Things are starting to wrap up at the hospital, now that there are only three weeks left in my project. I’ve had almost everyone in the office, surgeons and their assistants alike, come in to do at least one pair of anastomoses to compare to each other. As a reminder, each participant is doing one anastomosis with smooth sutures, and one with barbed sutures. One external variable that could possibly affect the results is the fact that a task or procedure will almost always be easier the second time a person does it. Since the participants cannot do both anastomoses at the same time, we had to find a way to minimize this effect. So everyone completed a practice session to get the first simulated anastomosis out of the way, while getting used to the tools. This way, the participants would have started moving along the learning curve before they were timed. To further minimize the effect of the learning curve on the data, some of the surgeons have thankfully been able to set aside enough time to do a second round of time trials. So far, both surgeons and physicians’ assistants have been suturing more quickly with the barbed sutures.

However, the material and length of the barbed sutures have been a bit cumbersome for some of the surgeons. For example, some suture material has more “memory” than other material, which means it maintains its shape if it is bent, similar to how a piece of paper will remain bent if it is folded in half. This can cause annoyances while using the suture, because it will bounce back to its previous position if one lets go of it. The length of the suture can also be an issue when using it laparoscopically, since one always wants to keep the material and tools within the camera’s field of view.

In other news, I was able to watch Dr. Workman, the pediatric plastic surgeon, during some of her cases this week. On Friday, she had a surgery on an infant who had been born with radial deficiency. Radial deficiency is a congenital condition in which there is a lack of length in the radius, one of the bones in the forearm. The shortened radius causes radial club hand, in which the wrist is angled toward the radius, usually accompanied by a deformed or missing thumb. In order to straighten this baby’s wrist, Dr. Workman first opened up the wrist and moved all the tendons and ligaments out of the way. She then drilled a rod all the way through one of the metacarpals, entering the bone in the wrist and exiting it near the fingers. She then switched to the other side of the rod and drilled it into the radius. To finish, Dr. Workman cut off the extra part of the rod and closed the muscle and skin. Now, the rod is acting as a longer radius, effectively keeping the baby’s wrist straight. She also said that, in 6 months, she would be able to make a new thumb for the infant from its index finger.