Week 5 - Pooja Nair

Name: Pooja Nair

Clinical Mentor: Dr. Jason Spector

This week I want to highlight a couple of surgeries I observed. The first case involved a transforaminal lumbar interbody fusion (TLIF), which included a laminectomy and a facetectomy. A laminectomy removes part of the lamina, a small section of bone that projects from the vertebra, while a facetectomy removes part of the facet joint, one of the paired joints on each side of the vertebrae. These steps decompress the spinal nerves and provide access to the affected disc. The procedure began with an incision in the lower back, followed by separation of the back muscles to expose the spine. After the damaged disc was removed, bone graft material was packed into an interbody cage and inserted between the vertebrae. Using the Brainlab system, which combines anatomical mapping with real‑time alignment guidance to enhance visualization, the surgeons placed pedicle screws and rods with high precision to stabilize the spine while the bone graft heals. An intraoperative X‑ray confirmed hardware placement. Before closure, vancomycin powder was applied to reduce the risk of postoperative infection.1,2

I also had the opportunity to observe three surgeries back to back, with only about 30 minutes of turnover between each case. The first involved autologous fat grafting for breast reconstruction. Fat was harvested from the abdomen using a liposuction cannula connected to a vacuum system. The aspirated fat was transferred into syringes and then spread onto Telfa gauze, an absorbent cotton fabric bonded on both sides with perforated non‑adherent film, to remove excess fluid and concentrate the fat cells. The processed fat was loaded into 5‑cc syringes, and just under 100 cc was carefully injected into the breast.

The second case was a mastopexy, or breast lift. The remaining skin paddle from a previous DIEP flap reconstruction had been intentionally left externalized for early perfusion monitoring. Once adequate blood flow was confirmed, the skin paddle was removed, the flap was inset, and the incision was closed to achieve the final breast contour.

The final procedure involved reconstruction of a scalp defect using a local flap. Because the wound was infected, DermiSphere could not be used for coverage. Instead, the surgeons mobilized healthy surrounding scalp tissue to achieve closure. This case underscored how infection can significantly influence reconstructive decision making and why vascularized, healthy tissue is essential for successful healing.

 

References

1.      TLIF Surgery: What It Is, Purpose, Procedure & Recovery. https://my.clevelandclinic.org/health/procedures/transforaminal-lumbar-interbody-fusion-tlif.

2.      Innovating Medtech for Better Patient Outcomes | Brainlab. https://www.brainlab.com/.

 

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