Shadowing: Plastic Surgery

31 Jul

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After multiple shifts with plastic surgeons in the OR they take over after mastectomies or other cancers are removed.  They are called to the Emergency room to evaluate superficial , I appreciate not only their physical skill, but the variety of their patients trauma.  In clinic, they see those hoping for cosmetic fixes (closing a diastasis between the rectus muscles) and those needing long-term wound care from paralysis.  They also work on the damage caused by gunshots (sometimes while the patient is under police guard).

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In clinic the residents and medical students do a first pass with each patient, then the attending joins them to finish up.  Though a slow process, the teaching that occurs is obvious.  One particular case highlighted the need for remembering or reviewing anatomy.  The patient, a woman in her early thirties, went to the emergency department on the weekend.  She claims to have grabbed the wrong end of a “butter-knife” in order to cut some cake.  The cuts on her dominant right hand were located at the metacarophalangeal joints of fingers four and five.  After her wounds were cleaned she was asked to move each digit.  The pinkie finger would not comply.  The residents opened the skin wider to confirm the flexor tendons were intact.  While they saw and pulled on one, getting the appropriate response, at this site the superficialis divides and hides.  Though they stitched her up and expected all would be well in a week, at clinic the attending took one look at the straight finger and suggested surgery to repair a cut tendon.  The residents did no harm, and learned to be a bit more thorough even when called in on such a small injury.

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