Week 4: Lighter week, heavier cases

This week was relatively light, so I'll discuss a few cases from clinic and summarize happenings in the OR and in lab.

One clinic case was a patient coming in for Botox and Juvéderm injections. I've talked a little bit about Botox before, so I'll describe Juvéderm here.. Juvéderm is an injectable hydrogel filler composed of hyaluronic acid (HA). It is used to fill defects, folds, and hollow spaces in the face, and for lip augmentation. For this patient, it was used to give the lips a plumper appearance and to decrease the appearance of the nasolabial folds (the lines running from the edges of the nose to the edges of the mouth). HA is absorbed by the body in about half a year, thus patients must come back for repeated injections. Unfortunately, it is an expensive product, and Dr. Spector is hoping that a cheaper (yet just as effective) alternative can be synthesized (polymer chemists.. a potential BME collaboration?).

We also consulted another patient with silicone injections from about 40 years ago, this time in the face, who was looking to have them removed due to a recent large inflammatory reaction. They did not hear what they were hoping to. A bit of background: in the seventies, silicone injections were all the rage, but their negative effects are just starting to emerge in patients. Silicone causes inflammation in the body, and over time, the particles in free injections (non-encapsulated) spread diffusely throughout the tissue. As a consequence, mild yet sustained inflammation remains around the injected area which can be provoked upon any greater disturbance (wound, inflammation, etc. in this case, the patient had applied a new skin care treatment largely composed of fibroblast conditioned medium). Patients come in to the clinic with pain and discomfort, but there is no easy surgical solution to this problem, as the silicone is so diffuse that it can only be see at a micro scale, and has likely infiltrated a large area of tissue. As opposed to encapsulated silicon (e.g. silicone breast implants), the injected silicone cannot simply be removed without requiring reconstruction of the tissue, leaving few treatment options until it becomes necessary to act (i.e. draining wound, necrotic tissue in the area). Dr. Spector refuses to operate on patients unless this is the case, and when they are disappointed to hear this, he always tells them to get a second opinion. He also reminds them that as someone who makes a living off of performing surgery, his refusal to operate is probably a sign that this is for their own benefit.

Last clinic case: a patient came in with an oozing scar on their scalp from neurosurgery many months ago. From a recent fall, they also a ~3 cm wound on their leg. A glioblastoma multiforme (GBM) patient, they had previously been irradiated and were currently on Avastin (i.e. bevacizumab, an anti-angiogenic therapy) and dexamethasone (anti-inflammatory and immunosuppressant). Unfortunately these treatments all interfere with the wound healing process, and there is little Dr. Spector could do but prescribe topical treatments for the wounds to prevent infection and promote closure. Still it is unlikely that either will fully heal, and the best course of action from here is just to monitor the wounds and prevent any worsening in their condition.

In the OR this week: Dr. Spector did a breast implant exchange (it is more difficult to reduce breast implant size than increase, and round implants may have greater success than shaped ones). The team did another debridement of the buttock wound we have been treating and also closed it by reducing its size (sutured skin edges together) and placing a skin graft over it. The patient whose leg/foot/ankle wounds were covered with integra last week got skin grafts this week, after an orthopedic surgery team from HSS (Dr. Fragomen) came in to fix the ankle joint with pins via x-ray guidance.

In lab this week: I learned to make sacrificial microfibers for microvessel constructs, made my first construct, and thawed some more cells in to prepare for experiments.