Marsha-Week 1

I finally made it to Summer Immersion this week after a two week delay in Ithaca from an unexpected illness. At 7 am on Monday morning I met Dr. Spector for the first time and got off to a quick start immersing myself into the clinical world. Dr. Spector is a plastic and reconstructive surgeon at New York Presbyterian, which means that he is involved in surgeries that cover the entire expanse of the body.

Mondays are when Dr. Spector typically has office visits—these are patients who have already undergone surgery and are returning for follow-up visits or those who are receiving consultations for anticipated surgeries. Previously, I had associated cosmetic appeal as the primary reason that a plastic surgeon would operate. This is not the case at all! During office hours, I realized that wound healing is a challenging and important part of any surgery. All too often we focus on the few hours the patient is physically on the operating table, and forget the weeks and months that are spent caring for the resulting wounds. This is a long process and can keep patients out of work for a significant amount of time. Pre-existing medical conditions such as diabetes or poor circulation can make wound healing even more challenging.

The operating room was an experience like no other: seeing the musculature and vasculature inside a living body is unbelievable, as well as knowing that in a matter of hours a procedure will be done to vastly improve someone’s quality of life. The common theme among Dr. Spector’s cases was “healthy vascularized tissue.” In many cases a diseased state was persisting because there was no healthy vascularized tissue in the area. This led to stagnation in healing from a previous procedure and was often accompanied by infection. In these situations, a muscle, such as the pectoralis muscle, that does not play a necessary role in everyday functionality is moved into the area of injury while still remaining connected to its original blood supply. This is called a flap procedure and solves the problem of no “healthy vascularized tissue” in the area. I saw flap procedures moving a muscle from the chest to the throat, from the calf to the ankle, and across the abdomen.

The other procedure that really excited me was a skin graft. In several situations, after moving a muscle in a flap procedure, there simply would not be enough skin to cover the wound; therefore, a skin graft was necessary. I always thought a graft meant a thick slab of skin being transferred from one area of the body to another. In essence, it is, minus the thick part. To perform a graft, the uppermost layer of skin from the thigh or butt area is shaved off in  a single continuous strip. The thickness of skin removed is no deeper than what you might encounter with a common scrape. The skin is then put through a meshing device which increases the area a graft can cover by converting it from a solid sheet of skin to a mesh. The meshed layer of skin is then stitched into place to provide a new source of epithelial cells to the area, and the graft is complete.

This week I also had a brief introduction to the lab but that will be discussed in a later entry once my project gets off the ground. There was so much excitement in Week 1, I cannot wait to see what is in store for next week and beyond.