Week Seven: My Jaw Dropping Trip to the OR

My summer immersion term ended on a high this week with my first, second, and third trips to the operating room (as a medical personal rather than a patient, anyways) (Figure 1). Seeing surgery in person is weird experience, to say the least. Part of me was utterly in awe and wanted to see more and more but another part of me was feeling a little nauseous. All in all, my scientific curiosity won over and I had a great time, although I don’t plan on becoming a surgeon anytime soon. If you’re wondering what this has to do with my time spent in Infectious Diseases and my research: it doesn’t but my roommate, Brittany, and her clinicians Dr. Jason Spector, were nice enough to let me tag along. After all, who wouldn’t take the opportunity to see surgery if they got the chance?

Figure 1. Me all geared up for surgery outside the OR

The first surgery was a mandible reconstruction from a fibula free flap, basically reconstructing a jaw from the little bone in the patient’s leg. The fibula is a mostly unnecessary bone in the leg, so it’s like we are all walking around with our own spare parts. The surgery was simulated from scans of the patient’s body prior to surgery and a company, called 3D Systems Inc., used 3D printing to make cutting guides for the mandible and the fibula (Figure 2). The patient had a large tumor removed from his jaw and with it he lost part of his mandible and some of his teeth and tongue. I was shocked that anyone could survive with their calf entirely split down the middle and with their entire jaw opened. It made me inspired by the resilience of the human body. The surgery took 12 hours and I was there for 10 hours of it. It was incredible to see the finished product, a single, long, well stitched wound on the left calf and a relatively normal looking young face with a line of stitches from ear to ear with a little line through the chin and bottom lip. One of the coolest parts? This new chin (which included some muscle and even some skin from the leg) was able to receive blood from the rest of the face. Dr. Spector carefully isolated and attached individual veins from the cheek to the new chin, either sewing them together by hand or using a special device that pulls the two ends together and clips them with a tiny piece of plastic and metal. All of this was done under microscope since the surgical area was about two finger tips wide.

Figure 2. An example Virtual Surgical Plan (VSP). Figure adapted from VSP System Medical Modeling. Note this is not from the actual patient discussed in this post.

Surgery number two was a skin graft. The surgeons shaved a 200um thick square section of skin from the patient’s thigh and used it to cover a wound on the patient’s scalp, the location of a tumor that had been removed weeks prior. The skin was sewn in place over the hole in the scalp and then layered with bandages and cotton soaked in mineral oil. The thigh was dressed in a silicone sheet to help it heal but the wound itself was only deep enough to be comparable to a rug burn and should heal quickly and easily. This surgery took about 30 minutes.

Surgery number three was a scar and bed sore removable on a buttock. It was a simple procedure, largely cutting out the undesired areas, sending samples to pathology to check for infection, and sewing the wound up again. It took about one and a half hours. The weirdest part about this surgery for me was seeing what fat looks like inside the body. I have opted to spare you all a picture.

In addition to my time spent in surgery, I have been working on my data analysis and statistics. I have separated the participants into groups by level of cognition, frail, pre-frail, and non-frail, years since diagnosis with HIV, viral load, and number of immune cells. These groups are then compared to each other to see if they have statistically significant differences between them. So far, I have seen that low cognition (MOCA scores less than 26/30) is associated only with older age and higher frailty scores but not with any other factors such as body composition, weight, HIV viral load, or immune cell counts. I did not find any statistically significant differences in any factors for participants having HIV for 23 years or more. This is good news and may imply that HIV therapies are effective in the long term at maintaining body composition, immune system function, and HIV viral loads. Participants who were frail were older, had higher Body Mass Index (BMI), Fat Mass Index (FMI), fat mass, and lower skeletal muscle mass. While we may not be able to control age, we can encourage those who are HIV+ to be extra considerate of their diet and exercise. However, our study does not allow us to determine whether people are frail because of their higher fat compartment or if they have higher fat compartments because they were frail first.  

This is my last day and my last blog post. I will be leaving New York City tomorrow after one more stop at Broadway to see Aladdin. It has been an inspiring summer. Overall, I have learned 1) That I am glad I am not a doctor or surgeon, 2) I am very proud and excited to be in the medical field as a biomedical engineer, and 3) the areas of infectious disease and immunology are awesome, and I am glad to be a part of them. I am incredibly grateful for the experiences I have had in my life and I am humbled by the chance to give something back to the scientific community. My goal is and will continue to be to do quality research with the goal of bettering the health of many. Thank you so much to all the mentors, sponsors, friends, and family who have made this possible. Thank you for reading!