3D Laser Scanning Helps Fix Injured Soldier

My submission this month tells the story of how 3D scanning technologies can impact and improve the life of a soldier injured in battle. Michael Fletcher came to our office in the summer of 2006 after significant medical treatment at both the Walter Reed Army Medical Hospital and The Johns Hopkins Hospital. We had already helped facial plastic surgeon Dr. Patrick Byrne with various medical procedures with our 3D imaging and modeling tools and he asked if we would assist again. Of course we agreed – we always do.

The story below is an excerpt from The Johns Hopkins Magazine. It better explains about the human side of the benefits of our 3D technology how it changed Fletchers life. My description would be much more technical how we laser scanned the patients face, manipulated the data into a digital model, and ultimately fabricated a plastic template using 3D printing for use literally during the surgery.

Many LiDAR News readers already use 3D scanning and software tools in much the same way to make digital models of industrial buildings, components, terrain, etc. and its pretty much the same thing just smaller and the terrain is somebodys face.

We are very proud of our work bringing 3D scanning technologies into the medical field. We have performed dozens of amazing projects that have helped dozens of critical patients, most involving facial prosthetics to restore a sense of normalcy to their lives.

As users of similar 3D technologies, I urge you to learn more. If anyone is interested in details of our 3D work for this medical procedure or others, please see our medical applications [link: http://www.directdimensions.com/apps_medical.htm] page or contact me directly at mraphael@dirdim.com.

Like Something from Nothing

Excerpted from Johns Hopkins Magazine – Winter 2008 (link) [Link: http://www.hopkinsmedicine.org/hmn/w08/feature2.cfm]

See the Magazine PDF [Link: http://www.directdimensions.com/pdfs/articles/DDI_Hopkins_Medicine_Wounded_Soldier_Win08.pdf]

By Ramsey Flynn

When the Humvee started to roll over during a high-speed turn near Iraq’s border with Kuwait on the early afternoon of August 12, 2005 a piece of Michael Flecher’s top-mounted turret gun caught him in the face, impaling him beneath the heavy machine moments later.

He remembers intense heat. He remembers standing up and taking a few steps and throwing his helmet off before passing out. Then he remembers waking up in Walter Reed Army Medical Hospital.

The center of his face was crushed, his nose completely erased into a formless scramble of flesh. By comparison, Fletchers other injuriesa blinded left eye, a left arm amputated at the shoulderseemed almost incidental. That the 21-year-old was alive at all was a testament to modern combat medicine: Fast-thinking military doctors had restarted his heart three times during the medevac operation.

By the time Senior Airman Fletcher came into the care of Patrick Byrne at Hopkins [Johns Hopkins Hospital in Baltimore, Maryland USA] in January of 2006, the four metal plates installed beneath the flesh of his mid-face had settled. Surgeons in Kuwait had placed them there just hours after his injury six months earlier, as an artificial foundation layer to protect the soft tissues beneath. But Fletcher still lacked any human approximation of a nose.

Byrne, an expert in facial plastic reconstruction, knew that building a new nose atop the crude foundation at the center of Michael Fletchers face would require a long series of difficult procedures. With the original nose missing entirely, he would have to craft one from scratch, harvesting raw parts from multiple locations throughout Fletchers body. He counseled Fletcher about the torturous changes ahead, and told him there might be an easier way. They could fashion a real-looking artificial nose.

Though Airman Fletcher welcomed anything that would reduce the awkward staring of strangers, he told Byrne hed suffer any pain required to have a real nose again.

Calling in the Engineers

First, Byrne needed to form his own small army. With so little natural structure to work with, Byrne sought adventurous partners. One came in the form of Hopkins colleague Juan Garcia, an anaplastologist whod already helped Byrne rebuild the faces of patients whod suffered disfiguring nasal cancers. Garcia developed prototype prostheses that allowed surgeons like Byrne to plan difficult procedures preoperatively. Once surgery started, Byrne could also use these prostheses to help guide his scalpels.

But the Fletcher case was something else altogether. Much of the relevant skin, along with the patients underlying nasal structure, was completely absent. Byrne and Garcia would have to devise a novel approach to recreate Fletchers nose from scratchwhile also matching the contours of his original nose.

In a process that graduated from silicone to stone and then to wax, Garcia fashioned a replica of the original nose.

Then he turned to technicians at Direct Dimensions, a suburban Maryland computer engineering lab, to transfer it to a 3-D image that would aid in the production of a clear plastic guide. The guide would be manufactured by precision plastics experts at Aberdeen Proving Ground. Once completed, it would serve as the governing mold that Byrne would fill with carefully sculpted flesh on the operating tablefrom parts of Airman Fletchers own body. Once the flesh version was sculpted, the guide could be discarded and the bandages applied.

Making It Real

The strategy required Fletcher to undergo six medical procedures over the course of nine months, starting in July of 2006.

By the afternoon of April 24, 2007, Fletcher was ready for his last procedure, some of it a redo, some of it just a minor refining of contours. During his pre-op visit with the patient, Byrne asked Fletcher which piece of music hed most like to hear while going under.

Got any jazz? asked the native of New Orleans. Fletcher hadnt been back to his hometown since hed left for the service in 2004. Jazz sounded like a great idea. Ive got Allen Toussaint, smiled Byrne.

The Unveiling

Just a week later, Michael Fletcher returned to Hopkins for the long-awaited removal of his bandage. He was greeted by three television crews.

Can you breathe? one reporter asked as he entered the suite, closely followed by his wife.

Yeah, smiled Fletcher from behind the bandage. Perfectly.

Another asked what he most looked forward to after the bandage came off.

Anonymity, he answered quickly. When you lose it, you know what it was. I want to be able to walk down the street with Yolanda and my boy and have no one notice me.

With little ceremony, Fletcher took his place on a stool. Patrick Byrne stepped close, gently peeling the bandage away. Even through the remaining traces of surgical scarring, the new nose looked remarkably normal.

Fletcher looked around, trying to read the faces of the 10 people gathered around him for some sign of approval.

Finally, one of them handed him a mirror. Wonderful, said Fletcher.

Further questions ensued. One reporter asked if he could touch Fletchers new nose, and if Fletcher could feel the sensations normally.

Fletcher assured the reporter that he could. The only difference between this and my old nose is that I cant wiggle it.

Now out of the Air Force and preparing for a new life somewhere in the immigration and customs service, Michael Fletcher has little need to wiggle his new nose. Two-year-old Mi-Trell, however, is doing a lot of that for him. Hes having a field day with it.

The story of Michael Fletcher and the 3D technology that helped restore his face was featured on CNNs Anderson Cooper 360 Program. [Link: http://youtu.be/jiCczogs8ps]

Dr. Patrick Byrne and anaplastologist Juan Garcia published an excellent medical paper on this procedure in the Archives of Facial Plastic Surgery Nose Reconstruction. [Link: http://www.directdimensions.com/comp_newsevents.php?fileName=DDI_Archives_of_Facial_Plastic_Surgery_Nose_Reconstruction_1007]

About the Author

Michael Raphael

Michael Raphael ... Michael earned a BS degree in Engineering Science and Mechanics from Virginia Tech, followed by a Masters of Engineering Administration from George Washington University. During his 10 years at Lockheed Martin as an engineer responsible for solving aerostructures manufacturing quality problems, Michael co-developed the FaroArm portable CMM and became the first user on the planet! In 1995, he founded Direct Dimensions, Inc., providing rapid solutions to 3D problems!