Bringing Inspiration One Step Closer to Reality

Clinical practitioners, engineers, and public and private institutional researchers come together to develop more effective treatments for the VSI at the Dartmouth Polytrauma Conference. The nearly five-hour drive to New York from Dartmouth College in Hanover, New Hampshire, passed swiftly. Reflecting on the past three days was so stimulating that I crossed the Hudson River before I knew it. Clearly affected by previous speakers who had graphically demonstrated the complex rehabilitation needs of polytrauma patients, Steve Marra, MD, assistant professor of surgery at Cooper University Hospital, Camden, New Jersey, spoke for many of the participants. "I have never experienced anything like this," he said as he opened his presentation on "Simulation of the Human Body and its Reactions to Surgical Procedures." "This conference has informed, invigorated, saddened, angered, and motivated me like never before in my career." His reaction was common among the attendees at the Polytrauma Conference at Dartmouth College, December 3-5, 2006, conceived and deftly conducted by Joseph Rosen, MD, plastic surgeon and adjunct professor at Dartmouth's Thayer School of Engineering. The event was opened by former Surgeon General C. Everett Koop and followed by presentations from physicists, physicians, psychologists, engineers, and researchers from Massachusetts Institute of Technology (MIT) and Carnegie Mellon University; from corporations like Raytheon, Stryker, and iRobot; and from rehabilitation centers like the Rehabilitation Institute of Chicago (RIC). Military and civilian surgeons shared the experiences they had in the hospitals of the Middle East and Germany, outlining the problems they encountered and demonstrating methods used to treat the very seriously injured (VSI) from Iraq and Afghanistan. Physicists explained the effects of complex forces associated with explosions of improvised explosive devices (IEDs) and the nature of the wounds they cause. Following the "blast" and damage to the eyes, ears, and other organs vulnerable to powerful shockwaves and reverberations, comes fire and heat, doing predictably destructive work, and finally shrapnel, which rips through flesh and bone without discrimination. The term "polytrauma," Rosen explained, refers to the cluster of visual, auditory, and vocal trauma, combined with brain injury, amputation, and facial disfigurement. "These injuries are unique, and their treatment requires a unique combination of specialists. That's why we're here. "We have to do better for these brave soldiers," Rosen continued. He should know. To date, Rosen and others have performed more than a dozen surgeries to try to reconstruct the facial features of Sgt. Jeffrey Mittman, whose face, arm, vision, and hearing were permanently altered by an IED explosion in Iraq. Journalist Susan Dentzer, who produced a public television special on Sergeant Mittman and his family, introduced him to the group and described the courage he and his family have demonstrated as they struggle to rebuild his body and their lives. Mittman expressed his gratitude to Rosen and the group for their efforts to improve his quality of life and the lives of other injured soldiers. Following presentations on visual and cochlear implants, robotics, virtual and enhanced realities, tissue regeneration, and brain/machine interface applications, the participants broke up into three groups. Group one focused on biology, surgery, and regeneration; group two focused on robotics and prostheses, sensory, motor, and neural interfaces; and group three focused on simulation, surgical simulations, virtual and enhanced reality, brain injuries, and psychological issues. The groups were asked to generate two proposals: one for treatment methods that can be implemented within the next one to five years, and another for a 10-15 year plan. Rosen's goal for the conference was "to identify the most effective currently available treatment methods, as well as to develop and outline a long-term research effort to develop more effective treatments." Each group presented its proposals on the third day, a rich blend of pragmatism and visionary creativity. Group two, which the other prosthetists and I joined, focused on quality of life, a seemingly obvious element, as the root of our ideas. In terms of prosthetics, we generally agreed that aesthetics for the patient with burns and/or facial disfigurement is a significant and often overlooked factor in the quality-of-life equation. We proposed that the use of 3D imaging and rapid prototyping, coupled with osseointegration, be more widely used for aesthetic and non-aesthetic prosthetic applications for extremity amputees, as well as craniofacial patients. Some remote-controlled simple robotic tools were identified for the severely impaired. Long-term research efforts included brain-machine interfaces to enhance control and proprioception of prostheses and the development of exoskeletal robotics and robotic assistants when appropriate. Rosen plans to schedule second-tier conferences in the future. Thomas Passero, CP, is the clinical director at Prosthetic & Orthotic Associates International Inc. and LIVINGSKIN®.

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