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Sculptural restorations for inoperable deformities
Sculptural Restorations for Inoperable Deformities ADOLPH M . BROWN, M .D .,
Beverly Hills, California
blind, the senile and R the crippled ofhasthebeen studied more in nHABILITATION
recent years than in the past. However, there is another segment of our population who require restoration to their places in society . Quite often this group of people are healthy in the ordinary sense but suffer the tragedy of facial deformity and disfigurements for which there is yet no medical or surgical remedy . Unless their deformities are accompanied by a cleft palate or harelip, these poor people do not endure functional disabilities or organic dysfunctions, and ordinarily one would think that they can carry out the normal activities of daily routine ; yet they are handicapped because of the way they look . Ordinary defects such as the crooked nose, the lop ear or the pigmented nevus can be corrected by routine plastic surgery . However, the handicapped people to whom I refer are beyond the care of present day surgical corrections and require artificial substitutes for missing parts of the face or body . Deformities requiring prosthetic correction are more of a handicap than most of us realize . They are barriers to the opportunities for work and play which are available to normal people . It is purely the esthetic aspect which makes these deformities different from other rehabilitation problems . Medical, surgical and social work are not enough . All this will lead the medical profession to a more serious consideration of the prosthetic art . Until recently prosthetic restoration technics have been an orphan child of the medical profession. Restorative cases were grudgingly admired for the moment but given neither permanent nor recognized places in clinics or medical schools . In the past cases beyond the power of plastic surgery were only grudgingly assigned for prosthetic correction . It seems that only by the "bloody" correction could a patient be really benefited according to most members of the healing profession . 688
Despite the almost "do nothing" attitude of medicine as a whole, some men have tried through the ages to replace missing parts of the face and body with substitutes rather than attempt reconstruction with living tissue . Some of the substitute materials, notably latex rubber and some of the newer polymerized synthetic resins such as polyvinyl butyral, have already proven their worth as restorative substances . The surgeon is the first to confess that reconstructive operations, such as that of the total ear, often at best carry the probability that the esthetic result of a whole operative series will be only fair . By prosthetic technics, however, an ear of latex or of vinyl resin can be made to match its mate with accuracy both as to color and translucence, with life-like elasticity and certainly with excellent sculptural details . Such an car, applied with a perspiration-resistant cement, can be produced without pain and without hospitalization or loss of the patient's working time . It is easier on the patient, the doctor and society. After a few recent wars, with the subsidization by government, rehabilitation with prostheses among both the military and civilian population is an improved and broadened art . Using the most suitable of the new synthetic compounds as fast as they are developed, the modern prosthetic expert is keeping pace with advancements in industrial fields . All this is being accomplished by a few medical men who form an inner clique of those interested in helping the patients heretofore considered beyond ordinary aid ; men unconsciously dedicating themselves to help the poor patients who previously have been transferred from department to department and clinic to clinic with nothing offered to conceal if not correct their disfigured faces and thus make life more endurable . (Figs . I to 3 .) To help such people, however, requires more than the ordinary knowledge held by pos-
Sculptural Restoration for Inoperable Deformities
Fic . I . A, congenital absence of ear : usually accompanied by malformations of the jaw and mastoid process . B, with ear prosthesis .
A, loss of nose and upper lip from syphilis . B, with prosthesis of latex . Upper lip prostheses present a problem involving the retention of saliva within the mouth . (From BROWN, A . M . Modern Plastic Surgical Prosthetics . New York, 1947 . Grune & Stratton .) FIG . 2 .
sessors of an M .D . degree . Men who seek to restore these deformities must have some knowledge of art, whether it is formally acquired or not . They must have mechanical ingenuity and a practical ability in chemistry . They must he improvisers, experimenters and true practitioners of medical art . They must have obstinancy, and courage enough to carry through and produce previously impossibleto-make artistic restorations, to overcome the obstacles intrinsic to each unusual case as it presents itself, and above all, courage enough for the patient, too . Fortunately, there are such men in medicine . Because of these true physicians new names are coming into medical terminology, namely, those of the vinyl resins, synthetic latices, neo-
prene dispersions, the methacrylates, new monomers and plasticizing agents . New products of manufacture are now found in the doctor's laboratory . Colored lacquers, tints and dyes from all industry are now combined to make artificial restorations the important adjuncts of surgical and medical practice they deserve to be . The patient with inoperable lupus of the face and the patient with hideous tertiary syphilis, unresponsive even to medication, are helped . Special equipment is now visible in the doctor s laboratory . Heaters, ovens, mixing equipment, homogenizers, grinders, polishers, and calking guns have been borrowed from industry to help the deformed . This is as it should be. 689
Sculptural Restoration for Inoperable Deformities
3A 3B FIG . 3 . A, carcinoma of antrurn . B, with prosthesis .
There are definite satisfactions which come to one who undertakes this sometimes heart breaking work . Among them is the comradeship which develops between men of various professions for a common cause . Once the purpose of the work is explained, the cooperation from engineers, chemists and other researchers in industry is astonishing. One finds himself posing questions which are strange to modern medicine . Why are fingernails, the cornea and tooth porcelain fluorescent to ultraviolet light? If artificial teeth, eyes and fingernails possess fluorescence by the
artificial addition of coal tar extracts, why are they more life-like? Why is blue sometimes discernible in Negro skin? How much of skin color is due to pigment, how much to transmitted color from the flesh below? How fluorescent is sebum? Is perspiration fluorescent? What is the mechanism of scoliosis after breast amputation? These arc the questions posed to modern practitioners of the restorative art . These problems, to the average doctor, seem annoying . To those who do this work, these problems are exasperating but intriguing .
