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

During the procedure, we observed the Zeiss Kinevo 900 surgical microscope, which offers a 1:6 zoom ratio (0.4×–2.4× magnification). This level of optical precision allowed the surgeons to distinguish subtle anatomical landmarks and tissue‑level color differences essential for microsurgery.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.

 

 

 

Comments

Post a Comment

Popular posts from this blog

Week 3: Eddie Wei - Multimodal Endoscope

Image
Figure 1: Multimodal OCT and Confocal Setup Housed in moving cart connected to Endoscope for operations Endoscope Design           This week, I finalized the optical setup and handheld endoscopic probe design in SolidWorks CAD for multimodal imaging with Optical Coherence Tomography (OCT) and Confocal Microscopy in both 360° side-view scanning and forward-view orientations, as shown in the setup and endoscope CAD figures above. Figure 2: Current OCT-Red ( Freund et al.)  and Confocal Fluorescence Microscopy-Green ( Wang et al. ) images in comparison to Histology.           As a brief review of their demonstrated applications in urology, OCT uses backscattered near-infrared light to generate depth-resolved structural images and can delineate bladder layers up to the muscularis with limited cellular information [1], while confocal fluorescence endoscopy uses fluorescein-induced emission and optical sectioning to distinguish...
Read more

Week One: Eddie Wei

Over the first week of immersion, I had the opportunity to observe a couple standard urologic operating room procedures, each offering a different perspective on diagnosis, imaging, and operative care. On June 1, I observed two standard operating room procedures. The first involved the treatment of four urinary bladder stones using a cystoscope inserted through the male urethra. The cystoscope was first equipped with a specialized head capable of generating a stream of water to break down the stones. After fragmentation, the water head was replaced with a suction tube to remove the stone fragments and excessive water from the water jet. The procedure was performed under direct real time visualization with a  standard 3x magnification camera integrated into the cystoscope. This procedure lasted 2-3 hours, with 2 and a half hours allocated to breaking down these stones using the water jet.  The second procedure involved a female patient undergoing blue-light cystoscopy to evalua...
Read more

Week 1- iqra

This week started off pretty slow since I didn’t meet with my clinician until Wednesday, but things picked up quick ly after that. One thing that has made a big difference is that Dr. Cheung sent an email out to the department about me shadowing, which has allowed me to move around and observe a variety of electrophysiology procedures rather than being limited to a single physician or case type. This has given me exposure to many different aspects of the field and has helped me gain a broader understanding of cardiac electrophysiology. In addition to clinical observations, I also met with one of the medical students working on my research project. During our meeting, we discussed some of the technical details and logistics of the project and worked through a few questions regarding the overall direction of the research. We are still in the early stages of planning, so there are additional details that need to be worked out, and we plan to continue those discussions next week. On Wednes...
Read more