5th week in Plastics

This past week I was able to see quite a few interesting cases. Monday morning I listened to a lecture on hand trauma and then watched and residents discussed how to approach specific cases. This lecture turned out to be very useful because we had a hand trauma case this week. A garbage man was unlucky enough to get his hand caught in the garbage compactor. He was brought into the OR in the hopes of salvaging his index finger which had been almost completely crushed. The surgeons removed the debris from the finger (including the crushed bone) and tried to piece back together what they could. A microscope was used to attach nerves, veins, and arteries that had been severed. With all the effort, the surgeons were still very skeptical that the finger would be able to survive because there appeared to be no blood flow in the tip of the finger.

In addition to plastics cases, I also attended a couple Neuro cases. This was very interesting to watch. The surgeons entered the brain through the nasal cavity, removing the septum in order to have a clear view of the interior. Although miniaturized, the tools were the same basic tools used during many of the plastics cases. The patient had a pituitary tumor which was removed through the nasal cavity with a device that worked by simply pinching off a small portion at a time. Once the tumor had been excised, the septum was reconstructed from tissue taken from the abdomen of the patient.

On Friday, I decided to see something other than surgical intervention to help patients. I went on rounds in the NICU with Mike and Dr. Frayer. I found that in the NICU the doctors are very concerned with the overall patient . In my experience thus far, many surgeons are there to treat one main problem, which may even be the root of a lot of other problems, but in the NICU, the health of the patient overall seems much more important. The main discussion of each patient was that of overall function. With all the advancements in medicine to date, it is amazing to me how important simple bodily functions matter. Calorie intake, weight gain or loss, peeing, pooping, and all the basic functions of living are of utmost importance in the NICU. Spending one day to complete rounds in the NICU was a very worthwhile experience.

Additionally, I want to discuss one case that I have been able to see progress through my time here. When I first arrived, the patient was in the hospital awaiting surgery. He had previously had surgery on his neck to stabilize some of his vertebrae and hardware was used to complete the surgery. You can see the hardware in the first image (metal on either side of the spine). An infection set in at the site of the surgery, and the patient was transfered to Plastics. I didn't realize prior to my time here that Plastic Surgeons work a lot on wound care and thus often receive patients from other services once infections are found. In this case, Dr. Spector took the patient to the OR to irrigate and debride the wound. He then closed the wound in layers to provide more stability to the wound. To do this each layer must be separated from the above tissue and then closed over. You can see in the second image how this was completed. Additionally, Jackson Pratt (white plastic in wound) drains were left in the patient to allow for drainage of fluids from the wound site. This prevents pockets of fluid for forming underneath which must then be remove with a needle. An image of just the drain is also shown (from: http://courses.vetmed.wsu.edu). The drains are cut to fit in the wound bed and then a small hole is made away from the incision and the drain is threaded through the hole. Once there is no longer large amount of fluid being drained, the JP is simply removed by pulling it through the insertion site. The ability to observe the fluid as it drains from the site is helpful because it can be an early indication of infection. Since the surgery the patient has been able to return home and the wound is nearly completely closed with minimal problems.