Very true statement from Dr. Cat @beautybydrcat Make sure to follow her. Her account is one of the most inspirational #girlboss on IG. Plastic Surgeon, Harvard graduate, entrepreneur, wife, and mother.💕 @beautybydrcat
Ascending thoracic aorta dacron graft interposition!! Several abnormalities of the ascending aorta and aortic arch, including aneurysm and dissection, often require urgent surgical treatment. By definition, an aneurysm is a localized or diffuse dilation of an artery with a diameter at least 50% greater than the normal size of the artery. Aneurysms that involve the ascending aorta may extend as far proximally as the aortic annulus and as far distally as the innominate artery, whereas descending thoracic aneurysms begin beyond the left subclavian artery. Arch aneurysms are as the name implies. Dissection is another condition that may affect the thoracic aorta. An intimal tear causes separation of the walls of the aorta. A false passage for blood develops between the layers of the aorta. This false lumen may extend into branches of the aorta in the chest or abdomen, causing malperfusion, ischemia, or occlusion with resultant complications. The dissection can also progress proximally, to involve the aortic sinus, aortic valve, and coronary arteries. Dissection can lead to aneurysmal change and early or late life threatening rupture. Surgical repair may involve endovascular stent grafting (in suitable candidates) or traditional open surgical repair using a graft, commonly a synthetic graft composed of polyethylene (Dacron). The one shown above is a Dacron sleeve around the dilated ascending aorta. This is a simple technique that allows the ascending aorta to adopt the shape of the dacron tube graft which avoids wrinkle formation, dislocation and erosion. In patients with only mild dilation, placing a dacron graft without excising the aortic tissue preserves the original tissues of the ascending aorta giving more strength and smooth endothelium internally.
I highly advise you to follow @pance_panre_usmle_review . . He posts weekly medical questions, interesting case studies, and has one of the most unique pages on IG! . . Check out his page @pance_panre_usmle_review for the answers and in depth explanations :)
Cut in half! Case of a utility knife accident where the knife slipped and cut the patient deep into the thumb! When performing procedures on the hands and upper extremities, many options are available for anesthesia. Regional anesthetics have a unique application for this kind of procedures, the most frequently used is the digital block, where you block nerve branches by applying anesthetic at both sides of the finger also called Oberst block. Although most surgeons would use traditional suturing, alternatives to sutures are often needed, such as techniques for evaluating and closing wounds in difficult-to-treat areas so as to minimize the risk of any adverse consequences and maximize the chances of a good outcome. What’s the best way to treat in your opinion?
Tummy tuck surgery, also known as abdominoplasty, removes excess fat and skin and, in most cases, restores weakened or separated muscles creating an abdominal profile that is smoother and firmer. The most common cause of abdominal deformity is pregnancy (often multiple pregnancies). Pregnancy stretches the skin beyond its biomechanical capability to spring back and stretches the musculoaponeurotic structures of the abdominal wall. The result is stretching and thinning of these structures and diastasis of the rectus muscle. Massive weight loss, whether from dieting or a gastric bypass surgery, also plays a role in excess skin and laxity of the abdominal wall. No surprise, the most significant area of the defect is around and below the umbilicus, where the excess skin is most apparent. Abdominoplasty removes not just the excess fat and skin and, but in most cases, restores weakened or separated muscles and tightens then to create a smooth and firm abdominal profile. Video credit @drmiamiland
Left nephrectomy performed for a patient who had Polycystic Kidney Disease (PKD)!! In PKD, clusters of fluid-filled sacs, called cysts, develop in the kidneys and interfere with their ability to filter waste products from the blood. The growth of cysts causes the kidneys to become enlarged and can lead to kidney failure. The main feature of PKD is a bilateral progressive increase in the number of cysts, that may lead to end-stage renal disease due to destruction of the parenchyma, which eventually necessitates the surgical removal of the kidney and transplantation. The disease is inherited with an autosomal dominant pattern, but cysts are not usually present at birth, they develop slowly over time, so the onset of renal failure occurs in middle age to later adult life. Patients experience hypertension and chronic renal failure, but they may also experience experience cyst hemorrhage, renal infection, or nephrolithiasis (kidney stones). A non-invasive, reliable and inexpensive diagnosis is made by ultrasound and the treatment is no other than removing the kidneys and performing a transplantation. Photo by @gingerlyn3
Intense photo of patient that got his hand stuck in a wood grinder!! The injury happened when the operator lost control of the grinder as a result of his taking one hand off it whilst it was still turning at high speed. He had taken one hand off the grinder because he was attempting to prevent the piece of wood on which he was working from falling when it came out of a support stand. The grinding wheel was still turning at high speed and the gyroscopic precessing force acting on the tool was too great for the operator to handle with one hand. This led to the grinder being deflected into his other arm causing an injury. Fortunately maximum restoration of the injured hand can be accomplished by careful extrication, followed by preservation and reconstruction of all viable tissues. Perioperative antibiotics and wound irrigation with antibiotic solution are recommended.
