week 2

During the second week, I tried to broaden my view beyond the plastic surgery, shadowing my mentor, Dr. Spector as well. I had valuable and various experiences since I was able to meet patients who have different problems through rounding in the department of pediatric and plastic surgery. Also, I was able to observe robotic surgery in urology.

As I attended Dr. Spector’s Lab meeting, I found out what his lab is currently researching on. Their interest is developing a better device to rend a better blood supply to the skin and tissue. Thus, they formed a 3-D fluidic vascular network using Melt-spun sugar fibers (cotton candy) and are trying to check cells’ viability in the fluidic system. The one of the significant issues in plastic surgery is keeping enough vasculature in the skin or tissue after skin graft or flap, so this device will help clinical treatment in terms of offering better blood supply. Also, diabetic patients are one of the major patients in plastic surgery since their wound healing capacity is much weaker than those of normal peoples they are very vulnerable to wound for a longer period. Thus his lab is also working on how H2S can contribute in wound healing capacity, increasing antioxidant which can protect cells from oxygen stress and lowering anoxia in tissue of diabetic mouse. As all of his research is deeply related with his clinical aspects, I believe that my experience during summer immersion will help me to approach closely to clinical aspects with engineering techniques.

Among surgeries that I watched during the second week, breast reduction surgery was really impressive and interesting. The patient who had surgery was teenager but had inappropriately big breasts which caused serious back pain. Also, there was a potential to keep growing. I thought that comparably it could be easy surgery but it took more time than I expected since not only aesthetic (cosmetic) parts but also primary functions of breasts had to be considered. Main blood supply and mammary gland are connected to the nipples of breasts directly through the soft tissue in the center of the breasts. Thus, the soft tissue directly attached to a nipple in the center of the breasts has to remain for the sake of keeping enough blood supply and intact mammary gland. If blood supply is not enough to support all of the tissue, tissue will be necrotic so enough blood supply is one of the most critical issues. 2.5 pounds of breast soft tissues per each side were taken out and they were the ones surrounding the center part. Also, since breast tissue is fat tissue, breast reduction surgery can have the same impact of liposuction so only certain amount of soft tissue can be removed following the policy of insurance.

Also, I was able to see Dr. Scherr's elaborate robotic surgery in Urology. Robotic surgery was performed under control of three surgeons’ well-coordinated cooperation. Dr. Scherr guided surgery via endoscopically looking through the bladder and two other surgeons controlled robotic arms as much accurately and promptly as possible. Robotic surgery itself looked really nice but for me it was hard to follow the procedure and figure out which part I was looking at since I am not familiar with urological anatomy and the screen showed the exact sites for the surgery only endoscopically but not whole structure. It would be good to have scope that can show the region for the surgery with both higher and lower magnification at the same time.

During office hour, I was able to see various cases and one of the interesting cases is hernia. Hernia is bulging abdominal wall above the disorganized organ or tissues caused by a weak muscular structure of abdomen wall. People who can suffer hernia are abnormally thin, post partum, or have had a surgery such as liposuction, and TRAM flap. Thus, hernia can be shown as a side effect of TRAM flap after mastectomy. Also, what bring a patient who had surgery for squamous cell carcinoma on the forehead back to the hospital is the damaged skin on the forehead because of radiation treatment. Thus, the patient needs to soft tissue skin graft on the fore head since soft tissue on the abdomen has many stem cells which help other cells healthy.

Lastly, I went to round to see infant patients in the pediatric department with Dr.Frayer. Most of new-born babies are twins, or triples or immature foetuses that are considerably tiny and venerable to be infected by dreadful bacteria such as Group B streptococcus (GBS). In general, infection is a really severe issue to infants since infants can be easily infected because of thinner skin. Also, once bacteria spreads to the bone it is hard to eradicate them because of porous structure of bone. Moreover, especially Infection of GBS causes 50% of motility so that it is crucial enough to keep an eye on this infection primarily. After rounding with Dr. Frayer, adult patients since there are limited ways to communicate with infants other than guessing what they feel from crying or smiling.
In the third week, I hope that I will see more variety of cases and learn plastic surgery more in detail.