Week 2-Marsha

Week 2 of Summer Immersion: Done! I am finally starting to figure out this maze of a hospital and am getting a feel for clinical medicine. I spent the week splitting my time between shadowing Dr. Spector and spending time in the lab.

The week started off Monday morning with a lecture on craniosyntosis. Craniosyntosis is a birth defect that occurs when the cranial bones fuse together prematurely, thus making the skull unable to expand symmetrically as the brain grows. Visible birth defects, especially protrusions that compensate for the areas unable to expand result. There is a specific field of plastic surgery that is dedicated to correcting these craniofacial abnormalities and the results are pretty amazing. In one corrective treatment, a new forehead was shaped out of a piece of skull. In another, the cranial cavity had to be sealed off from the sinuses. And in yet another, the eye sockets were realigned to be symmetrical and straight.

During office hours this week I saw several of the same patients as last week and was able to assess how they were progressing. The same thing happened during rounds when I saw the patients from last week’s surgeries. I completely understand how it is rewarding for doctors to see the transformation of their patients to a healthy state. The most rewarding case I have seen thus far was a thirteen year old patient who suffered severe trauma to their leg and ankle. Initially, it appeared the patient was going to lose their foot. However, over the course of several surgeries an auxiliary blood supply to the foot was achieved using graft transplants, and sensation in the toes is being regained. The happiness on the patient’s face when being told they could go home by the end of the week was priceless.

The surgeries this week were similar to last week: flap procedures and skin grafts. However, even though the general procedure is the same, there is always case-specific patient-to-patient variation. I saw a skin graft on the head for the first time. The graft was being used to cover an area where a tumor had previously been removed. I also saw the liver and intestines during an abdominal flap procedure. During many of the surgeries, tissue samples are removed and sent to histology for testing. On Friday I had the opportunity to follow a tissue sample from a tracheostomy-peck-flap procedure. Histology was being done to make sure all the cancerous tissue had been removed and was surrounded by a clean margin of healthy tissue. Although sample preparation takes several days, I saw the beginning of the process where the tissue is marked with various colored labeling dies prior to sectioning. I also saw a separate tissue sample being evaluated; it was concluded not invasive cancer based on an intact basal lamina.

We decided that my research project is going to focus on doing histology to better understand the dynamics of a co-culture blood vessel model being used in the lab. With this in mind, I was trained on the microtome which is a machine used to cut very thin slices of paraffin embedded tissue—10 μm in thickness. I also watched a microsurgery where a collagen constructs was attached to the femoral artery (inlet) and femoral vein (outlet) of a rat under anesthesia. This is proof of concept for the creation of a living artificial scaffold that could be used as an arterial or venal graft. Busy, busy, busy this week but things are moving forward on both the clinical and research fronts.