The NSAA Journal

I have been recently working on a project that I am very excited about. I am going to be working on the National Surgical Assistant Association Journal as the editor-in-chief. We expect it to be out early next year and we are hard at work compiling articles, research, etc. for our inaugural issue. For any surgical assistants reading this, please fill out the following questionnaire as we will be publishing the results in issue #1. More details to come.

Reconstruction – Free Flaps

Since my last post I have graduated from EVMS and moved to start my career in Atlanta, GA. I am working for Lotus Surgical Assistants, a private assisting group that specializes in plastic and reconstructive surgery. During my training, plastics had always been my favorite specialty and I could not be happier here!

Plastic and reconstructive surgery explains two subsets of plastic surgery as a whole. Plastic surgery is the larger category with “reconstructive” being one aspect of that. The most common type of reconstructive plastic surgery is that of the breast, post-mastectomy. There are many ways to do so and the types of surgery that I have been doing the most of would include autologous tissue transfer. Autologous flaps would include the latissimus dorsi and TRAM flap which are beneficial to the patient by allowing use of autologous (the patient’s own) tissue to prevent rejection.

Tissue trauma is another large part of reconstructive plastic surgery. The means by which a defect or tissue deficit is closed follows the reconstructive ladder. Most of the time, a patient is able to heal on their own. However, as the complexity of the injury increases, further down the latter we must go until we reach the bottom.

A “free flap” refers to the autologous tissue transfer to a distant area of the body. The most important feature of this transfer involves the ligation and subsequent re-anastomosis of the flap’s blood supply. This method usually involves a very technical procedure of microscopic vascular anatomosis.

This is a skill that I am still trying to master as it is probably the most technically difficult part of my job. Assisting under the microscope involves very steady hands and patience. I have a few free flap cases coming up so I will update what I have learned after then.

The “X Lap”

Lately, I have been doing quite a bit of general surgery. One of the hallmark operations in general surgery historically has been the exploratory laparotomy, or colloquially known as the x-lap or ex-lap. This involves doing a large mid-line incision on the abdomen to gain access small/large bowel, mid gut, or pelvis.

This kind of exposure comes at a cost, though. The larger the incision, the more damage done and the higher risk of infection. These reasons are some of the many currently driving the demand for minimally invasive surgery. The choice of incision often is made depending on surgical history and the type of procedure being performed.

Celiac Trunk Mnemonics

Picture this: you were up late last night and got to rotations late this morning. Your preceptor has thrown you into a whipple with a surgeon who is a notorious “pimper”. You need a celiac trunk knowledge injection STAT. I have the medicine.

The Celiac Trunk is the first main branch coming off of the abdominal aorta. It has three branches of it’s own. Easy enough, right? WRONG, there is Lots Coming Soon. That is our first mnemonic, but I never like using one for these three main branches. They are so important that I just like to know them straight: Left Gastric, Common Hepatic, Splenic.

*keep in mind that the Celiac Trunk is prone to variation

Let’s get to the tough stuff first. The Common Hepatic is a “commoner”. He is a geek that lives in his parent’s basement and plays RPG games on the computer.

Right Gastric = supplies the lesser curvature of the stomach. Think of the right side of the stomach.

Proper Hepatic = runs alongside the portal vein and common bile duct to form the portal triad. It gives off a small supraduodenal artery to the duodenal bulb.

Gastroduodenal = has three branches. Are you SRS??? Yes I am SRS!!! Superiopancreatoduodenal ~ Right Gastro-omental ~ Supraduodenal

*the common hepatic’s anatomy can also vary.

Ok, not too bad yet right? That was the toughest one. The rest are a breeze!

The Splenic Artery has four branches. For this one, Some People Like Sayings, but I dont.

Splenic branches = supply the spleen itself.
Pancreatic branches = multiple branches serving the pancreas.
Left Gastro-omental= supplies the middle of the greater curvature of the stomach.
Short Gastric = supplies the superior portion of the greater curvature of the stomach.

*splenic artery aneurysm.

And last but not least, the Left Gastric Artery which is Easy as Heck with it’s Esophageal branch and Hepatic branch.

Now that you are all studied up go in there and assist with confidence! Oh and don’t nick the aorta!

The Art of the Resume

Only until after finding Jesse Desjardins blog did I realize how weak my resume was. This guy is a marketing and social networking genius who is also an e-philanthropist, sharing all of his work for free.

You Suck At PowerPoint!
View more presentations from @JESSEDEE.

Are the days of the “geek” over?

When I was growing up, there were things that were synonymous with “geekdom”. Pocket protectors, knowledge of computers, obsessions with certain cartoons, books, etc. During the later half the 00’s and now into the 10’s, the social irony of “hipsterdom” has all but annulled these prerequisites to be a geek. The guy in your class who was obsessed with computers and spent his weekends playing video games in high school is now a successful social networking entrepreneur, with a pretty wife to boot.

