Week 1 Plastics - Lindsey

My first week in Plastics and all my experiences have been clinical. I spent a day in Dr. Spector's office hours following up on patients and meeting new consultations. There were a couple botox cases, but most of his consultations were about how he would do repairs after another surgeon left them with hole or lesion of some sort. Most of the follow ups consisted of examining the wound, maybe scraping off some scar tissue, cleaning and redressing it. A few of the patients had skin grafts and I could see how the repair process progressed. One patient would have a skin graft that had healed so well you couldn't tell it was even put on, while another patient's skin graft would resemble a pink skin-like mesh.

 

In the OR I was able to see two post- mestectomy breast reconstructions. The patients had been sent home with tissue expanders after their mestectomies, which where removed during this procedure and sizers were placed in. I found it interesting that different sizers were inserted, a few stitches were made around the tissue to hold then in place, and the patient was then placed in a sitting position ( the top portion of her bed was raised up so that her  breasts could hang freely, as they would in the patient's everyday shuffle.) The doctor and resident would then come to the foot of the bed and discuss which sizer looked best and the process would continue with a new sizer being put in and the patient raised to a sitting postion until the space left by the tissue expander looked as though it were naturally filled. Silicon implants were then placed in. Sometimes achieving the right look would require tucking or a different angle of suturing the breast tissue.

My second day in the OR I observed a tissue repair after removal of an insitu melanoma left a giant hole in the cheek.  I also observed  a rectus diastasis repair coupled with liposuction. It was interesting to see the patient's skin and flat just flopped to either side, while the rectus musles where stiched back together. In order to close the patient, a significant portion of her fat and skin were removed and the remaining skin was sewn back together. My favorite case of the week was a patient who had a pericadial esophageal fistula. This was the second time a repair was made and due to complications, Dr. Spector had to come in at a side angle. He excised a muscle flap from the rectus abdominis muscles and used that as a vascular sheath to cover the hole. The patient's chest was completely split open and you could see his heart beating inside his chest cavity.

Overall it has been a busy week and I am very pleased with my mentor and his students who have been so kind in explaining procedures to me.