Week 1 - Pooja Nair

Name: Pooja Nair

Clinical Mentor: Dr. Jason Spector

Week 1 of clinical immersion began with shadowing several plastic and reconstructive surgeries. One case I want to highlight was a state‑of‑the‑art hand reconstruction. A malfunctioning chemotherapy port had caused localized necrosis, and surgical debridement left a significant soft‑tissue defect in the hand. To restore coverage, the team performed a reverse radial forearm flap, elevating and rotating the flap into the defect to re‑establish soft‑tissue integrity.1,2

The donor site was then treated with DermiSphere™ (hDRT), a novel hydrogel‑based dermal regeneration template developed from technology discovered by Dr. Jason Spector. This innovative hydrogel–collagen matrix is designed to maintain an optimal wound‑bed environment and support regeneration following full‑thickness skin loss.3

the area from where skin flap was harvested was providing an utterly innovative hydrogel, collagen-based dermal regeneration template that maintains ideal conditions in the wound bed, DermiSphere™ (hDRT) is poised to offer a new solution for full-thickness skin loss.4,5

We also saw a microvascular anastomotic coupler used to connect veins and arteries. The device is engineered to create intima‑to‑intima contact without intraluminal sutures, reducing endothelial trauma and lowering thrombosis risk. The coupler everts vessel edges over tiny stainless‑steel pins so that only the natural endothelial lining is exposed to blood flow, minimizing microscopic gaps and endothelial injury, two major triggers of clot formation.6–8

In addition to the coupler, the team demonstrated microsuturing using threads finer than human hair to repair delicate vessels. After the anastomoses were completed, a Doppler flow detector was used to confirm vessel patency by detecting blood flow through high‑frequency sound waves reflected off circulating red blood cells. Once perfusion was verified, the wound was closed, concluding the operation.9,10

 

References

1.      Maan, Z. N., Legrand, A., Long, C. & Chang, J. C. Reverse radial forearm flap. Plastic and Reconstructive Surgery - Global Open vol. 5 Preprint at https://doi.org/10.1097/GOX.0000000000001287 (2017).

2.      Wang, J. Q. et al. Reverse posterior interosseous artery flap for reconstruction of the wrist and hand after sarcoma resection. Orthop. Surg. 5, 250–254 (2013).

3.      Fesarius Therapeutics | Dermal Tissue Regeneration. https://www.fesariustherapeutics.com/.

4.      ZEISS KINEVO 900 S | Surgical Microscopes. https://www.zeiss.com/meditec/en/products/surgical-microscopes/kinevo-900-s.html.

5.      Zeiss Kinevo 900 Surgical Microscope | Prescott’s. https://surgicalmicroscopes.prescottsmed.com/product/zeiss-kinevo-900/.

6.      Umezawa, H., Hokazono, Y., Taga, M. & Ogawa, R. Applying the Microvascular Anastomotic Coupler Device to End-to-side Venous Anastomosis in Reconstructive Surgery. Plast. Reconstr. Surg. Glob. Open 10, E4018 (2022).

7.      O’Connor, E. F. et al. The microvascular anastomotic coupler for venous anastomoses in free flap breast reconstruction improves outcomes. Gland Surg. 5, 88–92 (2016).

8.      Microvascular Anastomotic Coupler. https://www.synovismicro.com/html/products/gem_microvascular_anastomotic_coupler.html.

9.      Doppler ultrasound: What is it used for? - Mayo Clinic. https://www.mayoclinic.org/tests-procedures/ultrasound/expert-answers/doppler-ultrasound/faq-20058452.

10.    Synovis MCA | Global Excellence in Microsurgery. https://www.synovismicro.com/html/products/gem_flow_coupler_device_and_system.html#tab4-content.

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