Monday, June 21, 2010

Week 1 - Jen Richards

The first week of summer immersion in New York City seemed to fly by as I met my mentor, observed surgeries, and had bio-ethics training, all in one week! When I arrived in New York, New York, I first had to get settled into Olin Hall, located just across the street from the hospital. After being oriented and getting hospital ID's, I was ready to meet my surgeon mentor. I am shadowing Dr. Jason Spector, a plastic surgeon specializing in reconstruction and microsurgery. He is actually mentoring not just myself, but another BME student, Carissa Ball. Dr. Spector is extremely knowledgeable and is interested in teaching, which bodes well for the rest of the summer!

Tuesday I found myself dressed in scrubs and waiting in the operating room (OR) for the first time. I was excited and nervous at the same time. I really wanted to see this surgery, but I didn't want to be a distraction in any way. I soon found out that as long as I did not touch anything sterile, I could watch all I wanted. The OR was not the serious place I thought it would be. Although Dr. Spector, the residents and nurses working in the OR were focused on their work, there was a relaxed atmosphere with music playing in the background.

The first surgery I observed was a pressure sore located on the buttock of a paraplegic man. I was surprised to discover that pressure sores can occur within 2 hours of a constant pressure of only 30 mmHg! The necrotic tissue reached to the patient's pelvic bone, which meant the wound had to be fully opened, the necrotic tissue removed, and then sewn up again. Very interesting was that the surgeon used a biodegradable suture made of PGA/PLA for the inner tissue sutures, and a strong nylon suture for the outer stitching that will need removing later. The second surgery of the day was a preparation for a skin flap on a very severe burn patient. This patient has severe diabetes and did not realize the serious extent of his burns. The burns on his ankles extended all the way to the bone. Dr. Spector cleared the infected tissue away, and then cut a skin flap from the back of the patient's calf. A side note: what's the difference between a skin graft and a skin flap? Well, a skin graft is just a piece of tissue that is not vascularized in any way - so the wound must have it's own blood supply. However, a skin flap comes with its own vascularization, so it can be lain over an area that does not have its own blood supply. A little something I learned. The skin flap was simply opened then sewn up again (it will be left for a week so that the blood vessels have a chance to dilate).

The next day I spent in the OR with another plastic surgeon, Dr. Schwarz. The first surgery was treating a patient with carpel tunnel and trigger finger. This was a much simpler surgery, one that could completely cut off the blood supply to the hand without causing lasting harm. One tendon in the wrist was separated so as to give more room in the carpel tunnel, which will relieve pain. Also, the A-1 pulley in the trigger finger was released so that it would no longer click and pull when the patient moved it. The second surgery was a breast implant in a woman who had had a mastectomy. This patient insisted on saline implants because she had read about the dangers of silicone. Although the doctor tried to explain about the newer silicone implants, the patient would not be swayed. I learned that the patient's wishes are always taken into account in these surgeries.

All in all, the first week was a great success, and I am looking very much forward to the weeks to come!

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