Week 3 - Ruiz

Journal Club: Flaps and déjà vu

This week I delved deeper into the clinical world and, to my surprise, I found parallels between my graduate research environment and Dr. Grant’s hospital environment. Monday began bright and early with a 7am Journal Club meeting among the plastic surgery residents and attending surgeons. There were several science articles up for discussion - all very technical and very interesting (even for a graduate student who has just begun to garner a collection of plastic surgery terminology!). The first article focused on the use of tram flaps vs. pedicle flaps and evaluated patient satisfaction associated with both kinds of procedures. I thought it was interesting that the authors of this article were able to assess patient satisfaction and propose surgical means to improve patient satisfaction by reducing post-operation complications and discomfort during recovery. Another article that was brought up presented research on a new combined catheter/Doppler system that has been used to monitor free flaps in various plastic surgery procedures. Some interesting questions that arose during the ensuing discussion were: Does this system significantly increase the salvage rate of compromised flaps? How does this tool compare to other means of saving compromised flaps? (and) Are there any unforeseen drawbacks that a long term study might reveal? Witnessing the debate among the residents and surgeons was great because it gave me a window to a new connection I never expected – that journal clubs in the hospital learning environment are just like the journal clubs in my graduate school environment! It was almost like a déjà vu moment (minus the plastic surgery bits). Ultimately this meeting made me realize that research and patient care can progress and overlap each other in more ways than I initially thought.

Grand Rounds: Morbidity and Mortality

With Dr. Grant’s help I was also able to attend what the plastic surgery residents call a “Morbidity and Mortality Conference” (M&M for short) later in the week. This basically was a Grand Rounds session where the residents and surgeons gather to talk about and work through difficult cases that have come up in the hospital over the past couple weeks. In this Grand Rounds meeting 3 cases were presented which had serious complications post-surgery. One case of note involved a 43 year old woman with Crohn’s disease and rectal cancer that had to be removed. Her surgery was performed reasonably well, but afterwards her vaginal wall was collecting fluid and her body had a hard time healing around her surgical incisions. I think she also had gotten some infections in the area and had to be hospitalized at least two more times after the initial surgery. She was also obese, which further complicated matters. It was sad talking about everything that this woman had to suffer through, but it was also encouraging that the surgeons were working through the problems and collectively trying to attain the best solution and treatment for her in the future.

Interesting Surgery: Blepharoplasty and craniofacial reconstruction

For a change of perspective I decided to observe one of Dr. Spinelli’s surgeries involving a blepharoplasty and craniofacial reconstruction of a female patient’s upper and lower eyelids and some of her nasal cavity/cheek. She had previously had a maxillary sinus tumor in her maxilla. While the tumor had been successfully removed, the surgeon performing that procedure had not properly rebuilt and modified her cheek and eyelids after the tumor mass was excised. This was a follow-up (and somewhat of a “fixing” procedure) in which Dr. Spinelli went in and removed some of the metal plate/mesh holding together her cheekbone and subsequently transferred a deep superficial fascia flaps from the tissue surrounding her skull to her eyelids and nasal cavity. I was surprised that the women had very little nose bones to work with, and that the optimal tissue graft came from the top of her skull. I wonder how and why Dr. Spinelli chose that particular region for a source of tissue flaps? Is it just a common place to draw tissue from or are there some vascular or tissue density characteristics that must be taken into account? This surgery was fairly long and it involved several tissue grafts to help reconstruct the woman’s face. I had never seen a face reconstruction operation before and this made me really appreciate the amount of technical skill and attention to detail that must go into each and every plastic surgery operation!