The day before the accident, Manuel Cabrita was overcome by a bad feeling. “A bizarre intuition, so much so that I called my wife,” remembers the soldier, then on mission in Mali. The next day, July 31, 2017, the master corporal’s armored vehicle ran over an artisanal mine. The explosion took away an arm and a leg, and swept away his former face, now covered with several scars.
“When you are on a mission, danger is always present. But that day, there was no fight, no confrontation, the enemy was invisible,” says the forty-year-old, who came to bear witness to the sacrifices of the “4th generation of fire” and its reconstruction during a conference organized last October by the Foundation of Gules Brossés (read below).
After two years of hospitalization and thirty operations, the treatment is far from over. “The accident took place six years ago, but the site remains open,” he said. For the moment, my boxer head suits me, even if there are still grafts to be done on my nose. In any case, according to those around me, the result is stunning. »
A century of surgical progress
Reshaping a face like putting together the scattered pieces of a puzzle. Fill the holes, sew up the tears, screw the bones. Eminently technical, this know-how stems directly from the First World War and its hundreds of thousands of “broken faces”, whose need for repair gave rise to a new specialty: maxillofacial surgery.
“At the time, there was a corporation, dental mechanics, which fitted patients with disfigured jaws with prostheses,” recalls Professor Bernard Devauchelle, head of the maxillofacial surgery department at Amiens University Hospital. and author with his team of the first partial face transplant in the world, in 2005.
With the war of 14-18, doctors found themselves confronted with an unprecedented number of destroyed faces and the specificity of wounds in the trenches – “an immobile war which particularly exposed the faces, especially since the helmet did not intervene only late,” underlines Professor Devauchelle.
“Big names in surgery, on the French and Anglo-Saxon sides, then devoted themselves to reconstructive surgery and developed techniques for grafting tissue, skin, bone and cartilage,” he recalls. . They compensated for the absence of skin with flap techniques which we used until the 1960s and 1970s and which we still draw inspiration from today, even if they have evolved.
“Broken faces” by road accidents or attacks
A second revolution took place in the last third of the 20th century with the appearance of microsurgery techniques. “We have moved from the stage of tissue grafts to autotransplantations, that is to say the transposition of tissues that are revascularized,” explains the surgeon. More recently, 3D and robotics have further expanded the arsenal available to surgeons, while laboratory research is making great strides. “We are today capable of reproducing tissues ex vivo but also of reconstructing bone substance from stem cells,” enthuses Bernard Devauchelle.
After his facial reconstruction operation, Philippe drew with a felt-tip pen the curve of the nose that he would have liked to find. Photographer Mathieu Farcy built his project “I didn’t live in my face” (2) with people suffering from facial cancer. / MATHIEU FARCY/SIGNATURES
The patient profile has also evolved. If the fighting is still disfiguring, particularly in Ukraine, most of today’s broken faces are civilians, victims of a road accident, an attack with a firearm or a domestic accident (burning). , animal bite, etc.) “In addition to these traumas, there are two other major sources of disfigurement: birth defects, such as cleft lip and palate (also called cleft lip), and facial cancers,” specifies the professor. Here again, advances in surgery, particularly robotics, make it possible to limit the amputation necessary to remove the tumor.
Regardless of the cause of the disfigurement, the goal of reconstruction is both functional and aesthetic. “These two dimensions are inseparable,” insists the doctor. Restoring function to part of the face often improves its appearance. Above all, we give the patient the opportunity to regain social relationships because disfigurement often leads to isolation”
Once the bodily envelope has been restored, another stage begins which for many lasts a lifetime: that of interior reconstruction. “We don’t just have to repair the skull, we have to take care of what’s inside,” says Luc Beaussant, head of the Gules Brossés Foundation.
This general knows what he is talking about, having been the victim of an accident while on duty during a parachute jump in the fall of 1999. “Psychological healing is crucial. You have to learn to live with this new face, so different from the one before that you have to get new identity papers. A person repaired, even superbly, only heals if he accepts this image which has become his. »
To help them, most maxillofacial surgery services offer psychological support. “Some patients need it immediately, others manifest themselves months or even years later,” reports Caroline Demeule, psychologist at Pitié-Salpêtrière, in the department of Professor Chloé Bertolus who operated on Philippe Lançon after the attack. against Charlie Hebdo and to which he pays homage in Le Lambeau.
To explain her work, Caroline Demeule distinguishes between the face and the face. “The face, physically, is the object of surgical reconstruction. The psychologist takes care of the psychological reconstruction of the face, in its symbolic, emotional, identity dimension…”
At first, the mirrors in the rooms were systematically covered, to spare patients the shock of discovering themselves so different. “Suddenly, the image they will see of themselves will not be quite the same, if at all. On a psychological level, this creates an effect of narcissistic destabilization,” raises the caregiver. An experience all the more trying as the most mutilated faces often involve several interventions, like so many touch-ups which each time modify the painting, which is always transitory.
From repair to reconstruction
Partly crushed by the blow of a horse’s hoof, Caroline Puig-Grenetier’s face required “eight or nine operations”, the first of which lasted more than ten hours. “Ideally, I would have to do another one because my nose is deformed but I no longer have the courage, I have moved on to something else,” confides this director, whose documentary, Repairing my face (1), salutes the work of the “extraordinary surgeons” who operated on her and the courage of other “disfigured” people like her.
More than her face, it is her look from the past that this Stéphanoise has the feeling of having left in the accident, which occurred in 2015. “When I look at someone in the face, I know that I have this eye fixed which gives me a funny look. But we communicate a lot with our eyes,” says the director, whose right eye has been replaced by a prosthesis.
Because she did not want to impose this on her partner at the time, she preferred to “leave him”. Since then, I haven’t wanted to be with anyone,” she says in a soft voice. But no question of complaining. “I’m so happy to be alive, enjoying my daughter, my friends, everything else takes second place. And then I have the chance to be able to continue my work, even if I am slower than before…”
Manuel Cabrita is not yet reformed but will soon have to think about his professional reconstruction. Life after the army: another project that, for the moment, he prefers not to think about. “We often talk about reconstruction after an accident, but what the institution owes us and gives us is reparation,” he points out. Reconstruction is a path specific to each person. No one can do it for us. »
Broken faces, a hundred years later
It is estimated that the First World War caused 4 million injuries in France, including 500,000 to the face or head.
In 1921, three broken faces, Albert Jugon, Bienaime Jourdain and Colonel Picot, founded the Union of Injuries of the Face and Head (UBFT) to help them. The association’s motto is “smile anyway”.
In the 1930s, to financially support soldiersthe association created the National Lottery, which became the Française des jeux in 1976. It is from this company, of which it is the second shareholder after the State, that the UBFT draws its income.
In 2001, the association created the Foundation of Broken Mouths. Recognized as being of public utility, it funds research focused on facial and head trauma.
If the members of the UBFT are all “dressed bodies” (armies, gendarmerie, police, firefighters, etc.), the foundation’s action is intended for all victims of disfigurement.