week 5-Emily

This week shadowing in the clinic with Dr. Jason Spector was again filled with several interesting cases. I am amazed by how much I have been able to see throughout the summer and am so grateful for this experience. In the clinic, we saw a patient who was having facial skin resurfacing due to extensive burning that had happened earlier in his life. The treatment for this case was something I never knew could be done. Dr. Spector placed two tissue expanders in the patient’s neck and over the course of many weeks/months was filling up the tissue expanders with saline to stretch the skin in the neck. The goal of these tissue expanders is to create more skin. Dr. Spector said that the best place to take a skin graft to be used on the face is the neck due to similarity in color, texture, and hair. Due to the extensive damage to this patient’s facial skin, there was not enough skin to take from the neck without using these expanders. While this treatment works very well, it does not come without side effects. Having the skin expanded is a very painful experience that we have seen first-hand watching the patient go through this every week. In addition, to the pain of each expansion, the patient has to live with these large bulges on his neck for weeks/months which seems extremely uncomfortable. A similar technique is used for breast reconstruction to expand the tissue before placing the implant. This experience makes me think about the need for better artificial skin grafts. Not only does a skin graft need to be functional, it should also be aesthetically pleasing if it is to replace the current treatment. Especially in this case where the face is involved, patients care about appearance. Through all of these reconstruction type cases, you really see how small things like appearance and trying to get back to their “normal” can really make a big difference in quality of life for the patient.

              In addition to this and other clinical cases we saw in the office, we shadowed Dr. Spector on a surgical case where the patient has Ewing’s Sarcoma which is a cancer that forms in the bone or soft tissue. The patient had a recurrence after the first tumor resection, where this surgery would need to remove multiple ribs and part of the lung. It is remarkable that the body is able to handle such drastic surgery and removal of so much tissue. The main reconstruction required for this case is that physical structure needs to be brought back to the chest cavity to replace the function of the lost ribs. This can be done with a mesh type medical device to give the chest cavity the mechanical structure it needs. If the patient remains cancer free in the long term, the plastic reconstruction team will work to design custom fit titanium ribs. Something that was interesting to see is how the surgeon knows how much tumor to resect. This is done predominantly by surgeon touch being able to distinguish healthy tissue from cancerous tissue, which was really shocking to me. This just emphasizes the importance of experience and makes me wish there were a more concrete, quantitative way to know for sure all of the cancerous tissue was removed while in the surgery. This seems like a very worthwhile problem for a biomedical engineer to try and solve. While histology of the resected tumor is done to see if there are clear margins, results do not arrive until after the surgery is over. Knowing right there in the OR that you have removed all cancer would be extremely beneficial.

              In the lab, I assisted my fellow Cosgrove Lab mate Andrea with dissociating human muscle samples from patients. I received muscle samples from three patients this past week all from different surgeries/procedures. One sample was from the upper eyelids of an older woman having cosmetic surgery to remove excess skin. This procedure is known as a blepharoplasty and the muscle collected from the upper eye lid is known as the levator palpebrae superioris muscle. In addition, during a free flap oral reconstruction case, I was able to collect two muscle samples: the brachioradialis from the forearm and the buccinator muscle from the cheek. Dissociating these muscle samples, you see some of the added challenges in collecting human samples compared with animal samples. You get a lot of variability in the human samples which can often change the amount of time or amount of dissociation reagents used.

              In addition to shadowing and lab work I went to a lot of museums the past weekend. My favorite so far was the Tenement Museum, located in the Lower East Side of Manhattan. This museum takes an old Tenement where immigrants lived during the late 1800s, early 1900s and recreated it to resemble what it would have looked like at time. The museum tour takes you through the stories of some families who lived there on Orchard Street and goes through their stories in such great detail that you leave really feeling like you know the families who immigrated and leaved there in the lower east side during that time. The tour we went on actually explored more recent immigrants/migrants. This museum was very different from others I had ever been to and was extremely inspiring especially given all the recent discussion on immigration in our country.