SIENA, Italy — Italian auto racing champion-turned-Paralympic gold medalist Alex Zanardi underwent a five-hour surgery Monday to reconstruct his face following a crash on his handbike last month.

It was the third major operation that Zanardi has had since he crashed into an oncoming truck near the Tuscan town of Pienza on June 19 during a relay event.

Dr. Paolo Gennaro of Santa Maria alle Scotte Hospital in Siena said the operation required three-dimensional digital and computerized technology that was “made to measure” for Zanardi.

“The complexity of the case was fairly unique, although this is a type of fracture that we deal with routinely,” Gennaro said in a hospital statement.

After the surgery, Zanardi, 53, was returned to the intensive care unit in a medically induced coma.

“His condition remains stable in terms of his cardio-respiratory status and grave in terms of his neurological status,” the hospital medical bulletin read.

Zanardi, who lost both of his legs in an auto racing crash nearly 20 years ago, has been on a ventilator since the crash.

Zanardi suffered serious facial and cranial trauma, and doctors have warned of possible brain damage.

Zanardi won four gold medals and two silvers at the 2012 and 2016 Paralympics. He also competed in the New York City Marathon and set an Ironman record in his class.

Last month, Pope Francis penned a handwritten letter of encouragement assuring Zanardi and his family of his prayers. The pope praised Zanardi as an example of strength amid adversity.

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