AUSTIN, Texas (AP) ? Jacqui Saburido could soon have a new nose, thanks to an ancient procedure performed by Brazil's most famous plastic surgeon.
Saburido, 32, who was badly burned when the car she was riding in was struck by a drunken driver near Lake Travis in 1999 and who has become the face of worldwide campaigns against drunken driving, is undergoing a procedure to turn a flap of her skin into a new nose.
Dr. Ivo Pitanguy, a legend in his native Brazil considered by many to be a godfather of modern plastic surgery, and his team will attach the flap sometime this summer. And though Pitanguy, who by some accounts is the second-most well-known Brazilian after retired soccer star Pele, has been at the forefront of various innovations over the years, he is performing a procedure that was developed during World War I and has roots going back thousands of years.
"She was a very severe case, and we have many limitations, but we are doing the best we can," Pitanguy said from his clinic in Rio de Janeiro. "It's a little heroic thing, but we hope it will work well."
Saburido, whose nose, eyelids, ears and lips were burned away in the accident, is cautiously optimistic about the latest procedure.
"Let's hope it works," she said in a phone interview from Miami shortly before returning to her native Venezuela. "It's been a tough time, but we keep going little by little."
Saburido was a 20-year-old student studying English in Austin when the car in which she was riding burst into flames after a head-on collision on RM 2222. She burned for nearly a minute before paramedics put out the fire. Saburido suffered severe burns to nearly her entire body.
Two other people in the car died. Reggie Stephey, who was 18 at the time of the wreck, was convicted of two counts of intoxication manslaughter in 2001 and served seven years in prison.
In the years after the accident, Saburido lent her burned face to a Texas Department of Transportation campaign against drunken driving that has been taught in Texas schools for much of the past decade.
She has undergone more than 120 surgeries, but none has had a significant impact on her face.
In the latest procedure, skin taken from below Saburido's chest will be molded into a nose. The procedure, which uses what surgeons call a pedicled flap or tube, is time-consuming and complex, Pitanguy said.
First, Pitanguy had to find a source of healthy skin. Usually, skin from the forehead is used, but because Saburido's body was burned so extensively, Pitanguy had to search farther away.
"The difficulty was to find an area that was not burned and could be safely used," Pitanguy said. "Luckily the quality of the tissue under the chest is very good."
The procedure, which began for Saburido last year, takes several months and occurs in stages. Generally, it goes like this: Two parallel incisions are made at the donor site, and the skin is curled under and stitched together, forming a tube of flesh attached to the body at both ends. Once the blood flow in the tissue tube recovers, one end is disconnected, moved closer to the nasal area and reconnected to the body to restore blood flow.
The process, sometimes called "waltzing a flap," is repeated until the tube reaches the proper place on the face, where it is sculpted into a nose once the blood flow is firmly established. Sometimes cartilage from ears or ribs and other hard materials are used to shape the new nose.
In Saburido's case, Pitanguy has moved the tube up her chest. Pitanguy said his clinic has performed two movements of the tissue tube, which is currently attached near Saburido's neck.
"It's an older, yet tried and true method," said Dr. Adam Bryce Weinfeld, a plastic surgeon with Seton Medical Center's advanced facial surgery center. "Sometimes the older methods are the only way to do this."
Weinfeld often performs forehead flap procedures, in which tissue from the forehead is grafted to the nose in far less time.
More recently, microvascular surgery has been used to transplant large areas of skin from one part of the body to another. In microvascular surgery, surgeons look through powerful microscopes to remove skin and sever blood vessels, and then move the skin, along with its vascular system, to the new destination. But Pitanguy said microvascular nasal surgery was not an option given the severity of Saburido's burns.
Pitanguy trained with the man credited with developing the procedure, Sir Harold Gilles, a British surgeon who pioneered a number of plastic surgery procedures during World War I.
But the idea behind the procedure goes back even further. According to a 1995 article in the European Journal of Plastic Surgery, doctors in India as far back as 3000 B.C. used a method in which they cut a flap from the forehead to be used for nasal reconstruction. In 1597, Italian surgeon Gaspare Tagliacozzi described a rudimentary procedure in which flesh from the arm was grafted onto the face and shaped into a nose. The procedure was refined by Gilles, who made a number of plastic surgery advances as he operated on wounded British soldiers.
Pitanguy, 84, is a hero in his native Brazil, where his list of patients includes queens, presidents and movie stars. His success has made him wealthy, and his legend grew in Brazil when he bought a private island off the coast of Rio de Janeiro. But Pitanguy is also famous for offering his services to poor Brazilians, giving free reconstructive surgeries to those suffering from birth defects, as well as cosmetic surgeries to low-income Brazilians.
Pitanguy said he has been impressed with Saburido's spirit since beginning work with her last year.
"She has impressed everybody with her courage and determination," he said.
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Information from: Austin American-Statesman, http://www.statesman.com
Copyright 2011 The Associated Press.
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