Smokers’ lungs for transplant!! These lungs were donated for transplant by a 55-year-old with an extensive smoking history. As you can see, there are visible tar deposits within the lung tissue but it was still able to be used for transplant. A shortage of organ donors for lung transplantation leads to significant mortality among patients on the wait list. To deal with the shortage of donor lungs, transplantation specialists have turned to multiple strategies, including use of lungs from extended-criteria donors, such as smokers, including heavy smokers. A smoking history of
Grow an ear? Challenge accepted! Doctors have attached a new ear to a patient that was grown on her own forearm! In 2008, Sherrie Walters was diagnosed with a rapidly spreading and aggressive basal cell cancer, and had to have part of her ear, skull, and ear canal removed. But she has been the first patient to receive a new procedure that uses rib cartilage to build an entirely new ear. It was attached to the forearm under a piece of expanded skin. There it was allowed to grow for several months until surgeons deemed it ready for the transplant to her head. This fascinating approach adds to an expanding body of research into artificially grown human replacement tissues and organs. It is relatively early days for this technique, but research is moving fast in this area and we will undoubtedly hear more about it in the future. How incredible! Reconstructive surgery like this is just one of many innovative medical advances that we can expect to witness moving forward.
Globular heart from a patient with sickle cell anemia!! This very large heart has a globoid shape because all of the chambers are dilated. It felt very flabby, and the myocardium was poorly contractile. This is an example of a cardiomyopathy. This term is used to denote a disease where the heart muscle (myocardium) becomes weak and unable to contract with sufficient force (decreased contractility leading to a decreased stroke volume) to provide adequate perfusion (reduced cardiac output) for the cells of the body, but there is no specific histologic finding. Dilated cardiomyopathy is a progressive disease of heart muscle that is characterized by ventricular chamber enlargement and contractile systolic dysfunction with normal wall thickness. The right ventricle may also be dilated and dysfunctional. Patients experience fatigue, dyspnea on exertion, shortness of breath, cough, noctural dyspnea (at night) and orthopnea (dyspnea when lying flat). Diagnosis is made by echocardiogram, which typically shows dilated ventricles with diffuse hypokinesia resulting in a low ejection fraction (I.e. systolic dysfunction). Treatment is largely supportive, and mainly involves the management of symptoms caused by congestive heart failure with ACE inhibitors, beta blockers, angiotensin II receptor blockers and nitrates. Cardiac transplantation is an option for patients with severe heart failure, and a left ventricular assist device, or LVAD, may help to bridge a patient while awaiting transplantation.
One nasty dog bite and 16 stitches later! An 18 year old, a 110 pound dog, no internal damage, just one battle scar and an incredible stitch work from an ER doctor! Sliced lip in half from corner all the way down to the lateral jawline or mandible. Healed up version is shown on the last picture, just 2 months post incident. Credit to @adamphifer