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Plastic surgeons aid tsunami victims

International report — A pair of plastic surgeons recently traveled to Southern Asia to aid victims of the tsunami that devastated the area on Dec. 26.

Beverly Hills, Calif.-based private practitioner Paul W. Wallace, M.D., went to Thailand, where more than 5,000 were killed, 3,000 left missing and some 100,000 left homeless. There, Dr. Wallace digitally reconstructed victims' faces to help survivors identify family members. Dr. Munish (M.K.) Batra, M.D., F.A.C.S., headed to India where he helped with reconstructive surgeries on the coast of Chennai, one of the hardest hit regions.

Why Thailand?Dr. Wallace chose to go to Thailand after having attended a boxing convention in Phuket last October. No stranger to treating facial trauma, he is also medical director for the World Boxing Council.

As such, he proved to be a natural choice to assist Dr. Pornthip Rojanasunan, Thailand's deputy minister of forensic pathology, in identifying victims. He also spent one day performing woundcare at Vachira Phuket Hospital.

"A number of people who survived and were caught in the water received cuts, abrasions and lacerations all over from debris that was in the water," he says. Secondary infections and amputations also were common.

His main responsibilities, however, fell under the auspices of the government's massive victim identification effort.

"Our first order of business was to determine whether a corpse was an Asian or not," says Dr. Wallace. "After making that decision, we removed a rib for DNA purposes and we had a dental team that examined victims' teeth for any dental repair that had been done."

Next, he and two other physicians began performing digital facial reconstructions using software spliced together from several commercially available packages. First, they would expose victims' eyelids and configure what was left of their faces — a challenge because the tissues often were already decomposing. Then they would snap a photograph and digitally rearrange and rebuild features to produce three or four different images of what a victim might have looked like alive. If, with a little imagination, survivors recognized one of these images, the bodies would undergo DNA testing.

Carnage Words can hardly describe the carnage amid which Dr. Wallace worked, mainly in a Buddhist temple called Wat Bang Muang. Many bodies, stored in refrigerated trailers that held up to 64 at once, had spent at least a week out in the sun.

Under such conditions, he says, "The skin is the first thing to go. So faces lose any landmarks in terms of color, for example. All nasal cartilage was gone. The majority of the hair was usually gone. The bodies looked as though they were a sci-fi special effects creation. Our goal was to recreate recognizable facial images."

Pediatric faces proved particularly difficult because they had the least skin to begin with. For these victims and others, Dr. Wallace and his fellow volunteers often used a single remaining eyelid, for instance, to construct a mirror image for the other. In total, he worked on about 140 corpses at a pace of 20 daily. About a dozen had been identified using various forensic techniques by the time he left Phuket.

Unfinished businessAt press time, Dr. Wallace planned to return to the city for approximately two weeks in February, and periodically after that until all corpses' faces have been digitally reconstructed.

"We will go as long as monies are available to hire staff and we have the authority of the government to do it," he says.

The latter window may close soon, however. Although the largely Buddhist culture of Thailand sets no deadline for burying bodies, as does Indonesia's Muslim culture (three days), the Thai government might at some point choose to discontinue identification efforts. This appears likely, as the operation recently was turned over to the country's police forces.


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