Doctor Fixes The Torn Faces Of War

June 08, 1993|By Douglas Birch | Douglas Birch,Staff Writer

Pulling 10-hour shifts in a series of operating rooms in the former Yugoslavia, Dr. John L. Frodel Jr. worked feverishly to erase the obscene graffiti of war from the faces of some of its victims.

The Johns Hopkins Hospital physician, part of an international team of eight facial plastic surgeons who went to Croatia last month, built a new eye socket for a soldier whose jeep hit a mine. He replaced missing portions of the nose and upper jaw of a 15-year-old boy in a war-torn village who tried to commit suicide by shooting himself.

A soldier hit by a bullet lost the right side of his face. Dr. Frodel gave him a new one, using bone carefully shaved from other parts of the skull joined with surgical screws. It was, he said, "almost like [pieces in] an erector set."

The surgical tools were outdated. Croatian hospitals lacked modern titanium plates used to hold together bone fragments, so the surgeons brought their own. Most reconstructions were done without sophisticated computerized tomography, or CT scan, images of the damage.

To bridge the language gap, Dr. Frodel used hand signals with some patients and nurses.

"We had to kind of wing it, a bit," said the 38-year-old Fells Point resident, director of facial plastic and reconstructive surgery at Hopkins. "But I firmly believe we did every bit as good a job as we would have done at Hopkins."

Dr. Frodel was one of five U.S. doctors, all members of the American Academy of Facial Plastic and Reconstructive Surgery, who joined three Swiss surgeons in Zagreb May 2. The volunteers, along with Croatian surgeons and nurses, spent 11 of the next 12 days in hospitals in various towns rebuilding about 60 shattered faces.

The marathon surgery was arranged by plastic surgeon Sina Glumecic, who asked for help after he and Croatia's 14 other specialists in facial reconstruction found themselves overwhelmed with war-related work.

While the war has bitterly divided the region's ethnic groups, Dr. Frodel said the international team treated Croats, Serbs and Muslims alike. They treated civilians and soldiers, the young and the old.

Dr. Larry Marantette, the leader of the team, said the war victims had some of the worst facial injuries he had ever seen -- comparable, in most cases, to those produced by self-inflicted shotgun wounds and head-on motorcycle crashes.

"These were patients with parts of their faces missing, rather than just being fractured," said the physician, a plastic surgeon at the University of Minnesota.

Dr. Frodel said he saw more gunshot victims in his two weeks in the former Yugoslav republic than the average plastic surgeon might see in several years.

For the most part, the wounds were different than those produced in shootings in this country because they had been inflicted by large-caliber, military-style weapons.

Year of residency in 2 weeks'

"It was like a year of residency programs in two weeks," he said. "They challenged us with their most difficult cases. And there were a lot of them."

Despite their wounds, these patients were relatively lucky. In this dirty war of neighbor against neighbor, evacuating and treating the wounded can be difficult or impossible.

"We saw fewer kids than we expected to see," Dr. Frodel noted. "The reason was, they just didn't make it."

The plastic surgeons also saw surprisingly few people with brain injuries, given the fact they were reconstructing faces. Again, the reason was simple. "They died," he said.

Most of the patients had been injured in combat, by bombs or by snipers. But a surprising number were psychological victims of the war: botched suicides.

"We were told the suicide rate is up significantly because of this war," Dr. Marantette said.

One Croatian soldier, pinned down in a firefight with Serbian soldiers, feared he would be tortured if captured. All nine of his comrades were dead. So the soldier shot himself under the chin.

The Serbs overran the position and left the bloody and unconscious Croat for dead. Later, he regained consciousness and called for help.

"That suicide attempt is what saved his life," Dr. Marantette said. The plastic surgeons rebuilt the soldier's missing nose and a portion of his upper jaw.

Dr. Frodel worked on a 15-year-old whose older brother, a Croatian soldier, returned home wounded. Their emotionally distraught father turned angrily on the younger son and told him: "I wish it was you who was wounded instead of your brother."

The boy took his brother's pistol, walked into another room and shot himself.

Victims of ancient hatreds

Most of Dr. Frodel's patients were victims, in one way or another, of ancient ethnic hatreds. One was injured by an antique weapon from a previous war.

In the midst of the current fighting, a 9-year-old Croatian boy stepped on and detonated an unexploded bomb from World War II.

He lost a hand, part of a leg, was blinded and severely scarred.

Like many victims of explosives, the physician said, the boy was tattooed with bluish streaks, residue shot under the skin by the bomb.

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