New techniques use fat cells to smooth visages of veterans devastated by injury
March 6, 2011 10:00 AM
Jeremy Feldbusch lost his sight after a piece of artillery shrapnel tore through his skull in Iraq in 2003. He underwent a new procedure that transferred fat from other parts of his body to fill in the side temple area of his head.
By Mark Roth Pittsburgh Post-Gazette
Jeremy Feldbusch can't see the results of the special cosmetic surgery he recently got -- but he's pleased when people tell him what a good job the doctors did.
Mr. Feldbusch is blind because a piece of artillery shrapnel tore through his skull in Iraq in 2003. In January, UPMC surgeon J. Peter Rubin took fat from his abdomen and thighs and injected it into cavities that his war injuries had left on his face.
The procedure smoothed out the depressions that bordered a metal plate in his forehead and filled in some "potholes" near his right eye, as Mr. Feldbusch put it.
When people who know him say his face looks a lot better, "that makes me feel good. I tell people it's like when they came out with the Reebok pump shoes -- you're pumping me up."
Dr. Rubin, recently named chief of the Division of Plastic and Reconstructive Surgery at UPMC, has received $4.5 million from the Department of Defense for his fat resculpting project, and so far has performed the surgery on 11 injured veterans.
"There is a very high incidence of facial injuries in military trauma today," Dr. Rubin said. "Because the body armor is so advanced, our troops are surviving blasts that in previous conflicts would have taken their lives. So the extremities and head and face are more exposed."
Using techniques developed by New York plastic surgeon Sydney Coleman, who has assisted on the surgeries here, Dr. Rubin's team removes fat cells from a patient's body, centrifuges them to collect the most active cells, and injects them into injury sites using tiny tubes that can be as narrow as an intravenous needle.
Fat injections have been used in cosmetic surgery for years, but the problem has been that in many cases, the fat is absorbed by surrounding tissues and the work has to be done over.
Dr. Coleman's centrifuge technique is designed to prevent that by concentrating the fat cells, which helps them to thrive and grow new blood vessels once they are injected.
In a broader sense, Dr. Rubin's project is part of a fast-growing movement around the world to use fat stem cells to generate new tissues for all sorts of conditions, from breast reconstruction to growing new bone.
Most human tissues contain stem cells that can generate new cells of the same type to promote healing. Fat stem cells can not only grow new fat cells, but in the lab, they have been turned into bone, cartilage, skin and muscle.
In Dr. Rubin's lab and other sites around the world, fat stem cells are starting to be tested in human patients for a variety of conditions, said Jeffrey Gimble, a stem cell biology professor at Louisiana State University.
One of the most amazing experimental uses of fat stem cells has been in Finland, he said, where doctors have coaxed fat cells to turn into bone to help reconstruct the upper jaws of people who have had cysts or cancer.
In work at the Regea Institute for Regenerative Medicine, doctors have taken patients' fat stem cells, put them in a titanium cage and then inserted the cage in their abdomens, where there is a rich blood supply.
Eight months later, the fat cells have turned into bone. Doctors remove the cage, take out the newly formed bone and implant it into the patients' faces.
In Japan, doctors have now used fat stem cell injections in hundreds of women for breast enlargements, and report that the women think the results feel and look much more natural than synthetic implants, he said.
UPMC's Dr. Rubin is also working with fat stem cells for reconstruction in women who have had breast cancer. Because stem cells can promote tissue growth and new blood supply, there has been some concern that these injections might trigger a recurrence of the breast cancer, he said, "but our best evidence now shows if you have dormant cancer cells present, they are not likely to be reactivated by fat stem cells."
While some of the fat that Dr. Rubin injected into Mr. Feldbusch and the other injured soldiers consists of stem cells as well, the next step of his research will be to grow additional fat stem cells in the lab and "enrich" the mixture of fat cells that are put into the injury sites.
For Mr. Feldbusch, 31, an extroverted University of Pittsburgh graduate, the fat injections are just a finishing touch to a long and sometimes painful rehab process.
He lives with his mother, Charlene, and father, Brace, in a house in Blairsville, near the border of Westmoreland and Indiana counties.
They have been a vital part of his recovery, and also are among the founders of a national organization to help injured veterans called the Wounded Warrior Project, based in Jacksonville, Fla. They also appear with Mr. Feldbusch in a 2006 documentary film about his recovery, "Home Front," produced by Showtime.
On April 3, 2003, he was helping set up a mortar near the Haditha Hydroelectric Dam when a couple of enemy artillery rounds landed about 30 feet away from him.
A 1-inch piece of shrapnel hit his right temple, destroying that eye, burrowed through the middle of his brain's frontal lobes, cut the optic nerve of his left eye and lodged behind his forehead.
He woke up six weeks later at Brooke Army Medical Center in San Antonio, Texas. By that time, doctors had removed the shrapnel, put a metal plate in his forehead and helped him recover from a life-threatening bout of pneumonia.
"The first thing I remember hearing was my parents talking and I thought 'Why am I hearing my mom and dad? I'm in the middle of Iraq.' So they actually waited two weeks to tell me I was blind."
His weight had plummeted from 230 pounds to 150 pounds during his hospitalization, and so he began the long process of regaining strength, learning to walk, and adjusting to losing his sight.
More than anything else, though, he had to come back from his severe brain damage, including going through a phase where he lashed out frequently and "used every four-letter word in the book that your mom doesn't like you to use at the table."
Even today, he said, he sometimes struggles with impulse control -- a major function of the brain's frontal lobes.
"I experience the same impulses in my life as you do, but the [control] barrier's gone. Mine has turned into Swiss cheese. You've got a full piece of cheese in there, but mine is Swiss cheese, and sometimes, things just come out ... ."
Still, he is positive about his life. He has a longtime girlfriend, whom he met through his Wounded Warrior work, and he tries to stay active, going hunting with his dad, who serves as his eyes for sighting his rifle, using a laser scope or a small camera mounted on the rifle.
Fat stem cells, like those now growing in Mr. Feldbusch's face, have two complementary benefits, Dr. Rubin and Dr. Gimble said.
In some cases, they remain fat cells when they are put in the body, but can promote blood vessel growth and healing in other tissues, which has been shown in experimental work on heart disease patients.
In other cases, they can morph into completely different kinds of tissue, as the Finnish experiment shows.
And they have one other advantage, Dr. Gimble said: People are happy to donate them. "There is no other tissue that someone will actually pay their doctors to take out of them," he said.
Mr. Feldbusch jokes that he'd like to get rid of some of the fat cells he has added through his diet since he returned home.
But he is happy -- "I'm one of those glass-is-half-full guys" -- and he feels that his journey has only deepened his Christian faith.
"We all have hills we're going up in life, and most people when they can't make it, they stumble and fall and roll back and just get angry, and they kind of lose their faith in wanting to get back up.
"But then there are those who climb that hill and crest it and see a much brighter side. You've just got to have that perseverance inside you."