Surgery @ UMC

*Disclaimer: there may be some information that might be considered gross and might make some a little squeamish.

Okay, so I know I just posted yesterday, but I wanted to talk a little bit about the surgeries I assisted with today at UMC. Dr. Williams goes to UMC on Fridays. Unfortunately for me, this was the only Friday this month that he had anything scheduled there. I was able to be first assist for 4 different surgeries, place a pin, and do some stitches. So here is the run down of what happened today.

I got there early, around 7:00. Dr. Williams has the student take the pre-op H & P (history and physical). I wanted to get it done by 7:30 (when the first pt was supposed to go back for surgery). Well, I was working on it when Dr. Williams came in. I was surprised to see him because he is usually a little late. Anyway, we got it done and were ready to go and we waited, and waited, and waited, and waited. Turns out the 1st pt of the day didn't want the anesthesiologists that they have at UMC, so we had a guy from a private practice coming apparently, nobody told him that the surgery had been changed from 8:30 am to 7:30 am. So we waited an hour for him to show up, putting us and everybody else slightly behind. :)

The first surgery was a CTR (carpal tunnel release) along with a cubital tunnel release (elbow area). These two procedures free up the median and the ulnar nerves respectively. This pt was having weakness in the arms and pain and tingling in the ring and little fingers. It was a cool procedure. I've seen probably 5 or 6 of these done this past month. The cubital tunnel release requires that they shave off part of the bone that surrounds the ulnar nerve (the medial epicondyl). This helps free things up so the nerve can move freely. I was able to help suture the pts carpal tunnel incision.

Surgery #2 was the removal of osteophytes (bone spurs) on the 2nd, 3rd, and 4th digits at the DIP joint (joint right below the fingernail). This required some rather large incisions shaped like a capital Y. The skin was pealed back and then an instrument, kind of like pliers, was used to removed the osteophytes. Dr. Williams let me suture the incision on the ring finger. Pretty cool. It took me awhile, he finished his two in the time it took me to finish my one but oh well, he is very patient and a good teacher.

*So the picture is not from the actual surgery, just something to give you an idea of what we did, there was only one pin and wire surrounding the bone.

Number 3 was a young male that claimed he had broken his hand 2 weeks earlier. The X-rays showed an old fracture of the 3rd metacarpal bone (the bone in the palm of the hand) and it had a fragment of bone that was joined at the top of the bone, but pointing out as it moved towards the bottom. The doctor made an incision, located the old break and re broke the bone so that he could put the part that was sticking out back in line with the rest of the bone. He then wired it together. The next part was the exciting part; the placement of the pin. Dr. Williams let me do it, he of course guided me, but I was operating the drill. The X-rays taken after the placement of the pin showed that everything was in alignment. Pretty good for my first time. Okay, so it wasn't all me, definitely couldn't have done it by myself, but it was still a great experience. After Dr. Williams closed the inside, I placed the interrupted sutures along the outside.

The 4th surgery was the removal of a sebaceous cyst located on a pts face. It had been there for about 2 years and was the size of a golf ball, located lateral and inferior to the eye. I can't believe it took the pt this long to get the thing removed. I just watched this one, but yeah, sebaceous cysts are really gross, especially when they are punctured. Two years worth of oil and pus (looked a lot like cottage cheese) came out. Sorry for the comparison, hope it doesn't give anybody an aversion to cottage cheese. This pt was closed up and a drain was placed.

Okay, so that was it for the day. Really a great day. I wish that I had more opportunities to operate at UMC with Dr. Williams. He is a great teacher and very patient. He told me (I'm going to toot my own horn here) that I was better than probably 90% of the students that he has come in and suture. Thank you, thank you very much. I can hear the applause. :) He asked me if I had sutured before and I informed him that my dad was a veterinarian and had taught me a little and let me practice on some dogs he had operated on. He said my technique was great and he could tell that I had learned how to handle the instruments. He said my dad must be a good surgeon. Good job DAD!!!! Praise from one of the best hand surgeons in the west (you rock). So that was it. I will give a synopsis of the entire rotation next week, but there was my UMC experience. Hope everybody else has as great an experience as I did.