DAWN TO DUSK NEWS: wired

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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRBUBHMgv6K0UGsO2vaKmSbhQx0bzSRIHU7-NHy5n2fyksg1bAs5ZoVRuSp4lrawTzTcz6CQzeZYQJdoXKwZSnSSnieeeBI-FVINmaORM9nNL5b81RF6R4TPtgu0oRnFLqe9Qf6i1r-Z_r/s1600/nose-grown-on-forehead_72031_990x742.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRBUBHMgv6K0UGsO2vaKmSbhQx0bzSRIHU7-NHy5n2fyksg1bAs5ZoVRuSp4lrawTzTcz6CQzeZYQJdoXKwZSnSSnieeeBI-FVINmaORM9nNL5b81RF6R4TPtgu0oRnFLqe9Qf6i1r-Z_r/s1600/nose-grown-on-forehead_72031_990x742.jpg" width="640" /></a></div>
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<span style="font-size: large;">Growing a nose on a forehead or an ear on an arm is a revolutionary approach to surgical reconstruction.</span></h2>
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<span style="font-size: large;"><strong>mages
 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.</strong></span></h2>
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<span style="font-size: large;">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 <em>New England Journal of Medicine</em>.
 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.</span></div>
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<span style="font-size: large;">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 <em>NEJM </em>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.</span></div>
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<span style="font-size: large;"><strong>The photographs look like some sort of cruel joke. Is this a serious procedure?</strong></span></div>
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<span style="font-size: large;">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.]</span></div>
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<span style="font-size: large;"><strong>What are the layers, and why is each layer important?</strong></span></div>
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<span style="font-size: large;">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.</span></div>
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<span style="font-size: large;"><strong>So how do you help ensure a good blood supply?</strong></span></div>
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<span style="font-size: large;">Prelamination,
 or implantation of tissue or cartilage to a skin flap while preserving 
blood supply, provides that inner layer. You put a skin graft on the 
undersurface of the skin flap, then allow it to heal under the surface 
of the forehead, so you've created two layers. You can then split the 
layers and put cartilage grafts inside, like a sandwich.</span></div>
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<span style="font-size: large;"><strong>What did you think when you saw the forehead/nose photograph circulating on the Internet?</strong></span></div>
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<span style="font-size: large;">In
 reconstructive surgery we're always trying to provide creative 
solutions. I'm impressed with the creativity of surgeons worldwide, but 
with a clear caveat. I personally have a healthy dose of skepticism as 
to whether or not this was necessary and was the optimal choice. Why 
they chose to do it in the forehead instead of the usual way—construct 
it right there where needed on the nose and then transplant skin from 
the forehead—we'll never know. Perhaps they had some concerns about the 
blood supply. With something as complicated as nose or ear 
reconstruction, there's really no particular standard of care or defined
 solution. When it comes to how you take living tissue to re-create 
something close enough to make people feel it's a real nose or a real 
ear, there are endless feasible strategies.</span></div>
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<span style="font-size: large;"><strong>Where do we go from here with this type of reconstructive surgery?</strong></span></div>
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<span style="font-size: large;">I
 believe that it's a realistic possibility that at some point in the 
future we can take samples of cells and we'll be able to grow composites
 in the laboratory. It would be the same strategy, constructing a 
three-layer body part but out of cells taken from the patient. That's 
the holy grail. But before that, maybe cartilage can be grown in the 
lab, and from there, use the forehead flap.</span></div>
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<span style="font-size: large;"><strong>How 
do patients react to such bizarre, if temporary, placement of a 
reconstructed body part? Even though few have full noses on their 
foreheads, a fairly common reconstruction requires a flap of skin 
running from the forehead and attached to the nose to stay in place 
while healing for several weeks or months.</strong></span></div>
<span style="font-size: large;">The range of 
coping strategies is all over the map. I've seen people continue their 
professional work. Others won't leave the house until the procedure is 
complete. The woman with the ear reconstruction on her arm was lucky. 
She could cover up the growing tissue and cartilage with a sleeve. And 
she had some fun with it. "She was playing with her kids, and if they 
got in trouble, she'd roll up her sleeve and say, 'Tell it to the arm,'"
 said Byrne.</span><br />
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why this man has nose on forehead???

Growing a nose on a forehead or an ear on an arm is a revolutionary approach to surgical reconstruction. mages of a no...