6qo
Beverly Hills, California
blind, the senile and R the crippled ofhasthebeen studied more in nHABILITATION
recent years than in the past. However, there is another segment of our population who require restoration to their places in society . Quite often this group of people are healthy in the ordinary sense but suffer the tragedy of facial deformity and disfigurements for which there is yet no medical or surgical remedy . Unless their deformities are accompanied by a cleft palate or harelip, these poor people do not endure functional disabilities or organic dysfunctions, and ordinarily one would think that they can carry out the normal activities of daily routine ; yet they are handicapped because of the way they look . Ordinary defects such as the crooked nose, the lop ear or the pigmented nevus can be corrected by routine plastic surgery . However, the handicapped people to whom I refer are beyond the care of present day surgical corrections and require artificial substitutes for missing parts of the face or body . Deformities requiring prosthetic correction are more of a handicap than most of us realize . They are barriers to the opportunities for work and play which are available to normal people . It is purely the esthetic aspect which makes these deformities different from other rehabilitation problems . Medical, surgical and social work are not enough . All this will lead the medical profession to a more serious consideration of the prosthetic art . Until recently prosthetic restoration technics have been an orphan child of the medical profession. Restorative cases were grudgingly admired for the moment but given neither permanent nor recognized places in clinics or medical schools . In the past cases beyond the power of plastic surgery were only grudgingly assigned for prosthetic correction . It seems that only by the "bloody" correction could a patient be really benefited according to most members of the healing profession . 688
Despite the almost "do nothing" attitude of medicine as a whole, some men have tried through the ages to replace missing parts of the face and body with substitutes rather than attempt reconstruction with living tissue . Some of the substitute materials, notably latex rubber and some of the newer polymerized synthetic resins such as polyvinyl butyral, have already proven their worth as restorative substances . The surgeon is the first to confess that reconstructive operations, such as that of the total ear, often at best carry the probability that the esthetic result of a whole operative series will be only fair . By prosthetic technics, however, an ear of latex or of vinyl resin can be made to match its mate with accuracy both as to color and translucence, with life-like elasticity and certainly with excellent sculptural details . Such an car, applied with a perspiration-resistant cement, can be produced without pain and without hospitalization or loss of the patient's working time . It is easier on the patient, the doctor and society. After a few recent wars, with the subsidization by government, rehabilitation with prostheses among both the military and civilian population is an improved and broadened art . Using the most suitable of the new synthetic compounds as fast as they are developed, the modern prosthetic expert is keeping pace with advancements in industrial fields . All this is being accomplished by a few medical men who form an inner clique of those interested in helping the patients heretofore considered beyond ordinary aid ; men unconsciously dedicating themselves to help the poor patients who previously have been transferred from department to department and clinic to clinic with nothing offered to conceal if not correct their disfigured faces and thus make life more endurable . (Figs . I to 3 .) To help such people, however, requires more than the ordinary knowledge held by pos-
Sculptural Restoration for Inoperable Deformities
Fic . I . A, congenital absence of ear : usually accompanied by malformations of the jaw and mastoid process . B, with ear prosthesis .
A, loss of nose and upper lip from syphilis . B, with prosthesis of latex . Upper lip prostheses present a problem involving the retention of saliva within the mouth . (From BROWN, A . M . Modern Plastic Surgical Prosthetics . New York, 1947 . Grune & Stratton .) FIG . 2 .
sessors of an M .D . degree . Men who seek to restore these deformities must have some knowledge of art, whether it is formally acquired or not . They must have mechanical ingenuity and a practical ability in chemistry . They must he improvisers, experimenters and true practitioners of medical art . They must have obstinancy, and courage enough to carry through and produce previously impossibleto-make artistic restorations, to overcome the obstacles intrinsic to each unusual case as it presents itself, and above all, courage enough for the patient, too . Fortunately, there are such men in medicine . Because of these true physicians new names are coming into medical terminology, namely, those of the vinyl resins, synthetic latices, neo-
prene dispersions, the methacrylates, new monomers and plasticizing agents . New products of manufacture are now found in the doctor's laboratory . Colored lacquers, tints and dyes from all industry are now combined to make artificial restorations the important adjuncts of surgical and medical practice they deserve to be . The patient with inoperable lupus of the face and the patient with hideous tertiary syphilis, unresponsive even to medication, are helped . Special equipment is now visible in the doctor s laboratory . Heaters, ovens, mixing equipment, homogenizers, grinders, polishers, and calking guns have been borrowed from industry to help the deformed . This is as it should be. 689
Sculptural Restoration for Inoperable Deformities
3A 3B FIG . 3 . A, carcinoma of antrurn . B, with prosthesis .
There are definite satisfactions which come to one who undertakes this sometimes heart breaking work . Among them is the comradeship which develops between men of various professions for a common cause . Once the purpose of the work is explained, the cooperation from engineers, chemists and other researchers in industry is astonishing. One finds himself posing questions which are strange to modern medicine . Why are fingernails, the cornea and tooth porcelain fluorescent to ultraviolet light? If artificial teeth, eyes and fingernails possess fluorescence by the
artificial addition of coal tar extracts, why are they more life-like? Why is blue sometimes discernible in Negro skin? How much of skin color is due to pigment, how much to transmitted color from the flesh below? How fluorescent is sebum? Is perspiration fluorescent? What is the mechanism of scoliosis after breast amputation? These arc the questions posed to modern practitioners of the restorative art . These problems, to the average doctor, seem annoying . To those who do this work, these problems are exasperating but intriguing .
6qo