Week 5: A Shaved Head and taking off a face

This week was a busy week in the operating room with interesting, complex, and long cases. The great part of being with the plastics and reconstructive team is the wide variety of patients they operate on from burn victims to cancer patients to cosmetic procedures. As a cancer researcher and a student I learned about standard of care practices but seeing them in action was a whole other experience. On Monday and Tuesday the plastics team coordinated with the head and neck team for two surgical resections of cancer. The first case was a scalp carcinoma. The pre operative images showed inconclusive boundaries at the periosteum so during surgery it had to be determined to what extent the legion and underlying tissue had to be removed. During the excision there was evidence the cancer had extended down to the bone so they used a drill to shave down the skull to remove any residual invading cells. Afterwards to cover the hole that used the biomaterial integra and made a bolster with xeroform and  moist dressings. 

The next surgery started with me being asked if I had seen the movie Face/Off where facial transplants were performed. That day I got to see a face partially removed and then replaced in real life. In this procedure a burn victims face was partially removed but then rebuilt with his own tissue from his neck. This patient had been burned and undergone previous reconstructions in the past but there was not enough skin at the time of the previous operation and as a result the bottom lip was under too much tension.  To create enough skin for the face,  tissue expanders were used in the neck to stretch the skin. The tissue expanders used here were pouches of saline which had ports under the skin that can be used to inject saline and gradually increase the size of the expander over time. These had been implanted in the patient several months earlier and had expanded the skin so when they were removed today there was excess skin. The area under his eyes down to the chin was peeled back and also separated from the lip. The skin from the neck was pulled up onto the face and burn scars were removed. To keep the skin from sagging down over time, permanent sutures were used with suture anchors drilled  into the cheek bones. 

The longest surgery I have seen here happened this week and required 3 surgical teams for the 9+ hour procedure. This involved the head and neck surgeons, the general surgeons, and plastic surgeons. It was the excision of an oral tumor that occupied the side and floor of the mouth. For the first part of the procedure the general surgeons inserted a feeding tube because the patient would be unable to eat post-op. Next the head and neck team excised the tumor and preformed an elective  neck lymph node dissection to remove the lymph nodes so they could be analysis for metastatic cancer cells. Next the plastics team were the ones to fill the gaping hole in the patients mouth that led to the neck. To do this they took  skin and muscle flap from the forearm alone with some longer blood vessels they had dissected out. They transplanted the flap  to the mouth and used a surgical microscope to re-attach and suture the vessels from the flap to those in the neck to ensure a good blood supply to the tissue. The donor site on the arm showed exposed muscles and tendons after the flap was removed but it was covered with a split thickness skin graft from the thigh and then the arm was splinted to prevent the patient from moving it during recovery.

In lab we suffered a tragic bacterial infection which contaminated two of my isolated cell populations but I was able to isolate two more cell populations this week from breast tissue so hopefully those stay healthy and thrive. I also started staining decell samples this week so I am excited to see the results of that next week . 

Figure 1: The last step in the isolation of Adipose Stromal Cells (pellet) from Breast Tissue.

City Life

Last weekend we saw Chicago on Broadway and waiting in line for rush tickets got us 2nd row seats where we got to see all the action in extraordinary detail. I walked across the Brooklyn Bridge and got some great views of the Manhattan skyline along the way. After work on Monday we used the brain power of 8 engineers to escape from a Clock tower themed escape room. 

Figure 2: The Brooklyn Bridge