September is Aneurysm Awareness Month, so I’ll be sharing various medical illustrations depicting them and their treatment each week. I created these images for the Microsurgical Basics and Bypass Techniques book, written by Evgenii Belykn, MD, PhD @ebelykh. It shows tandem clipping with fenestrated clip, placed to save an arterial branch in the fenestration window, and the wrapping of an artery bearing a small blister-type aneurysm #aneurysmclip #bypass #aneurysm #clipping #microsurgery #endoscope #bypasssurgery #vascular #pathology #medicalillustration #cintiq #wacomtablet #scienceart #medical #pathologyassistant #ortech #neuronurse #paschool #physcicianassistant #neuro #illustrators #artistsoninstagram #neurosurgery #photoshoppainting #digitalartists #pathological #surgical #techniques (at Phoenix, Arizona) https://www.instagram.com/p/CTUstbEl9MI/?utm_medium=tumblr
A revolutionary procedure could make donor organs available for more patients — regardless of their blood type. Researchers from the University Health Network in Toronto have proven that it’s possible to convert the blood type of an organ, creating a universal organ that would avoid rejection during transplants.
A 57-year-old man with life-threatening heart disease has received a heart from a genetically modified pig, a groundbreaking procedure that offers hope to hundreds of thousands of patients with failing organs.
It is the first successful transplant of a pig’s heart into a human being. The eight-hour operation took place in Baltimore, and the patient, David Bennett Sr. of Maryland, was doing well three days later, according to surgeons at the University of Maryland Medical Center.
It makes me so, so angry when I see those posts that are like “HORRIFYING EARLY PLASTIC SURGERY RESULTS FROM WW2,” because all of those lists are full of images that aren’t the final result and are used for pure shock value. Harold Gillies, who performed most of those surgeries, was an incredibly talented surgeon. Here are some images of the full results of his surgeries.
I need to emphasize that I can’t post the “before” pictures that go with these because the men did not have faces. The injuries were so extensive that these men were missing nearly all of their facial features, and through cutting-edge techniques that “looked scary” at the time (e.g. extensive skin grafts), Gillies saved these men from a medical nightmare.
Gillies performed the world’s first ftm bottom surgery for trans man Michael Dillon and pioneered mtf bottom surgery! Respect his legacy.
Not the same surgeon or procedure, but relevant to the topic. I always like to celebrate women in early medical fields because they were often overshadowed even by their assistants if they happened to be a man.
Here is a video of the masterful prosthesis work of Anna Coleman Ladd (1878-1939).
My final rotation of the year! It seems like yesterday that I was following a hand drawn map of the hospital to locate the ophthalmology room for my very first rotation. How far I’ve come!
On this rotation we began with a small group of four students (rather than the usual eight) which was then divided in half, with two students beginning on soft tissue and the other two on orthopaedics. I was assigned to soft tissue surgery for the first week and it was hectic! My buddy and I were run off our feet trying to complete the work of four students. We arrived at 7:30 each morning and didn’t leave until after 7:00 at night when our patient records were completed. Once home, our evenings were spent frantically researching surgical procedures to avoid looking like complete idiots when the specialists inevitably quizzed us the following day.
Students were assigned to cases and responsible for collecting a history during the initial consultation with the owner, performing a physical examination, scrubbing into the surgery, writing a detailed surgical report, looking after the patient in hospital, administering medications, overseeing wound care, recording vitals and the progress of recovery, and eventually discharging the patient. Our ultimate goal was to get our patients through all of those stages and discharged as quickly as possible, to minimise the number of animals in our care and allow us to leave the hospital at a semi-reasonable hour each day.
Although being a group of just two students meant that we had an insane workload to keep on top of, we did get special treatment in the form of being allowed to scrub into almost every surgery! Students in previous groups were lucky to scrub into five surgeries during the whole rotation, whereas I scrubbed into ten just in the first week! Even so, being specialist surgery, our job primarily consisted of passing surgical instruments and cutting suture material (which was never quite the right length). One day towards the end of the first week, the surgeon surprised me by letting me place two sutures: a simple interrupted and a cruciate. That was two more than my fellow student, so I counted myself lucky!
During the first week, I was involved with a huge variety of soft tissue cases (prepare for big words) including an abdominal hernia repair, ventral bulla osteotomy, two dermoid sinus removals, multiple wound repairs, adrenalectomy, thyroidectomy, melanoma removal and skin flap, tongue biopsy, emergency plication to correct an intussusception, gastropexy, and ovariohysterectomy.
The most memorable case from this rotation was a soft tissue sarcoma removal from the hind leg of an elderly Golden Retriever. The surgery was performed on Monday and I arrived early the following day to find her leg very swollen. Over the week, the leg continued to swell and her condition steadily declined. By Thursday her breathing was laboured and I could hardly hear a heart beat. Our patient was transferred to the ICU to spend the night in an oxygen tank. The following morning she was much the same, still struggling for each breath. The vets had tentatively diagnosed her with von Willebrand Disease, an inherited clotting disorder caused by a defective or deficient protein. This meant the swelling in her leg was likely pooled blood as a result of uncontrolled bleeding from the surgical site. The disorder had never been detected previously and so it was an incredibly unfortunate and unforeseen complication. On Friday evening I went to check on her before heading home and reached the ICU just as someone yelled, “SHE’S ARRESTED!”. The emergency team sprung into action and began CPR. Her owners were contacted and the decision was made to let her go. It was a devastating end to what should have been a simple mass removal. Everyone involved was deeply affected by her death.
