This summer immersion experience in Weill Cornell Medicine with Dr. Spector has started off very exciting. After a quick orientation to the program, an in-person introductory meeting with Dr. Spector, a plastic surgeon, and a conversation with lab researchers, we got started with OR observations right away. The first time in the OR was only on the second day. We were still in the middle of getting all out trainings complete and access to buildings, but we were able to go into the OR room and be only a couple steps away from the sterile field. This first operation was a full day procedure, where a tongue was being reconstructed after cancer had been resected away by utilizing a flap taken from the forearm. This OR had a lot of people working in sync to ensure that the surgery gets done, where there was both the ENT team opening up the arteries and veins in the side of the neck, and the plastic surgery team cutting a (surprisingly) big cut in the forearm to carefully resect the flap to ensure the arteries remain intact. Once both teams were done, Dr. Spector and his chief resident Dr. Jamie Bernstein started the microsurgery of carefully reattaching the arteries and veins from the neck to the flap that was sewn to the tongue. Not only was seeing a very detailed procedure done was cool, but there was a very neat engineering device that aided in the vein connection. The coupler shown below allowed the closure of these very small structures.
We also saw three back to back surgeries (ie cases) the very next day. The first one was a scalp melanoma removal and placement of an Integra Matrix Wound Dressing. To ensure that the collagen and GAGs in the Integra would be able to promote skin healing, the first layer of the skull tissue was drilled away to induce granulation tissue that would promote vascularization to grow upwards. This Integra dressing would stay for 2-3 weeks to have the optimal window for natural healing but also prevention of outside infection before a skin graft would be placed over the newly formed tissue. This procedure was both to ensure that the skin graft would not visually leave a dent on the top of the scalp, but also to ensure that it has enough vascularization to survive the placement. Another procedure was that of a keloid removals on the back that have been consistently coming back after previous removals. The last case was that of a facial graft with a face lift to help with facial nerve paralysis. The whole one side of the facial skin was lifted up and held open with a crowbar like instrument from the side of the ear. As the connective tissue from the skin to the deeper tissue layers were removed, sutures were placed below and above the mouth. A mesh sling was then cut to size/shape (think of a tank top shape) and pulled into those placed sutures and tightened on the other end closer to the ear. This would allow a lifting of the corners of the mouth to improve patient quality of life. A facelift was then performed by cutting a slit in the skin near the ear and sewing back the skin along the side of the face at a slightly higher position. The extra skin remaining at the jaw had its epidermis removed and all its other layers pushed under the face to fill a dip in the face from a previous surgery. One interesting surgery tool, beside the surgery itself, was that of these cauterizing forceps. These surgical tools were forceps that would be inert during normal movement, but when the surgeon wished to cauterize something another resident would touch the metallic end of the forceps with the electric components and the instrument would cauterize.
For being my first time in the OR, this was a great first week experience and I am excited for what the next weeks here entail.
Comments
Post a Comment