Monday, July 5, 2010

Week Three - Jenny Puetzer

During week three of summer immersion I continued to see a lot of patients, observed many surgeries, and started my research project.

The most interesting patient case that I saw this week was a 21 year old female who was born with a birth defect in which her lateral menisci in both knees did not form correctly. Instead of being the typical C shape of a meniscus, they were complete half circles which then wear more easily within the knee and lead to increased pain. This is called a discoid meniscus. The patient has already been through 4 arthroscopy surgeries (2 on each knee) to take out parts of the discoid menisci so to relieve pain, however she has now been referred to Dr. Rodeo because her meniscus has completely worn down in her right leg which has lead to not only the loss of her meniscus but also a large chunk of cartilage on her condyle. Dr. Rodeo informed her she will need a meniscus transplant from a cadaver and an allograft of cartilage. Since my research focuses on meniscal tissue engineering and the prevention of this process it was very interesting to hear about the process, hazards, and expectation of the meniscal transplant. It will take approximately 3-4 months to find matching donor tissue and the meniscal transplant has variable out comes with the best transplants lasting out to 10 years. This transplant is done in an attempt to delay total knee replacement.

On Wednesday I accompanied Carissa to observe two plastic surgeries with her host Dr. Spector. The first surgery was the first step in restoring skin to the top of the skull of a patient which had skin cancer. The skull was worn down to where the blood vessels are in the bone and then Integra, a tissue engineered skin substitute was laid on top of the skull. The Integra will integrate with the skull and then in two weeks they will do a skin graft over the Integra to complete the process. The Integra is composed of collagen and GAGs and provides a surface that the skin graft can successfully attached to. It was very interesting to see a tissue engineered product in use. The second surgery was continued work on a patient who was a diabetic with burns on his ankle and feet. In this surgery they were attempting to save an exposed tendon in the ankle by detaching a muscle from the calf and relocating it over the tendon. A skin graft was then placed over the tendon/muscle.

I observed an additional five orthopedic surgeries also this week. The majority were on shoulder injuries consisting of rotator cuff repairs, bicept repairs, and repair of a broken clavical bone. The most interesting surgery I saw was the repair of an ACL. The patient had an ACL graft 20 years ago which had now failed and he had a torn meniscus. The meniscus was repaired by removing the torn portion of the meniscus. The old ACL tunnels were cleaned out and new tunnels were drilled for placement of the new graft. While drilling the tunnel in the tibia the old hardware was hit and X-ray had to be brought in to locate the hardware and determine how to get around it or to take it out. They decided it was better to leave it in and take off a few treads as going by it then to try and get to it to take it out. Finally the graft was put in the knee with a bone graft on one side and a ligament button on the other to secure the ACL graft in the knee.

This week I also finally started my research project. I will be assisting in a very large study at HSS in which they are using sheep to determine if it is possible to use MRI to locate and observe healing in torn menisci. Next week surgery on the sheep knees, imaging and dissection will be taking place. This week I observed how they do the knee dissection so that I can be of help next week. I look forward to seeing and participating in this research project next week.

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