Health: How to feel a new person for pounds 19,235: Celia Hall reports on the specialists who craft new body parts from gold, titanium and plastic

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Their patients say they are sent by God. They are the artist-craftsmen of the NHS who ply their trade when the surgeons have done their best - or worst.

Mutilation caused by injury or surgery is perhaps the hardest burden for a victim to bear, especially when the damage is to a visible part of the body, particularly the face. But around the country there are half a dozen specialist laboratories, usually supporting major cancer centres, where technicians skilled in working with precious metals and plastic can design, mould and tint the missing body parts - and begin the process of making life seem possible again for these people.

So good are they at their jobs that other hospital staff who meet their patients returning to prosthetic units for replacements or checks can fail to spot the artificial chins, jaws, noses or ears.

Most prostheses, being implants, are indeed invisible, replacing bones and soft tissue. David Gavin, chief prosthetics technician at the Maxillo-facial and Plastics Laboratory at Mount Vernon Hospital in Middlesex, says: 'We will try to make anything at all.'

Two taxing calls were made on their services recently: to manufacture a 'three-quarter skull plate' that extended from the back of the head to the eye socket, and to design a silicone bottom. It was a difficult feat to create the right texture, weight and movement for the silicone bottom, but so successful were the technicians that it is now being used for research into bed sores in another part of the hospital.

Gold and titanium, which is very strong for its light weight, are often used in replacements. Titanium is supplied free to the laboratory as industrial waste. Another element frequently used is silicone, which the technicians mould and colour with extraordinary dexterity to match a patient's own skin.

Sometimes a mould is taken before surgery. Where there are naturally two matching body parts, a copy will be made of the one that remains intact. Where a nose is to be replaced but circumstances have prevented a mould being made, a brother or sister will be asked to model the prosthesis.

A wide range of methods is used to secure the external parts to the body, from sticking them on to using under-skin magnets or screwing them into bone. Ingenuity is the name of this game.

The men and women who do this work, the unsung heroes of the NHS, are paid beween pounds 10,500 and pounds 18,300 a year. The prosthetic human that the Independent has put together (see picture) is worth a little over pounds 19,000.

Many of these replacements are state-of-the art products. The cementless hip replacement joint, for instance, is designed so that human bone will grow into part of it to hold it firmly. The honeycomb design of the cup, however, means that the bone can grow into the metal only to a limited extent, making any future replacement easier.

Sum of the parts: a bill for Prosthetic Man

1. Titanium skull plate*

2. Gold orbital floor to replace eye socket*

3. Staples made of hydroxylapatite (a plastic that mimics bone) to replace a bone of the inner ear: pounds 200

4. Silicone replacement ear that can be stuck on using medical glue or fixed to bone with a titanium screw*

5. Silicone nose* (see 4)

6. Silicone chin* (see 4)

7. Blom-Singer Voice Prosthesis and parts to replace the larynx (voice box): pounds 150

8. Stainless steel shoulder: pounds 700

9. Stainless steel 'nail' inside the humerus (bone of upper arm): pounds 200

10. Dacron tube to replace section of aorta: pounds 600

11. Heart valves: pounds 1,400 each

12. Silicone nipple*

13. Textured silicone breast implant: pounds 380 per pair

14. Heart pacemaker: pounds 3,000

15. Heart pacemaker for babies or elderly people with thin skin: pounds 1,200

16. Dacron branched tubing to replace blood vessels: pounds 600

17. Cementless hip-replacement system, titanium and ceramic: pounds 1,500

18. Penis implant to restore potency. Inflatable tubes replace the column of erectile tissue and are activated by a pump mechanism in the scrotal sac: pounds 4,500

19. Silicone testicle: pounds 200

20. Stainless steel femural nail and screws inside the femur: pounds 440

21. Stainless steel tibial nail and screws: pounds 220

22. Stainless steel hip screw system for revision hip surgery: pounds 2,000

23. Cobalt, chromium, titanium and polyethylene knee replacement: pounds 1,300

24. Silicone knuckle replacement: pounds 125

25. Titanium fingerbone fixing plate: pounds 10

26. Silicone fingertip*

Those marked * are custom-made by hand at the Maxillo-facial and Plastics Laboratory, Mount Vernon Hospital, Middlesex. The gold and titanium come from 'off-cuts' and are provided free or at special prices by industry. A notional cost of pounds 100 has been given for such items.

Parts were also kindly lent by Smith & Nephew plc; Cloverleaf; Cardiology Department, Harefield Hospital, Harefield; Mr David Evans, hand specialist, the Hand Clinic, Windsor; Mr Roger Kirby, urologist, St Bartholomew's Hospital; Dr Alison Perry, Ear Nose and Throat and Speech Therapy Unit, Charing Cross Hospital.

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