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Saturday, January 21, 2006

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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 most people

see are the shows on TV, extreme makeover shows, and they think that's

," 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 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 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 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 for a consult for breast implantation. To help maintain

the surgeons' skills in all areas of , 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 , 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.)