Tuesday, July 3, 2007

Continuing Plastics

In the past week I have been able to see many very interesting cases both in the OR and during office hours. On Monday I attended the monthly Mortality and Morbidity meeting where the death of patients being cared for by plastics is discussed. At the beginning of the meeting a particular program recently implemented in plastics was introduced by a company representative. The program is an online program that allows patients to read and view information on the particular procedure that the surgeon has suggested be performed. This is a beneficial way for patients to have many of their questions and concerns addressed. Additionally, at the meeting a case where a patient had died post surgery was discussed along with the possible causes of death.

Later in the week, I attended many surgeries including a breast reduction, hernia repair with tissue expanders, debridements, excessive skin removals, and eye lifts. During the breast reduction it was interesting to see which parts of the breast were maintained and which were removed; the top portion of the skin was maintained but the breast was formed of mammary tissue from the lower portion of the breast while maintaining the intact nipple. Over 1.1 kg was removed from each breast! Durign the eye procedure a piece of gold was sewn into create a more normal appearance in the eye lid and a portion of the roof of the mouth was inserted below the eye to improve appearance. Using autologous tissue is the best way to avoid complications with an implant.

During office hours it is always interesting to see what case we will walk in on next. In some of the most interesting cases, the patients are dealing with wound healing issues. I have been amazed to see patients that are able to go home even with very large open wounds. The V.A.C. (Vacuum Assisted Closure) system is very often used to help in these cases. This is a fairly basic idea developed over 10 years ago. The patient is fitted with a sponge that covers the open wound and a plastic seal is placed over the sponge. Then a hole is made in the seal and a vacuum hose is attached which allows for continuous suction of the wound. This has been shown to greatly aid in wound closure. In addition, during office hours I have seen Dr. Spector remove small tissue masses and sebaceous cyst, inject steriods to decrease keloid formation, clean wounds of dead tissue, and perform patient consults.

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