At the end of the first week, the resident came to see us in the student tutorial room. He told us we had done a fantastic job and he really appreciated our help. The hard work of final year students is often taken for granted, so the few times people have acknowledged and appreciated my efforts have really stuck with me!
Just as we were beginning to feel comfortable with soft tissue surgery, Monday came around and it was time to switch to orthopaedics. New surgeries, new patients, new team. At least I still had my student buddy for support and entertainment. There was an interesting mix of cases on orthopaedics, including bilateral hip dysplasia, intervertebral disc disease, two medial patellar luxations, shoulder arthroscopy, stifle arthroscopy and joint tap, and many tibial plateau levelling osteotomies.
Over the two week rotation, we had several tutorials on wound management, brachycephalic airway syndrome, neurology and fracture management. On the last Friday we had a short exam, followed by an orthopaedic cadaver lab, where we practiced our surgical approaches to the hip and stifle joints, and performed a femoral head ostectomy (a procedure in which the head of the femur is cut off to remove the hip joint).
The last surgery finished late on Friday and the hospital was eerily quiet. It was the strangest feeling saving my final reports, packing up my belongings and preparing to leave the hospital for the last time. The four of us didn’t really know how to react. We congratulated one another on finishing and headed home in stunned disbelief, unsure whether to laugh or cry. We didn’t have much time to process these feelings before our minds became consumed with panicked thoughts of the impending exams. It was time to put our heads down and bums up for one final push to the finish line!
Schimmelbusch Anesthetic Mask were used in the Late 19th and early 20th century. It was invented by Kurt Schimmelbush, and first used in 1890.
The device consists of a wire frame which is covered with several beds of gauze and applied to the patient’s face over the mouth and nose. Then high-volatility anesthetic (usually diethyl ether or halothane, and historically chloroform) is dripped on it, allowing the patient to inhale a mix of the evaporated anesthetic and air.
Welcome back to Mangled Mondays, where every Monday we talk about another facet of maiming, mangling, mauling, and mistreating your main characters — and all of their friends.
Today we’ll be talking about Wound Care.For the rest of the Mangled Mondays series, [click here].
]Wound care is, in and of itself, an enormous topic. There are entire teams in hospitals dedicated to wound care and helping people heal.. To cover it in one chapter is a hopeless endeavor.
How to Clean a Cut
Cleaning a wound has two goals: getting out obvious pieces of dirt or other contaminants, and killing bacteria that are located in the wound. This is generally accomplished with irrigation (running sterile water or tap water through the wound) and application of an antiseptic. Antiseptics are materials, usually liquids, that are used to kill bacteria.
Antiseptics are actually pretty controversial in medicine, and it’s okay if your characters choose touse them, or choose notto use them. Neither answer is “right,” although if the wound has been exposed to something like mud or a dirty river, your characters will likely choose to use an antiseptic.
The argument in favor of using antiseptics is that they kill bacteria, which theoretically improves wound healing and is safer in the long run. Bacterial infections compete for nutrients with the damaged tissue and cause prolonged inflammation of the wound. This is especially true in characters whose immune systems are compromised or who may not have ideal circulation to the wounded area, such as diabetics or those with HIV.
The argument against antiseptics is that they may, on a cellular level, damage the tissue most in need of healing.
If your characters are going to use antiseptics on their wounds, they’ll likely use povidine-iodine (known in the biz by a popular brand name, Betadine) or hydrogen peroxide to clean their wounds. Alcohols aren’t recommended, becaeuse they tend to damage the cells of the tissue that’s trying to heal.
(It’s worth noting, by the way, that doctors are split over hydrogen peroxide for initial wound cleaning; the doctors who edited this book agreed that Betadine is better for ongoing wound care.)
However, whatever a character has always used is what they will reach for in their time of crisis.
Open or Closed?
When it comes to the decision to close a wound with sutures, time is an important factor.
A wound that remains open for 24 hours after the initial injury is actually better off staying open. It has a better chance of healing well on its own than it will if it’s closed after 24 hours, and many doctors have a hard 12-hour cutoff for wound closure. One guideline is that after 6–8 hours, wounds that aren’t on the face or scalp will be left open.
Missing Flesh or Bite Wound = Open Approach
The deeper the wound, the more likely an open approach will be used. That’s because closing a wound over missing tissue entraps bacteria and makes it likely that infection will develop where it cannot drain.
Bite wounds cannot be sutured for the same reason wounds that have removed chunks of flesh cannot be sutured: bacteria trapping can be fatal. Bites are especially prone to bacterial infection, because mouths are filthy, filthy places filled with bacteria. If your character chooses not to seek medical help for a cat or human bite, it’s particularly likely to get infected; a dog bite is less so.
Surgical Wounds = Drains
Surgical incisions into the chest or the abdomen typically have a plastic tube left in place to drain the wound in order to make sure that no fluid builds up in the cavity. Not only does this help prevent infection, it reduces the time it takes to heal and allows the staff to be certain that a wound is healing well on the inside.
If an incision and the underlying surgical wounds are healing well, the drain can usually be removed in 1–3 days.
This post is an excerpt from Blood on the Page Volume One: A Writer’s Compendium of Injuries. The book details thirty-one injuries with which to maim, mangle, and maul your characters, as well as nine indispensable articles of Wound Wisdom covering everything from burn stages to suture selection.
Print and digital editions are available on [Amazon], and digital editions are available [everywhere else].
Spend Less Time Researching and More Time Writing. Pick up a Copy of Blood on the Page Volume One.
