India Dykes - Dr. Spector - Week 1


 Day 1 Mon. - Met with Carly and Kelly for our orientation/introduction to the immersion term. Carly gave us a tour of the hospital and took us to get our WCM badges. 

Faith, Jenny, Julia, and I met with Dr. Spector in the afternoon and discussed plans with him for the rest of the week which included shadowing his upcoming surgeries. Then we took a tour of the lab and met with Xue and Sophia who we will be collaborating with on our research projects.

Day 2 Tues. - Our day started at 7:30am in the OR. We had a bit of a slow start since the scrub machine system was down so it took a while to get badge access for the machine. But the OR staff was very helpful and made sure to get it through as soon as possible.

We went to the Tuesday morning immersion meeting where we met Dr. Rob Min and Dr. Mert Sabuncu in-person, introduced ourselves, and learned about their education and career journeys as well as advice on what to do in the city this summer.

After the meeting we were able to get our scrubs and observe in the OR where we saw a tongue reconstruction using a radial forearm free flap. The tissue flap was used to reconstruct the tongue, and the radial artery and cephalic vein were reconnected to the blood supply of the neck using microsurgery. This technique supplies immediate blood supply to the tissue flap giving it a good chance of successful healing in the mouth. 

This surgery was interesting because of the multiple surgical sites, the reconstructive complexity, and it involved two teams working on the donor and recipient sites at the same time. It was a very full and busy OR that day.

Day 3 Wed. - We spent another day at the OR observing 3 shorter surgeries. 

The first was a melanoma removal and skin graft preparation to the scalp following radiation therapy. The melanoma removal required removing part of the entire epidermis and dermis down to skull. This makes it very difficult to attach a skin graft since the hard outer cortical bone of the skull will not contribute to the tissue regeneration. This made it necessary to burr down (essentially grind off) the cortical bone to expose the soft/spongy trabecular bone. On top of this a dermal regeneration product called Integra was applied which has a silicone outer layer (which acts as a temporary epidermis-like barrier) and an inner layer of bovine type I collagen and shark derived GAG. This promotes vascularization and granulation from the trabecular bone into the skin graft area. This is left on for 2 weeks after which it is removed and the partial-thickness skin graft will be done over the area where the melanoma was removed.

 
The second surgery we observed was a keloid scar removal. Keloid scars are a type of abnormal scarring that can form after an initial injury heals. They are a type of benign tumor that occurs when fibroblasts over produce disorganized collagen which continues to grow beyond the boundaries of the original scar. While they are benign, they can be very uncomfortable, painful, itchy, and continue to grow over time. After the keloid excision it can be necessary to apply local radiation to stop another keloid from forming.

The final surgery we observed was a facial sling to correct facial drooping that occurred after a tumor resection on the parotid gland damaged the facial nerve causing paralysis. This can cause issues such as not being able to fully close the eye causing dryness, irritation, and sometimes corneal damage and difficulty closing the mouth which can impair chewing and talking. To fix this the surgical team attached a surgical mesh under the skin to the bottom and top of the mouth and connected it under tension toward the ear. This was followed by a facelift procedure to correct the drooping of the facial skin.

Day 4 & 5 Thurs. Fri. - These two days I worked on the training modules, and prepared for the lab meeting on Friday afternoon. Dr. Spector's lab meets once a week to discuss research progress and present a journal article. This week the the article was Adipose-derived stromal cells mediate in vivo adipogenesis, angiogenesis and inflammation in decellularized adipose tissue bioscaffolds by Han et. al which discussed their work on understanding the effects of adipose-derived stem/stromal cells to promote the recruitment of beneficial host cell populations that contribute to the development of adipose tissues on decellularized adipose tissue bioscaffolds. This is particularly interesting because they were looking at the use of allogeneic cells (from a cell donor rather than from the patient) which would potentially allow for successful adipose tissue regeneration even when extracting cells from the patient would be problematic such as in older patients or those with health problems.

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