Julia Bellamy / Dr. Jason Spector - Week 4

In the OR this week, we observed an ear reconstruction following a squamous cell carcinoma removal by ENT Dr. Kutler. Carcinoma was removed from two areas of the ear, leaving skin that needed to be filled. It was determined by Dr. Spector that Integra was not needed, as the carcinoma removal left enough vascularized tissue exposed that the full thickness skin graft (FTSG) can immediately be applied. The skin graft was harvested from the clavicle region, and the size was determined by tracing the shape of the opening left on the ear with deformable plastic piece that was then flattened to get the 2D shape. The FTSG was then attached to the ear.

I also shadowed Dr. Spector in clinic this week as well. This week there were a lot of people coming in for consults, post-op follow ups, and new patients. One patient had a post-op appointment from a squamous cell carcinoma removal from the mandible region. They had just come in from radiation treatment, and they mentioned that the radiation was worse than the intense jaw reconstruction surgery they had to do. I learned that radiation in the head and neck area is worse than other areas because the whole blood volume moves through the area, so essentially the whole body is getting irradiated. Another was the third visit from a patient following up from two previous filler injections in the face and presented with symptoms of asymmetrical inflammation. There was a new patient consult for a "mommy makeover". What was interesting was the use of bras implant sizers, where the patient can get an idea of the size, feel, and shape of an implant worn in the bra to determine the general size they would want for aesthetic plastic surgery, Another patient was on a post-op visit from an intense upper soft palette flap from the lower leg. It was very interesting to see that the leg skin flap has been re-mucosolated to resemble the surrounding soft palette and was nearly indistinguishable from the original tissue. This flap was needed from necrotic tissue formation from drugs to treat osteoporosis. Another patient was there for a consult for a cyst removal in the breast and to ensure that after removal the breasts are even, with a potential to do a tummy tuck due to a small diastase and umbilical hernia, which would (potentially) allow the tummy tuck to be covered by insurance. Another patient was here for a consult to add nipples following a total mastectomy on one side from cancer and a nipple removal case on the other side to ensure no re-emergence of the cancer. It was interesting to hear how a 3D nipple would be reconstructed, as I have only heard of tattooing a very realistic looking 2D nipple and areola. The procedure would be cutting two skin flaps on the breast and wrapping them around each other to form a 3D nipple, and then tattooing the areola. 

This week was also a busy research lab week. From a patient that did a breast reduction, we harvested the fat tissue and performed an adipocyte and stromal vascular fraction (SVF) isolation. It was interesting to work and dissect a  human tissue sample and work with fat tissue which I have not done before. I ran the SVF (2.6 million cells/ml) through the Smart Syringe to find the dielectric impedance spectroscopy readings for a patient sample. Also this week, was two experiments for Human umbilical vein endothelial cells (HUVECs). The first experiment was at lower concentrations (0.5, 1, and 1.5 million cells/ml) that I ran through the smart syringe. There seemed to be less noticeable differences so later in the week I ran another HUVECs through the Smart Syringe at higher concentrations (2.5, 5, and 10 million cells/ml).