CUSTOM-MADE PROSTHESES A custom-made prosthesis is an artificial substitute for human anatomy designed and created for an individual patient based on a direct mold of the patient in accordance with a physician’s order. Each prosthesis we make is carefully sculpted to restore visual balance and symmetry to the face or body. We faithfully simulate the texture, color, and translucency of living tissue. In addition to a natural appearance—reliable retention, comfort, ease of use, and durability are necessary for successful prosthetic restoration. We choose medical and health grade materials that replicate the texture, consistency, and elasticity of human anatomy as closely as possible. For example, in the case of an auricular (external ear) prosthesis, silicone with a soft consistency may be used for the earlobe in combination with a more rigid silicone for the cartilage framework of the ear. Our goal is to normalize appearance—to create a prosthesis so convincing that it is unnoticed in public—allowing the patient to go about life without drawing attention to that aspect of his or her physical appearance. As an artificial substitute for living tissue, however, there are still some limitations. The prosthesis does not blush, tan, grow, or age in concert with the patient’s surrounding tissue. It must be removed daily to be cleaned, and to allow for cleaning of the underlying skin. Periodic replacements are necessary to maintain acceptable aesthetics and hygiene of the prosthesis and underlying tissue. Photo: Auricular prosthesis to demonstrate material Design and Fabrication An aesthetically pleasing and well-fitted prosthesis is dependent on careful planning and attention to detail. The process of designing and fabricating a prosthesis requires a minimum of three office visits, in addition to the initial consultation. Additional appointments may be needed for some types of prostheses and retention methods. Based on physical examination, a personal interview, and communication with the referring physician, we develop an individualized patient treatment plan. We make a moulage (mold) using gentle impression materials. From the moulage, we produce an accurate model of the patient. Next, we create a wax prototype that closely approximates the missing anatomy. The patient tries on the prototype, and together we assess the comfort and contours. The prototype is finalized by the sculptural definition of each pore and wrinkle. We develop individualized color formulae to mimic subtle color variations such as moles, freckles, and capillaries. When the prototype is complete, we fabricate a durable mold, which provides for reproduction of the prosthesis in the selected materials. We paint pigmented silicone into the mold in layers to imitate the anatomical layers that comprise the details of the patient’s complexion. This intrinsic coloration technique results in a prosthesis that is natural in appearance and more durable than most prostheses. The patient tries on the prosthesis and we make necessary adjustments and add the final color details. When appropriate, we individually insert hair to enhance the realistic appearance of the prosthesis. We give verbal and written instructions for wear and care of the prosthesis and schedule a follow-up visit. Semi-annual or annual office visits are recommended and may extend the useful life of the prosthesis. Facial Prosthetic Rehabilitation We are sensitive to the fact that absent facial anatomy causes emotional distress in addition to the loss of function. We work to reduce emotional distress by providing exceptional prosthetic rehabilitation. Most of our patients are referred following surgical removal of a tumor or subsequent to a traumatic injury. Some of our patients are born with a facial difference, such as microtia. Burn survivors may also benefit from prosthetic rehabilitation. We create prosthetic devices for any missing facial feature or anatomical structure including nasal (nose), ocular and orbital (eye and eyelids), auricular (ear), partial facial, as well as more extensive prostheses. Each prosthesis is custom-made in our own laboratory. This gives us complete control over every aspect of quality. Our custom prostheses are distinguished by: lifelike contours and texture, realistic color match, and precise fit for a subtle blend at the margins. Our goal in the construction of any prosthesis is to restore anatomical form and function. The prosthesis may function to close open defects improving patient comfort, protect sensitive tissue, and support eyeglasses and/or hearing aids. In the case of an ear prosthesis, some acoustic improvement may be realized. A facial prosthesis is secured using medical grade adhesives, anatomical retention, and/or craniofacial bone anchored implants. Increasingly, we use bone anchored implants to simplify use of the prosthesis, add security and stability to the prosthesis, and extend the useful life of the prosthesis. When craniofacial implants are selected for retention, we team with surgical specialists and provide the surgeon with a surgical template to guide location of implant placement. Photo: Patient with Prosthetic Nose Patient with Prosthetic Ear Patient with Prosthetic Eye Craniofacial Bone Anchored Implants Craniofacial bone anchored implants provide several advantages over adhesive retention including the following: enhanced aesthetic result with very thin edges that blend with the natural skin; useful life expectancy of the prosthesis is extended; the prosthesis is attached with precision and ease; patients report greater confidence in secure retention; and inconvenience of cleaning of adhesive products from the skin is avoided. Placement of craniofacial bone anchored implants requires one or two minor surgical procedures. Threaded titanium fixtures are surgically implanted into the bone by your surgeon. Then a connection component, called the abutment, is installed onto the fixture. The abutment extends through a small surgical opening in the skin. Your surgeon may also thin the skin around the abutment to prevent soft tissue complications. The implants are allowed to heal