Week 5 - Daniella

Week 5: July 8-12, 2019

This week, I was given the unique opportunity to shadow Dr. Jason Spector in surgery for a patient undergoing oral cancer resection with a free flap transfer. This surgery, lasting from 7:30am to 6:30pm, was actually a joint effort between an oral surgeon and Dr. Spector, a plastic surgeon. Coordination and communication are key, especially when the number of staff members in the operating room number over ten. There were many components to this surgery; while the oral surgeon was resecting the large tumor from the inner mouth in addition to several adjacent teeth, Dr. Spector was excising a portion of the forearm which included a layer of subcutaneous fat and several blood vessels. From the entire surgery, what I found most fascinating was anastomosis, surgical joining, of the arteries and veins from the oral cavity and forearm flap, which was completed by two doctors under a microscope. The veins were connected using a coupling device whereby the edges of the two separate blood vessels are secured with pins to implantable rings on the device. When the vessels are ready to be joined, the device is closed and the vessels are press-fit together. In contrast, since the walls of the arteries are much thinner and tend to tear using this device, they are manually sutured together. The precision required for such a surgery was astonishing, especially given that it took multiple hours to complete. Another highlight of the surgery was harvesting a skin autograft from the patient’s thigh to replace the tissue excised for the flap. To do so, the physician assistant used a tool called an electric dermatome to allow for smooth, high-speed cutting of a thin layer of skin. Prior to suturing the graft to the patient’s forearm, the tissue needed to be perforated multiple times with a scalpel, appearing much like a mesh, to ensure proper placement while suturing and promote proper fluid drainage during recovery.  I am very thankful to Garrett, Leigh and Emily for facilitating this surgery shadowing experience since Dr. Spector is their clinical mentor.

In the lab, now that all of my ordered antibodies had arrived, I spent the majority of my time validating the general inflammatory panel and macrophage panel I developed to characterize immune cells in human tendon tissue. To do so, I conducted several trials on fixed and unfixed human peripheral mononuclear blood cells (PMBC). Given that cell death occurred the next day in the fixed samples, I decided to process my human tendon samples in a single day so that I can analyze live cells. While this requires long, busy days of tissue digestion, antibody staining, and flow cytometric analysis, it is the best way to maximize my data collection for precious human samples. Once I was satisfied with my validation of the panels with human PBMCs, I moved ahead and began analyzing my first human tendon sample, a pathological biceps tendon from a patient undergoing a rotator cuff repair, having been diagnosed with biceps tendinitis.