Sunday, June 27, 2010

Week 2 - Carissa

This week was a bit of an eye opener. I was able to follow Dr. Spector during patient appointments for an entire day on Monday. Most patients came in for post-op check-ups to see how they were recovering after reconstructive surgery. Of course there were a few patients who came in for elective surgeries, but I was surprised how much plastic surgeons affect the outcome of patients healing from serious burns, broken bones, or unhappy encounters with cars or buses. There was one woman who did a remarkable job of keeping an upbeat attitude after multiple reconstructive surgeries after nearly losing her leg after getting hit by a NYC bus. Fortunately orthopedic and plastic surgeons have been able to use metal plates, muscle flaps, and skin grafts to save her leg so far. It was amazing to see how modern medicine has been able to do so much to help her keep the leg she would have otherwise lost.

Surgery this week was a very intense schedule. All told, we spent 3 solid days in the operating room observing many different types of procedures. The surgery that sticks out the most in my mind was a procedure where a woman had a broken leg, and her fall had caused the creation of a dead section of skin right below her knee. Her tibia was expose, so a regular skin graft couldn't be used to cover the wound. Instead, Dr. Gayle took the medial portion of the patient's gastroc muscle and moved it across her tibia to cover the wound, while leaving it connected to the blood vessels at the base of the calf. Once the muscle was sewn in place, then a skin graft was used to cover the rest of the wound. To let fluids and air in and out of the wound, the surgeon performed "in situ pie crusting" which is just poking holes in the graft to let it breathe... like a pie. The patient is expected to heal well, and I hope to see her next week during a follow-up appointment.

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