Week 7 - Pooja Nair

Name: Pooja Nair

Clinical Mentor: Dr. Jason Spector

 

Last week, we observed the closure of a spine surgery. During the procedure, we saw the use of Bovie electrocautery, which uses high-frequency electrical current to cut tissue while simultaneously achieving hemostasis by coagulating and sealing blood vessels. A grounding pad was placed on the patient to safely complete the electrical circuit. The procedure concluded with layered closure of the paraspinal muscles, followed by closure of the skin.

We also observed a complex head and neck reconstruction. The patient had previously undergone resection of a neck tumor at another hospital, and the resulting defect had been reconstructed with a free flap harvested from the thigh. Although the reconstruction initially healed well, the patient returned approximately one year later with exposed bone. During surgery, the ENT team first debrided the wound and drilled the exposed bone to remove nonviable tissue. Dr. Spector and his team then continued the debridement using a Goulian blade, which allowed them to efficiently shave away thin layers of devitalized tissue over a larger area, creating a healthy wound bed. Rather than performing another free flap reconstruction, the defect was treated with DermiSphere, a dermal regeneration template designed to promote tissue regeneration. An Adaptic nonadherent dressing, consisting of petrolatum-impregnated knitted mesh, was placed over the DermiSphere and secured with sutures to protect the regenerating tissue while preventing adherence to the wound bed. The dressing also helped maintain a moist environment to support successful integration of the dermal template.

One week later, we observed the patient return to the operating room for reassessment and possible skin grafting. The initial DermiSphere had integrated well, revealing a healthy wound bed with mild punctate bleeding, indicating successful vascularization. Because the wound was progressing appropriately, a skin graft was not necessary at that stage. Instead, another application of DermiSphere was placed over the newly exposed area to continue supporting tissue regeneration.

This week also began with another spine surgery closure before moving on to several reconstructive procedures. The following day, we observed a breast reduction with mastopexy. In this patient, breast volume was already appropriate, so the procedure focused primarily on removing excess skin around the areola and lower portion of the breast to improve breast shape and symmetry rather than removing a significant amount of breast tissue. The breast was then reshaped, and the incisions were closed.

The next case involved a patient whose burn injuries had healed well following treatment with DermiSphere. The patient was also receiving intralesional steroid injections to treat a hypertrophic scar. Because scar contracture had tethered the patient's lower lip to the chin, Dr. Spector and his team released the contracture and reconstructed the resulting defect using a full-thickness skin graft harvested from the submental region beneath the chin. Scar contractures occur when healing tissue tightens and restricts normal movement. Full-thickness skin grafts contain the entire dermis, making them less prone to secondary contraction than split-thickness skin grafts and a better option for areas where mobility and function are essential, such as around the mouth.

 


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