Week 2 Jess Orton

This week I was able to shadow my clinical mentor, Dr. Jason Spector of plastic and reconstructive surgery, in both the operating room as well as the clinic. One thing I quickly picked up on is that Dr. Spector sees a variety of cases and patients. In the OR I saw everything from a double amputation of the legs, to tissue fillers being inserted into the head. Beyond operating on his patients, Dr. Spector is often called in to close up other surgeries or perform reconstructive work to ensure optimal healing and function. In the clinic, Dr. Spector saw everything from tummy tuck consultations and Botox injections, to the treatment of chronic wounds and pressure sores, and follow-up visits for a variety of previous reconstruction surgeries. We saw quite a few jaw/facial reconstructions which was interesting as we were able to see patients at a variety of states post operation- from 3-4 weeks ago, all the way to 9 years post-op. 

The patient 9 years out from her surgery had come back due to some episodes of swelling and pain in her face in the reconstructed area. Dr. Spector explained to us the procedure that she had undergone, which officially is called a free fibula reconstruction of the mandible without condylar restoration, but in layman's terms means they took two pieces of bone from her leg and used that to replace part of her jaw that was removed. He explained how he had worked with biomedical engineers to create a personalized plan for the patient's surgery using 3D modeling of her bone structure in the skull and fibula. The company then was able to accurately identify and create cutting guides for the best area of bone in the fibula to use to recapitulate the 3D geometric shape of the jaw (image left below, blue section). After the fibula is cut, the two new pieces of the mandible are held together and to the rest of the skull by a metal plate and screws (image left below, red section).

Upon examination of the inside of the patient's mouth, it was apparent that part of the metal plate was visible, indicating that this was likely the reason for the episodes of swelling and pain the patient was experiencing. Dr. Spector suggested that the patient undergo surgery to remove the metal plate, as the bone was fully healed now and the plate could only cause more harm than good left inside. While the technology used was more advanced than prior techniques, it still leaves room for improvement. Dr. Spector mentioned that he is currently collaborating on research using resorbable materials instead of metal plates for these types of surgeries, to avoid such post-op complications.

Outside of work I am still enjoying exploring NYC. I've managed to make it to a few different spots in Manhattan, see a Yankees game in the Bronx and take the ferry to Brooklyn. I hope to accomplish some more sightseeing this weekend and see some great fireworks of course.

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