Week 1 - Leigh Slyker

The first week of immersion has been eye opening to say the least. Shadowing Dr. Spector along with two of my fellow first years has already afforded us the opportunity to shadow eight surgeries, five of which were performed in the OR, and the remainder being done in the clinic. While the surgeries were by far the most engaging of our experiences so far, we also followed Dr. Spector through his clinic hours, as he followed up on patients as they healed from previous operations, and discussed options with new patients.

The first day we were with Dr. Spector, we saw right away the wide range of patients he treated. From elective to reconstructive procedures, facial reconstruction to spinal fusion, the range of tissues involved was a significant departure from the usual experience in research, where one is expected to focus one tissue, one system, and to delve deeply into its complexities. Of his many frequently recurring refrains, Dr. Spector's "[plastic surgeons] work everywhere in the body" became quite accurate as a description of his practice. The diversity of tissues relevant to his practice is then well mirrored in the diversity of interest in the students shadowing alongside me. Just in his cases from this week, Dr Spector procured tissue samples of auricular cartilage, breast, and muscle tissue. As such, each of our research is made more relevant with the opportunity to work with patient specific tissue, as opposed to animal tissue samples, the standard to which I've become accustomed.

Still, the most interesting part of this week, at least for me, was a procedure that has little relevance to my research. The procedure was a revision of a pneumonectomy that had been performed previously. There was a hole left in the brocheal tube of the patient, and so a muscle flap had to be swung through the patient's rib-cage in order to cover the hole. Due to the complication of the procedure, and the fact that it was joint between Dr. Spector and another surgeon, we were not able to see as much of the surgery up close as we might have liked. Of course, with a procedure as involved as this one, I can understand completely the focus on patient care, rather than our education.

I have attached images of the procedure below,

In the center of the image on the left, you can see the hole in the bronchus.



On the right, you can see the piece of muscle flap being used to cover the hole.


Seeing the lengths to which Dr. Spector had to go to fix a whole in this woman's bronchus, detaching her pectoral muscle, swinging it through her ribs, attaching it to cover the whole, made me think about the possibility for tissue engineering to simplify this process. What if when the woman went through the pneumonectomy in the first place, some of her cells could be harvest and grown into a flap that could be used in the event of revision surgery. What if an easily vascularized biomaterial could be used to cover the hole without any need for muscle flap transfer.

Seeing firsthand the difficulties patients and surgeons alike face of course gives hope to an aspiring innovator of tissue engineering and biomaterials. It affirms the need for these technologies, and how patients can suffer, how resources and time are taken up without them. Only time will tell as to whether I will see such innovations in my lifetime, but I think the possibility is quite likely. Lets hope my confidence in that matter doesn't erode too quickly.