week 3-Emily

              This week was another surgery filled week! This week in particular was very eye opening seeing all the biomedical engineer designed products used in surgery that dramatically improve patient outcomes. One surgery we saw was an all-day surgery removing a cancerous tumor from a patient’s mouth and throat. It was interesting to see how a surgical team including a head and neck surgeon, plastic surgeon, and oral surgeon all work together in one case. The head and neck surgery team and the plastic surgery team were working on the patient at the same time. The plastic team was preparing the flap that would be used from the thigh while the head and neck surgery team began opening up the patient’s jaw to remove the tumor. It was interesting to see how each surgery team also had their own team of assistants and instrument tables. It almost seemed like there were two surgeries going on at once on the same patient. During the surgery, the plastics team worked to locate healthy blood vessels that would supply the flap using a Doppler Blood Flow Monitor. Once the team located a good flap with adequate blood flow, they opened up the leg to get the flap ready for transfer but left it connected to the blood supply until the head and neck surgery team was ready for it. Later into the surgery, it became apparent why they didn’t want to disconnect the flap from the blood supply until the very last possible moment. Once the flap was ready to be used for reconstruction in the mouth, they disconnected the flap from its blood supply in the leg. At this point, they recorded a “time of ischemia” meaning the start of when the tissue was without a blood supply. It was then really interesting to see how they connected a vein and artery from the flap with a local vein and artery from the face.

              To connect the vein from the flap to the vein of the local tissue, a device called a micro-surgery coupling device which is used for anastomosis. This device takes away the need to use sutures to connect the veins together. This device worked by putting each vein into a ring where the two rings are then connected with a hinge so that once the veins are in the rings, the hinge allows the surgeon to bring the two together and clamp together. It is interesting to note that Dr. Spector does not use this device for the anastomosis of the arteries due to the higher elasticity of arteries compared to veins. The arteries would not be able to stay put when being pulled through and over each ring. The elasticity would cause them to retract. It was interesting to then see the contrast of how they anastomosed the artery. They had to suture the arteries together which took significantly longer. As time was passing, the flap was still in ischemia. Seeing this made me realize how an improvement in time here could be a very significant improvement. The tissue was in ischemia for about two hours so having a better method for anastomosis of the arteries could really help. This tissue flap that was used was not muscle. It was skin and some fat. If the tissue had been muscle, it would not have been able to undergo so much ischemia due to the higher metabolic demands of muscle compared to skin and fat. Seeing the final outcome of this patient was really impressive but it definitely was a long and intensive procedure.

              The rest of the week was nice seeing patients we had seen in previous weeks. It is nice to see the follow-up appointments and see the patients getting better. Dr. Spector also helped get us setup to see a surgery outside of plastic surgery. We were able to shadow another surgeon as he repaired an abdominal aortic aneurysm. This surgery was very eye opening seeing the extent that the medical device representative was involved in the surgery. The surgeons really relied on the knowledge of the representative and he was key in the success of the surgery. These experiences this week really showed me all the little pieces to the puzzle that are involved in patient care. Each of these pieces need to work in order to help patients and each piece is essential and important.