Nov. 1--Juan Cruz, a former Defense Department accountant, was burned over 50 percent of his body when terrorists crashed an airliner into the Pentagon on Sept 11, 2001.

"All I remember is that I was burning. My clothes were burning, and there was smoke all around," said Cruz, 57.

Since then, he has been through 40 surgical procedures, two cornea transplants and major facial reconstruction. He has had to give up driving because his vision is so clouded.

But Cruz, whose face was reconstructed at the Johns Hopkins Bayview Medical Center, represents a patient that plastic surgeons are seeing more often these days: the kind who wouldn't have survived years ago.

As military surgeons, hospital emergency departments and urban trauma centers improve survival rates for victims critically injured in fires and accidents and on battlefields, their patients are increasingly winding up in the care of specialists whose domain has long been associated with the tummy tuck and the nose job.

"There's no question more people are surviving, and it's creating a whole new set of challenges," said Dr. Paul Cederna, a plastic surgeon from the University of Michigan Health Systems, who joined 6,000 colleagues in Baltimore this week for the American Society of Plastic Surgeons' annual convention.

At the meeting, Cederna said physicians still need better ways to connect nerve endings with prosthetic devices for better control. But advances in microsurgery are enabling them to reattach blood vessels -- about the size of human hairs -- and move tissues from one body part to another, such as from one leg bone to another, with more precision than ever.

"It's work done in pretty small areas, and it's very tricky," Cederna said.

Among the challenges remaining are finding better ways to treat patients like Cruz, who face long and complex recoveries. "The doctors have said I was alive because of all the different techniques they have now. I also like to think it's because I was in good shape," said Cruz, who does push-ups and runs up to two miles a few times a week.

At the American Society of Plastic Surgical Nurses' convention, held concurrently here, Cruz's doctor described his technique for restoring facial features on such critically burned patients.

"For someone to get facial burns, it's usually a case where the injuries are really extensive. In a major fire, your first instinct is to cover your face," said Dr. Robert J. Spence, director of burn reconstruction at the Johns Hopkins Burn Center.