Vascular surgery

Long, long days is what I have to say! We start at 4:30am and go until 8:00pm without any real breaks. You have to find time to go to the bathroom. Today was a clinic day. We saw all kinds of patients with vascular disease. Many of these patients have wounds that will not heal on their feet or legs. The wounds will not heal because they lack the proper circulation due to their vascular disease. See the pictures to the right. This is a patient's foot that I treated today. He had a right hallux (big toe) amputation due to an ulcer that turned gangrenous. He needs vascular repair surgery or he will eventually lose the limb below the knee. We are working him into next week's surgery schedule. Many of these patients are diabetic. If they do not receive a vascular repair surgery to restore blood flow they will end up loosing their limbs. 

You can imagine that these wounds that are not healing have some magnificent aromas. Today I had to change so many foul rotten dressing. Once I removed the bandages I then had to asses the wound and debride (cut out) and gangrenous tissue. Then I would write a prescription for antibiotics if there was a true infection. Some of these patients had already had part of their limbs amputated. Some of the ulcers were pretty foul. This type of clinic work is the worst part of the vascular surgeons job. They like to be in the OR like all the rest of the surgeons but inevitably they have to evaluate and follow patients in clinic.

The fun / better part of vascular surgery is life in the OR. What does the vascular surgeon do in the OR? They will do surgery involving vessel repair (arteries and veins) anywhere in the body. Often they will not do the vessel work directly on the heart. The hart procedures are done by cardiovascular surgeons. Often smokers, diabetics and or the aged patient will have vessels that have become occluded. This compromises circulation of blood to vessels which causes ischemia and death of the affected tissue. The vascular surgeon will take the occluded part of the vessel and either put a stent in or replace it with a vessel graft. They do a lot of rerouting of the vessels. Theses surgeries are great and help the patients quality of life by preserving a limb and getting rid of the associated pain that these patients have.

Tomorrow we are in the OR. We have a patient who has a tumor on her kidney that has grown all the way up her vena cava (big vein that carries deoxygenated blood) to the right atrium of the heart. Vascular, Urology (for the kidney) and Cardiovascular (for the heart) are all working together on this surgery. The surgery will take all day and involve many areas of the body. It will be great to see all the anatomy and I should be able to do some of the cutting and suturing. Tomorrow will be a long but interesting / fun day. I have to study up in all of my anatomy and surgical technique for this surgery as I will be grilled and tested throughout the entire surgery. Sometimes if you answer the questions incorrectly or do not know the answers one of the surgeons my kick you out of the OR to go and study. Hopefully we do not have any of these megalomaniac surgeons on the case tomorrow. Even if there is I can usually win them over with some humor and they tend to look past any questions that I can't answer. They keep me around for comic relief.