Video 1 Transcript
Okay, brief crazy story. This patient has passed away, so I can use his story now. Unfortunately, not from the incident, but from subsequent events. I was called to the ER from the OR, even though I wasn't on call. One of the surgeons desperately called and needed some help. The man was bleeding out, hemorrhaging from his face. He had received a crossbow arrow that entered underneath his zygoma, his cheek, and was sticking out underneath his other eye, and it had broken off. It's a very interesting story. After he got hit by the arrow, he drove himself in several different locations to try to get help from the fire department. A lot of bleeding happened, and he was able to drive himself and finally get help. I came down to the emergency room, and I was able to put my finger on the artery and stop the bleed. After I stopped the bleed with my finger, I asked for a Foley catheter. That's a catheter that goes up the urethra and is able to go into a urinary bladder. Well, they didn't have one. They had another larger bulb, and we were able to feed that into where the maxillary artery was bleeding. It's an artery that branches off the internal carotid that feeds the face. Well, that pressure tamponaded the bleeding, so we were able to stop the bleed so they could put more blood in the individual. Well, we attached this catheter to his face, bandaged him up. He stopped bleeding. We were able to send him off, and they do what's called an embolization, where they go up the femoral artery and are able to put a little coil or a little occlusion of the artery so he wouldn't bleed out. It saved his life for that moment. The story gets very complicated. It's in the paper, but I'll stop there for now and maybe add later on.
Video 2 Transcript
One of the more challenging otolaryngologic surgeries is called a total laryngectomy. That's where the cancer invades into the voice box or the thyroid cartilage inside that area and you have to remove that. So you take the airway and this food tube, you remove the airway and you connect the food tube with the mouth. So anything that goes in the mouth or nose goes into one solid pipe into the stomach and the airway gets pulled out to a little hole right here called a stoma. Well, that is a very challenging surgery. The complication gets to where the tumor starts to evolve and erode into the mucosa, which of the esophagus, which is part of the food tube. And if it does that, you have to surgically remove that. Now, getting that closed, you have to have a certain amount of tissue left to close it. If you don't, you have to figure out a way to close that and some ways of doing that is pulling the stomach up or doing that pec flap. The pec flap is taking a piece of tissue from the chest and with some of the tissues below and some of the arteries below fed by one of the arteries that feeds that flap. You have to tunnel it underneath the or over the clavicle. We go over the clavicle but underneath the skin of the clavicle and then we pull it up into that area, wrap the skin in a circumferential way and create a neopharynx or a new pharynx with that skin paddle. And yes, they can grow hair into their hypopharynx from that chest, but some of the tougher ones are more obese people or be because there's a lot of fatty tissue between the pec muscle and the skin and sometimes those blood vessels can get disrupted and then the pec flap dies and then you're in another difficult situation. But I had one of those cases. She lived another 10 years before she had metastatic other disease but she did well otherwise.
