Face to Face by Jim McCaul

Author:Jim McCaul
Language: eng
Format: epub
Publisher: Transworld
Published: 2018-07-11T16:00:00+00:00

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AS THE NEW millennium unfolded I was now beginning to carry out proper facial surgery and assisting at major cancer operations. I was allowed to do the close on arms after flaps had been raised from them, and I was actually treating some skin cancers and facial traumas, and looking after patients with serious infections.

The first time I raised a flap to reconstruct the face myself, I was told to take it from a patient’s forearm. I was pretty nervous about it because a lot can go wrong when taking a flap from there, including damaging the motor nerves and muscles. You also have to anticipate where the important blood vessels will be, and it does vary quite considerably between individuals. In someone who has a physical job, or works out a lot, the muscle will have grown around the blood vessels, whereas a sedentary old person’s blood vessels will just meander in between the muscle layers.

I had been revising the anatomy the night before and was still doing so the following morning as I got ready to go to the theatre suite. Even when I knew the anatomy backwards, I still tended to walk into the theatre suite with a reference book – a sort of atlas on how to go about these things – under my arm, using it as a kind of lucky charm.

On that first time raising a flap, the consultant supervising me, Stuart Hislop, did his best to put me at my ease, saying, ‘You’ve got two hours, Jim, so there’s plenty of time. I’m here if you need me, but just take your time.’ I was reassured that he had confidence in me and believed I wouldn’t make a mess of it, and I knew that I could ask for his help if I needed it, so I got the tourniquet on the arm and cracked on with it. I managed to do it, and did it well, though I used every minute of those two hours, working slowly and carefully to make sure I got it right. These days I can do the same procedure in about twenty-five minutes.

The aim in surgery is obviously always to avoid mistakes and to maintain your concentration throughout, because a moment’s inattention can have potentially fatal consequences. So far in my surgical career I’ve avoided any disastrous errors, but towards the end of my surgical training there was a moment when I went on to autopilot, though luckily the only consequence was that we went for lunch a couple of hours later than normal.

As a surgical trainee, normally you’d dissect a flap ready for transplant but then leave it attached to the blood supply while removing the tumour with the other surgeon. Normally we’d all then have a break and come back in afterwards to complete the operation. However, on this occasion, having finished the preparation of the flap, I carried straight on and cut across the radial artery, severing the blood flow to the flap. I

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