April 2012 (Part 2)
By Jennifer Devereaux, OREXer ’11-12
First Flora and I went to Grand Rounds, Dr. Krosin talked about Orthopedic Damage Control. Ortho doctors use metal plates, pins, and screws to support bones that have been broken. He also mentioned that multiple surgeries are sometimes needed to repair a broken pelvis for example. So ortho will recreate the pelvic bone structure, then another set of surgeons will repair the vasculature but then ortho will have to modify their work and destroy all the vasculature work and this could go on several times. I took away from Dr. Krosin’s presentation that if the surgery can be organised then the patient will be facing less risk.
My first surgery was the repair of a nose following the removal of a large squamous cell carcinoma. The student did most of the repair and used incisions called “dog ear incisions.” The look of the dog ear incision was much like a spiral to create a more spreadable and stretchable flap of skin. The doctor stretched the skin over the nickel size area and stitched up the work. The surgery was very short.
My second surgery was wonderful and I am glad I saw it. Dr. Harken was the surgeon and he had a student with him as well. The patient needed to have his right femoral epicondyle plus about 2 inches of proximal bone amputated. The patient’s lower leg was already amputated. The patient came in with a bandage around his existing wound, and the wound was weeping blood. A pneumatic tourniquet was applied around the patient’s thigh, but despite the tourniquet the patient’s tissue weeped blood throughout the whole surgery. The doctors cut away tissue using cauterization. Then they cut off the portion of bone to be removed using a wire saw. Then the remaining tissue was folded over the bony stump and sutured. The student surgeon did a great job. For such a dramatic surgery the whole undertaking took just a few hours.