WASHINGTON, DC—Military and civilian researchers are embarking on efforts to develop regenerative therapies that could help injured servicemembers who survived the battlefield, but have sustained serious facial injuries. “The face is vulnerable on the battlefield because it is frequently exposed, since that is how we sense the environment,” said Col Robert Hale, DDS, chief of oral and maxillofacial surgery at Brooke Army Medical Center, who spoke at the USU-HJF Military Medicine Symposium held in September.
Hale said that a cohort of 7,770 soldiers he studied from 2001 to 2007 from the Joint Theater Trauma Registry showed that 26% of all soldiers injured in the battlefield had injuries to the facial region. He found that 41% of all injuries to the face would be considered serious by most professionals.
Battlefield facial injuries can be so severe that conventional treatment cannot restore function and form to the face adequately, Hale explained.
As a way to address severe facial injuries—as well as severe injuries on other areas of the body— civilian and military researchers have been collaborating through the Armed Forces Institute of Regenerative Medicine (AFIRM) to develop regenerative therapies. AFIRM consists of more than 200 scientists working from more than 30 universities and the US Army Institute of Surgical Research (USAISR). Researchers hope that, one day, regenerative medicine will be able to regrow bone, tendons, skin, and muscles, benefiting injured servicemembers.
Regenerative Medicine in Its Infancy
Improvements in battlefield medicine, coupled with advancements in body armor and helmets, have increased the numbers of servicemembers who survive crippling and disfiguring injuries. However, regenerative medicine needs to catch up, and such research is critical to these efforts. “The challenge is that our ability to save lives has outpaced our ability to restore form and function,” said Joachim Kohn, PhD, director for the Rutgers-Cleveland Clinic Consortium of AFIRM.
AFIRM’s regenerative medicine research is concentrated in five major programs: limb repair, craniofacial repair, burn repair, scarless wound healing, and compartment syndrome repair.
Researchers point out that currently the field of regenerative medicine is still in its infancy. “In survey after survey, most patients would prefer natural and living substitutes over an artificial prosthesis. The problem is that the biggest limb that we can regenerate in the lab and make work is the pinky and not the whole pinky … So we are quite a ways from regenerating a leg or an arm,” Kohn explained.
He noted that breakthroughs have been slow in regenerative medicine due to the complexity of the human body. For example, he pointed out that cells die if they are too far from a blood vessel.
Scientists with AFIRM are conducting a number of research projects that they believe hold great promise, according to Kohn. One area that scientists are researching is the development of new approaches to reduce the need for life-long immunosupression for transplant recipients, which shortens their life. “It is really important that we are making progress in circumventing immunosupression.”
Researchers are examining the use of an autologous engineered skin substitute for severe burns. Another study is examining how to improve the appearance of scars. Scarring from surgery can be severe in wounded servicemembers. One study is using a procedure called “autologous fat transfer” in which tissue is taken from other parts of the body and placed on the wound to determine if it will improve the appearance of the scar from the wound.