week 3

During the third week, I tried to see more various cases in plastic surgery and get more profound knowledge in this area, through attending conference, lab meeting, office hour and surgery as well.

Among surgeries during the third week, microsurgery to repair lip cleft was impressive. The patient was 3 year-old young kid having incomplete bilateral lip cleft. Incomplete bilateral lip cleft is a small gap or an indentation in both sides of the top lip but this gap or indentation does not connect to nose. If cleft continues up to the nose, it is called complete cleft. The upper Lip and palates were dissected to several pieces and nasal section also followed subsequently. Since movement of lips and palates are deeply involved in speaking, eating, and facial expression, dissected upper lip and palates had to be reconnected elaborately to make muscles adjacent to the lip move properly. Potential force and tension of facial muscle adjacent to mouth also had to be considered to rejoin the pieces of lips and palates. Even though surgery itself may look like just a successive procedure repeating dissection and suture, actually there are much more invisible factors that has to be considered to make our body function properly. Also, as I observed surgery, I realized that every single step from anesthetizing patients to waking up patients from anesthetic during procedure is critical. One case was not able to be proceeded further since the patient bled severely while anesthetized.

In addition to the surgeries, I attended monthly based conference in the department of plastic surgery, which is called “Morbidity and Mortality”. This conference offers a chance to share extraordinary experiences and propose suggestion to the challenge that they face when they were dealing with those cases. There were several cases discussed. The first case was debridement, spinal fusion and local back wound free flap. Spinal fusion is for patient who has impaired neurologic function and muscle development. The second case was about congenital cleft lip and palate. In this case, several prior surgeries to correct the cleft had been done but they did not work well. Thus, residual cleft and nasal deformity were repaired and even tongue flap was followed. The third case was a patient who had surgery for Glioblastoma but the incision part was infected. Thus, scalp and skull near the infected part were debrided. It was really great time to learn about various cases that I have not seen before.

Also, I was able to interact with patients during post-op office hour and a diabetic patient came back after debriding wound on the feet for skin graft since opening wound part was infected. The infected part totally turned to green like mold. After surgery, especially for immune-deficient patients such as diabetic patients, one of the most critical things is protecting from infection. In this case, open wound was infected by Pseudomonas which commonly causes infection to immune-deficient patients. Thus, keeping operating room cool, injecting antibiotics during surgery and having patients take antibiotics after surgery, patient are efforts to protect patients from infection.

In week 4, hopefully I can get involved in a specific project in addition to clinical experience.