Week 4: BBQ in Brooklyn

This week, I saw an amputation. An 86 year old woman presented with gangrene in her left foot. I was surprised to know that there are actually two forms of gangrene: wet and dry. Previously, I just associated the term with infection or something really unpleasant. Dry gangrene is a necrosis of the tissue brought on by insufficient blood supply. Wet is more common when blood supply is blocked, leaving stagnant blood to form a bacterial breeding ground. I know those sound similar, but just think no infection vs. infection. The procedure I observed was in regard to dry gangrene and required amputation just below the knee. I'm not sure if it is common practice to go that superior for a foot amputation or if I missed out on additional considerations. Personally, I found the time leading up to the procedure (i.e. wheeling the patient into the OR, delivering anesthetics, etc.) more interesting than in previous cases. Mostly because the only thought I could muster was, "this person will not have their leg in a few hours." I also kept wondering what it must be like to wake up from such an operation. Dr. Lane actually answered that to some extent by taking a minute or two out of surgery to explain how limb salvage (prosthesis) patients and amputation patients compare post-operatively. Not surprisingly, amputation patients are in a bit more pain and emotional distress after their procedure. But when comparing a "bad" limb salvage procedure to a "bad" amputation, amputation patients are better-off post-operatively. I place "bad" in quotations because I don't really know how that was assessed in the study Dr. Lane was referring to. The surgery itself was interesting to watch. Dr. Lane and his assistants identified specific nerves and arteries that needed to be cut and tied before cutting the bone. A posterior flap was also created to cover the remaining tissue and a specialist was brought in to lead this conclusion to the operation.

Additionally in the OR this week, I observed a hernigou procedure, in which stem cells are isolated from a patients own blood marrow and implanted into a poorly healing fracture site with a demineralized bone matrix. Similar to the kyphoplasty, this procedure is guided by x-rays so there wasn't too much to observe at the surgical table. A lot of the action was going on at a cart that was supporting what I believed to be a centrifuge, or something analogous that separated the stem cells from the blood plasma. 

In the clinic I saw a few patients, but I've been spending more time working on the case study regarding Dr. Lane's Stanmore prosthesis patient. We are setting him up to have a gait analysis performed at the Motional Analysis Lab, with the intention of periodical assessments to track his progress. He's actually coming in this week so I'm excited to potentially see more of the rehabilitation aspect of HSS.

Lastly, Happy Birthday America! Thanks for a great time in Brooklyn. Oh, and also for teaching me that Jay-Z got his name from the J and Z subway lines. I was so ignorant...