What's it like?

What's it like, you may ask, to use part of someone's forehead to reconstruct their nose? What's it like to reconstruct someone's jaw by using a bone from their lower leg? What's it like to cut off someone's ear? Well, listen up and I will tell you...

During my month on the Ear, Nose, and Throat Surgery service, I had the joy of participating in some big time surgeries. Although my hours during November were terrible, I look back at the month and am happy I chose ENT as my specialty.

One memorable patient was a middle-aged gentleman who had Mohs surgery to remove a skin cancer from his nose. Unfortunately, his cancer was extensive, and by the time the dermatologist excised the entire lesion, he was missing a large segment of his shnoz. Fortunately we had the answer: the paramedian forehead flap. In the initial surgery, we cut a segment of the patient's forehead and rotated it down to cover the defect in his nose. In 5 weeks, we will bring him back to the OR to sculpt his nose into something that will look remarkably like his nose before surgery. Although the first surgery leaves the patient looking rather deformed, subsequent surgeries leave the patient looking great.

Another patient we operated on last month was an 18 yr-old girl who had blown off a portion of her face with a shotgun in a suicide attempt. A large chunk of her mandible was missing, so we reconstructed it with a fibular free flap. This involved taking a segment of her fibula along with its blood supply and using it to recreate the missing segment of her jaw. The transferred bone is kept alive by plugging in its blood supply to an artery and a vein in her neck. The surgery started in the morning and went until after midnight. As the intern, I was designated to close the leg wound after the flap was raised and to sew in the skin graft. In November, I think I did about 6 of these surgeries, so I jokingly became known amongst my colleagues as the fibula specialist or "fibulologist." I would get pages from nurses in the OR that would say "they are ready for the fibulologist in OR #4."

Another old guy came in with a cancer involving his ear and ear canal, so we had to do the unthinkabkle--chop his ear off. It is a weird feeling to cut off a man's ear, no matter what the indication may be. I would hope that any of you reading this would pay close attention to you faces and skin and go see a doctor before things get out of hand. Not that I don't enjoy cutting off ears and noses and reconstructing faces, but I would rather not see it happen to someone I know.