The straight lines that have separated the social classes in the high school world are becoming blurry and the days of the jocks and nerds are over. Determination, intelligence, charisma and skill are the keys to one’s success and with the social barriers coming down, geeks are as confident as ever to let their “freak flag” fly.

So tomorrow when you go into work, take a look at your superiors and imagine where they fell on the social spectrum in their teenage years.

Congratulations Mark Zuckerberg on being named Time Magazine’s “Man of the Year”.

Basic Metabolic Panel & Complete Blood Count “Fishbone Diagram” Explained!

I made this diagram today explaining the BMP/CBC “Fishbone” diagram. This is a short-hand way of writing essential labs for a patient. It can often confuse those who are not familiar with it so I made a diagram explaining each of the abbreviations and their respective values.

Feel free to use and share!

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It was also designed to fit perfectly as an iPhone “lock screen” wallpaper.

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This can also be found under the “links” tab at the top of the page.

Transplant Surgery

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Transplant Surgery has become a recent interest of mine. One good thing about my current location is that the medical center offers many different types of transplantation surgery. If you are interested in transplant surgery, here is a list of approved transplant centers in the United States and their specific distinctions.

Oh, and you never know when having a spare pair of gloves will come in handy! This weekend I witnessed a car vs. motorcycle accident and went to help the gentlemen who was in the crash. He suffered some cuts and what looked like a broken ankle but was lucky. Make sure to always wear a helmet!

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First Rotation Finished.

My first rotation is finished. It consisted mainly of Orthopedics, Plastics, General, and some ENT. I start a new one on Monday and hope to get some more Vascular and Neuro. There is still a lot I have to learn but I am getting more confident with each case. Humility, hard work, and showing an interest are the most important things for setting up opportunities for you to learn. You get what you put in.

Here were my Top 25 cases for rotation #1 (email for the name of the location).

26 27447 ­ ARTHROPLASTY, KNEE, CONDYLE & PLATEAU; MEDIAL & LATERAL COMPARTMENTS, W/WO PATELLA RESURFACING
12 19357 ­ BREAST RECONSTRUCTION W/TISSUE EXPANDER, IMMEDIATE/DELAYED, W/SUBSEQ EXPANSION
7 19350 ­ NIPPLE/AREOLA RECONSTRUCTION
6 19367  BREAST RECONSTRUCTION W/MYOCUTANEOUS (TRAM) FLAP, SINGLE PEDICLE W/CLOSURE DONOR SITE
6 19303 ­ MASTECTOMY SIMPLE COMPLETE
6 19307 ­ MASTECTOMY MODIFIED RADICAL W/AX LYMPH NOD W/WO PECT/ALIS MIN
5 19380 ­ REVISION, RECONSTRUCTED BREAST
5 27130 ­ ARTHROPLASTY, ACETABULAR/PROXIMAL FEMORAL PROSTHETIC REPLACEMENT, W/WO
AUTOGRAFT/ALLOGRAFT
5 27134 ­ REVISION, TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, W/WO AUTOGRAFT/ALLOGRAFT
5 29827 ­ ARTHROSCOPY, SHOULDER, SURGICAL; W/ROTATOR CUFF REPAIR
4 15847 ­ EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABD
4 57284 ­ PARAVAGINAL DEFECT REPAIR (W/REPAIR, CYSTOCELE)
3 38792 ­ INJECTION PROC; IDENTIFICATION, SENTINEL NODE
3 58150 ­ TOTAL ABDOMINAL HYSTERECTOMY W/WO REMOVAL TUBE(S)/OVARY(S)
2 15830 ­ EXCISION SKIN & SUBQ TISSUE ABD PANNICULECTOMY
2 19101 ­ BX, BREAST; OPEN INCISIONAL
2 19370 ­ OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST
2 20680 ­ REMOVAL, IMPLANT; DEEP
2 26536 ­ ARTHROPLASTY, INTERPHALANGEAL JOINT; W/PROSTHETIC IMPLANT, EACH JOINT
2 27477 ­ ARREST, EPIPHYSEAL, ANY METHOD; TIBIA & FIBULA, PROXIMAL
2 29823 ­ ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE
2 29824 ­ ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY W/ARTICULAR SURFACE
2 29826 ­ ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION, SUBACROMIAL SPACE W/PARTIAL ACROMIOPLASTY
2 29828 ­ ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS
2 29883 ­ ARTHROSCOPY, KNEE, SURGICAL; W/MENISCUS REPAIR, MEDIAL & LATERAL
Oh and any guesses as to whether this patient has any problems with walking?

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Orthopedics Week!

This week was dominated by total knee/hip arthroplasties and arthroscopies! I also did some GYN, which I did not expect to enjoy so much. Great anatomy and very hands-on! They let the students do a lot of hands on stuff (dissection, clipping, suturing, etc.). All in all, a good week.