for three months, permitting a bond or osseointegration to form between the titanium fixture and the bone. At the same time the skin heals around the abutment. After the healing phase, we take a new moulage and attach specialized components that provide secure attachment of the prosthesis. The most commonly used retention components are magnets and/or a gold bar framework with corresponding magnets or clips in the prosthesis. The standard design and fabrication process is then followed with slight modifications. Photo of components Finger and Hand Prosthetic Rehabilitation We are sensitive to the fact that finger and hand amputation causes psychological distress in addition to the loss of function. We work to lessen emotional distress by providing exceptional prosthetic rehabilitation. The psychological impact varies among individuals, and is not necessarily proportional to the extent of the injury. We create custom fingertip, finger, thumb, partial hand, and hand prostheses. Most of our patients have suffered a traumatic amputation or have lost anatomy due to the progression of a disease, such as diabetes or scleroderma. Some of our patients are born missing part or all of a hand. Our custom silicone prostheses are distinguished by: lifelike texture matching the patient’s own skin, realistic color match, precise suction fit, and individually made acrylic nails that can be polished if desired. Our goal in the construction of any prosthesis is to restore anatomical form and function. We know that significant functional deficiencies result from the loss of a single finger. The degree of functional impairment is directly related to the extent of tissue loss. A prosthesis can restore near-normal function in distal finger amputations by restoring finger length. The longer the residual finger, the more secure the resulting pinch force or grip. We strive to give our patients the greatest degree of function possible. The prosthesis also serves to protect sensitive or painful areas on the residual finger. In the case of a total hand restoration, we offer passively adjustable fingers that can assist in holding objects and making daily tasks more manageable. Photos: Patient with finger prosthesis Patient with thumb prosthesis Patient with hand prosthesis Other Somatic Prostheses With an appropriate physician referral, we create custom-made prostheses for other parts of the body disfigured by disease, surgery, or trauma that require aesthetic compatibility for successful prosthetic rehabilitation. There is no ―typical‖ somatic prosthesis—needs vary based on the tissue loss and the individual patient. We have given devoted our skills to development of a custom-made nipple prosthesis that is extremely realistic. Our design often avoids the use of skin adhesives. Nipple prostheses avoid additional surgical procedures and secondary surgical sites. Photo of prosthesis Custom Protective Facemasks Protective facemasks are custom-fabricated for patients who have suffered an injury (usually a nasal fracture) and have been referred by a physician to reduce risk of additional injury. Most patients are athletes who wish to continue to practice and/or compete during healing. The mask is custom fabricated from a full facial moulage (mold) and is custom fitted as well. Protective athletic facemasks can usually be completed in one week. We have experience making masks for athletes who compete professionally, as well as high school and college athletes. Your physician must approve the completed facemask and authorize return to your sport. The rules for competition within your sport should be verified to ensuret hat the facemask is allowed during competition. Photo of mask LOCATIONS Patients are seen by appointment at the following locations: Milwaukee Lincoln Professional Center 10401 W. Lincoln Avenue Suite 105 West Allis, WI 53227 and Madison Prosthetic Dental Associates 2725 Marshall Court Madison, WI 53705 Local patients are usually scheduled for weekly appointments, although visits can be compressed if preferred. When out-of-state patients travel to Milwaukee for treatment, appointments can be consolidated into a 5–10 day period. LINKS to MAPQUEST? Initial consultations can also be arranged in: Charlotte, North Carolina and Phoenix, Arizona HEALTH PROFESSIONALS Physician Information A physician’s order is required for every patient. We commonly receive referrals from surgical specialties, especially otolaryngology and plastic and reconstructive surgeons, primary care physicians, radiation oncologists, dermatologic surgeons, oral surgeons, and maxillofacial prosthodontists. A pre-surgical consultation is encouraged whenever possible, especially for rhinectomy patients. Please call us for pre-surgical planning when bone-anchored craniofacial implants have been selected to retain the prosthesis, so that the best possible results can be achieved for the patient. We welcome input from you regarding any phase of prosthetic restoration. Each patient is advised to return to his or her physician for follow up visits when the prosthesis is complete. We routinely send post-treatment photographs to referring physicians. In addition to prosthetic restoration, call us for compression devices to prevent keloid formation, post-surgical stents, and protective masks for athletes. Other available services, which may be helpful, include creation of models or templates for your surgical treatment planning. We also create three-dimensional prototype models for patient education. Call us with your innovative ideas for ways we can assist you. Other Health Professionals Information Many patient referrals come from non-physicians: nurses and nurse practitioners, physician assistants, audiologists, radiation technologists, limb orthotists/prosthetists, ocularists, occupational therapists, physical therapists, hand therapists, and psychologists. We recognize the importance of teamwork, and the value of communicating with related health professionals to optimize quality of care. When patient needs extend beyond our areas of expertise, we refer to health professionals who can meet the needs of our patients.