IN THE FIELD
Q&A with anaplastologists across the globe
FPIR
What led you to pursue a career in anaplastology?
FLEMING
A long time ago in a galaxy far away I worked as a prosthetic artist in the film and television industry. I spent a lot of time simulating operating scenes on a television hospital wards and hanging out with aliens on spaceships. Though this field is extremely different to anaplastology, certain aspects have been invaluable. In particular the techniques that simulate and augment the body in a way that is imperceptible, and an open-mindset culture that thrives on problem solving.
After this, the shift to anaplastology was quite long and has been very much guided by the BCCA requirements for certification. Academically, I began a degree in Clinical Science and eventually achieved a masters in Maxillofacial Prosthetic Rehabilitation from King’s College London.
Australia is really lacking in clinicians, practice guidelines and training pathways, so it is extremely difficult to get started and there are very few jobs. I was lucky enough to move into the field in 2005 under the wing of a surgeon who was concerned about his elderly patients who had difficulty travelling far to access facial prosthetics. Later I established this service as Prosthetic Art Technology, which still exists today. We now provide prosthetics for a large area of the Australian east coast.
FPIR
As a clinical anaplastologist, what kinds of prostheses do you provide? Do you specialize in any particular area of the body?
FLEMING
Primarily I provide all kinds of external facial prostheses, usually ears, orbits, and noses. We are the skin cancer capital of the world unfortunately, so this means we see a lot of ears and noses. Other types include scar divots, nipples, fingers, toes, hands and feet. In the last 6 years I have spent time working closely with a limb prosthetic facility. This has been a great experience that has allowed a greater understanding of the needs of limb amputees. I collaborate with the P+O clinicians on weight bearing prosthesis, cosmetic arm and leg covers, and any other custom silicone solution that may be required such as a silicone prosthetic socket liner.
FPIR
What techniques and technologies do you use in the process of fabrication?
FLEMING
For now I am still very analogue in my methods so I enjoy hand sculpting and moulding my prostheses. I find this to be helpful when with the patient because they can get really involved in the process while we are sculpting and start to take some ownership of the prosthesis as it shapes to their liking. I think this is helpful for patient acceptance of the prosthesis, which is an important aspect.
In terms of colouring I prefer to mix my silicone colours by eye mostly, though I do a lot of travelling clinics which puts me in terrible lighting situations. Because of this I have incorporated the Spectromatch eskin system for my travelling clinics, I have found really helpful for consistent colour matching in tricky light environments. Later this year I will be implementing some CAD/CAM processes into the workflow, which I’m looking forward to.
FPIR
What skillsets have you found to be essential to be successful in your work?
FLEMING
That’s a good question because there are so many facets to what we do. Problem solving is a big aspect because every person and their anatomy are so different it’s never the same job twice. Understanding what each person requiring a prosthesis needs in terms of care, support, and information is also really important. We are in their lives for the whole time they choose to wear a prosthesis or have us as a clinician, which can be for life so that’s huge. Finally it’s the art and science, I love how those two are married in this field. The more I learn the more I understand how integral the clinical knowledge and skills are, and of course you can’t do this without being an artist at heart.
FPIR
What innovations have you drawn from or integrated into you workflow?
FLEMING
I really enjoy the cross-collaboration that comes with this work given the many different specialties we mix with, I’m often inspired after a talk with a hand therapist or a plastic surgeon, or a cancer care-nurse for example. It often sparks a new workflow idea or process to try or think about. My favorite innovation though is all the way from the year 1917 with Anna Coleman-Ladd’s Studio for Portrait masks. In particular, I’m inspired by the way that she set up her studio to make badly wounded soldiers feel comfortable by surrounding them in a warm and inviting environment. I work in a beautiful part of Australia and have endeavored to create a space that fulfills clinical needs, and is also a relaxing and healing environment for people that visit me for a prosthesis.
On a more technical level, I have integrated techniques from the dental field and from the film industry in terms of mould-making and other aspects of manufacturing and fabrication, certainly the digital workflows we are looking at draw from both of these fields. From the P+O field I use HCR silicones and milling techniques for hands, feet and other larger prosthesis.
FPIR
What advances would you like to see in the field of anaplastology?
FLEMING
On a local scale, Australia is in a terrible position in terms of anaplastology provision, I would go so far to use the word crisis. Unfortunately as I mentioned, we have no regulation, no education pathways, no dedicated government funding schemes for facial prosthesis, and very few service providers with relevant training. On top of that a number of wonderful clinicians that have worked for years in the public sector in the main hospitals providing maxillofacial prosthetic services have retired or are on the verge of retiring without having adequate succession planning. It’s an incredible loss to the field here, and a terrible situation for those that need facial prostheses.
It is my goal to see this change, I would like to see Australia advance with regulation, funding for services, and recognised education pathways. This would help immensely with lack of service and also allow the many people that want to enter the field here a real possibility to do so.
On a global scale, I’d love to see someone crack the silicone colour stability and longevity issue which would allow for longer–lasting, more colour stable prostheses – an ongoing challenge for our profession.
FPIR
What do you enjoy most about your work as an anaplastologist?
FLEMING
It is honestly the most rewarding job I could imagine. It is such a privilege to be a part of people’s lives who have had the most extraordinary, often extremely difficult experiences. To meet them on the other side of that and be part of the lifetime healing journey is really a great honour. I also really enjoy the mix of patient clinical work and lab-time in making the prosthesis. There is something very special about seeing the whole process from start to finish and being able to use your art brain and clinical brain to create the missing physical piece for a person, there is nothing better than seeing a happy patient walk out the door.
"If anyone, anywhere in the world cannot access our devices, then we [anaplastologists] have not succeeded."
- Daril Atkins, Certified Clinical Anaplastologist, Rashid Hospital, Dubai