to conduct research. The service also offers a
unique opportunity for the USUHS residents. "We're also restarting humanitarian
trips down to Central and South America in fiscal year '05," Kolb said.
(Editor's note: Michael Dukes writes for the Stripe newspaper at Walter
Reed Army Medical Center.)
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