Monday, July 19, 2010

Week 5 - Ruiz

This week I went to a guest lecture conference that was held for the new incoming plastic surgery residents. This week an attending physician from the Memorial Sloan-Kettering clinic came and gave a lecture on mandible reconstruction. I was really impressed with the depth of knowledge that a doctor needs for just this one type of procedure! The guest lecturer gave us a very thorough review, starting with an explanation of the main considerations – function, form, composition, etc. – which must be taken into account when planning this operation. He especially stressed knowing everything there is to know about the gold standard flap used for mandible reconstruction: the fibula flap. He showed us many detailed images showing us the critical anatomy of the fibula, and explained that the greatest advantage to using this flap is that it has a segmented blood supply. This unique characteristic essentially means that the fibula is a flap that can be shaped and optimized for many types of mandible reconstructions. We then went through a number of case examples in which he called upon the residents to help him plan out mandible reconstruction surgeries for each patient in each case. I really enjoyed the discussion and debate surrounding different real-world cases, in addition to connecting our anatomy knowledge of the flaps and the mandible with the reconstruction goals of the procedure.

I was also able to attend patient rounds and office patient consults with Dr. Grant. This week a diverse array of patients were seen. Some had just had a nasal reconstruction operation, some were coming in for office procedures (i.e. liposuction or facial augmentation using injectable dermal fillers), and others came for first-time consults about eyelid alteration surgeries and breast implant procedures. I am still very surprised by how expensive plastic surgery is! For instance, one Asian teenager came in wanting eyelid surgery, and she was told that having the operation to “create” more Caucasian-looking eyelids would cost about $4000. Another patient came in seeking facial augmentation to remove her wrinkles. Dr. Grant told her that he would need to use 2-3 tubes of dermal filler – with each tube costing about $750. I understand that these procedures help the patients feel better about themselves and happier in general, but I wonder how these prices got to be so high…

Another interesting aspect of my week was shadowing in the ER with Dr. Sperling. He gave me a full tour of the Emergency Department and explained the triage process and how patients were sequestered into different wings of the ER. I then paired up with one of the ER attendings to observe how they treated and diagnosed incoming patients to the ER. I never really realized how much problem-solving is involved with ER diagnostics! One of the attending physicians told me that “we always assume that the patient has a very serious/dangerous condition until proven otherwise.” In narrowing down the possible conditions, a lot of the discussion, lab tests, and diagnostics in the ER are used as forms of evidence that the ER doctors must then gather, organize, interpret, and integrate into one final diagnosis. This was a very different (but equally interesting) kind of clinic compared to the plastic surgery patient consults that I’ve observed with Dr. Grant!

In my spare time this week I have been working hard analyzing the literature and current perspectives on injectable dermal fillers for my research project. In the middle of the week I drafted up an outline for my review/ analysis and discussed the pros and cons of it with Dr. Grant. I have come up with a few theories on how nanotechnology and biomedical engineering can enhance the field of dermal fillers, and in the next week I plan to flesh out these ideas, back them up with current research findings, and hopefully finish a more polished rough draft of my review.

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