Week 6 - Daniella

July 14-19, 2019

By far, this week has certainly been the busiest and most stressful. Not only am I trying to analyze all of the human tendon samples I have collected this summer with flow cytometry, but also shadowing surgeries multiple times this week. 

On Thursday, I was able to shadow a total knee replacement surgery performed by Dr. Rodeo. It certainly was an interesting experience and unlike any other surgeries I had seen previously. The doctors and technicians wore these hazmat-like suits with hood and facemasks not only to increase sterility of the procedure but to protect themselves from blood splatter. Additionally, surrounding the sterile field were these clear plastic moveable panels that I was required to stand behind to observe the surgery. Both of these measures are common with all open joint surgeries. As with most orthopedic surgeries I have witnessed, it takes quite a bit of time to prep both the patient and tools required for surgery and communication amongst many individuals is required. While the patient was still conscious before the surgery, a team of anesthesiologists (attending physician, resident, and fellow) administered a nerve block to both the spine and knee guided by ultrasound, which appeared to be a difficult and tedious procedure.

I was joined by an OR technician in shadowing this surgery who provided a lot of useful commentary during the actual procedure. Using the Touch Surgery app, we ourselves walked through the procedure in an interactive manner on her phone screen, providing further information on the procedure taking place. As in the case of many orthopedic surgeries, there was a lot of hammering and drilling required to remove the existing joint and implanting the device and manipulation of the knee position was required multiple times.  It was also interesting that a representative from the company providing the medical equipment and implant was there to assist by answering any instrumentation questions and providing guidance to the tech when needed, all behind the confines of the plastic walls. Before implanting the real implant, trial sizes are placed to ensure the best fit of the device. The pace of the surgery picks up once they are ready to go with the real implant as there is a limited time that the bone cement can be used before it hardens permanently.

On Friday, I shadowed Dr. Rodeo for an ACL reconstruction surgery in which an Achilles tendon allograft harvested from a cadaver was used to replace the torn ACL. From this surgery, I was able to collect a sample of healthy patellar tendon for my characterization study. This was an interesting opportunity for me to connect the human experience to the samples I have been processing in the lab. While the knee joint was being debrided by the surgeon to remove the torn ACL tissue, Dr. Rodeo’s physician assistant was preparing the allograft. To do so, the Achilles tendon attaching to the bone was shaped into cylinder to fit into femur using a electric bone saw. The tendon itself was prepared by placing multiple loop sutures by hand, which not only helps to pull the graft into ACL region and identify the graft length. Once prepped, the graft was pulled into region of interest through two incisions in the leg while the bone plug was lightly hammered to be flush with drilled femoral region. During this process, I was surprised that they left an excess piece of Achilles tendon was just hanging outside of the patient’s leg for a period of time. This whole process of reconstructing the ACL with a tendon allograft seemed somewhat like a magic trick.