Surgery Godfather - Chapter 32
Chapter 32: Chapter 0031: The Effort is Under the Stage
“Senior Brother Yang performs fracture surgery so well too.”
“Collarbone fracture, very simple, I can perform it as well.”
“Can you do it in 6 minutes?”
“—”
Song Zimo sits silently on the side.
For this guy to perform so many collarbone surgeries, one would think he only knew how to handle amputated fingers.
He avoids and protects even the cutaneous nerves on the collarbone. Many doctors don’t pay attention to such details, especially when making a horizontal incision. With a swipe of the scalpel, the cutaneous nerves are severed, causing numbness around the site of the operation after surgery. Numbness is a small issue, not a big deal.
The hemostasis is extremely well done; hardly any blood could be seen on the gauze. The dissection of the periosteum was minimized, maximally protecting the blood supply of the fracture.
Secondly, comminuted fracture of the collarbone, should not look down on any fracture surgery. Because there will never be two identical fractures, trauma orthopedics challenge one’s adaptability.
The collarbone was not only broken into several segments, but each segment was also divided into several pieces, front and back. Doctors are often left embarrassed trying to fix these fractures. Some doctors are forced to rush and barely complete the operation.
Completing a surgery and doing it well are two different stories. High-quality operations have fewer complications and have better post-surgery recovery.
“This is difficult!”
Looking at the shattered fragments of bone, even some experienced attending physicians expressed concerns.
Old Han looked at the X-rays on the view box. It was indeed difficult.
The surgery has started the fracture reduction. Everyone sharpened their focus, with Song Zimo fully concentrating as well.
Let’s see how he deals with this type of fracture, or how he perfectly manages it.
With Song Zimo’s experience, he recognized that seeing Yang Ping handle the first collarbone surgery was not something one could achieve after a few or even dozens of operations. He believed that Yang Ping could handle it, but he was curious how he would perfectly handle it.
1.2 mm Kirschner wire, the steel wire used this time was even thinner.
The forceps were carefully holding the bone fragments, very steady, as if it were holding an egg securely without putting too much pressure and crushing it. Even if there was a bit of soft tissue left, it was gently retained.
First the big pieces, then the smaller ones.
Horizontal, vertical, oblique, almost every piece of bone had a thin steel wire.
Once the bone fragments were assembled, the shape was restored.
“How to put the steel plate, these will interfere with the placement.”
Someone frowned.
The steel plate was shaped, and then placed. This time it was placed on the front side. Most of the steel wires avoided the steel plate; two could not avoid but just passed out from the hole of the plate without affecting the placement of the plate.
The location of each inserted wire was pre-planned, taking into account the placement of the steel plate, and everyone suddenly realized.
The placement of the screws, the direction of the screws in each hole is different, each will hold a piece of bone. Each time a screw is implanted, at least one wire is removed. After the last screw is implanted, the wire was completely pulled out.
The fracture was reduced nicely, and it was securely fixed.
Old Han smiled slightly, handling it with seasoned skill. He had spent a lot of time and effort to figure out how to address the interference between temporary fixation and final fixation. It seemed this young man had also put in a lot of work.
Song Zimo was satisfied. Behind the simplicity, a lot of effort was often required.
Another way to put it: one minute on stage, ten years off stage.
The entire process reflected the philosophy of protecting the blood flow at all times. Even some bone fragments with a little soft tissue, which could be pulled off with a slight movement, were still protected.
Bone fragments attached to soft tissue have blood supply, and are therefore living bone, while those not connected to the soft tissue, completely separated, are effectively dead bone. Living bone has healing ability, dead bone doesn’t, it can only rely on the growth of living bone to replace it.
After fifteen minutes of cleaning and sterilizing the operating room, the third operation was about to begin.
This operation involved exploring the blood vessels and nerves beneath the collarbone, which was already classified as a Level 4 surgery.
This type of investigation is a high-risk operation.
Old Han was a bit worried about the third operation.
Once it involves exploring of blood vessels and nerves, it’s no longer a simple collarbone fracture operation. The stubborn old heads in the expert group won’t take it lightly in their evaluation, they would find fault even in the trivial things.
“The tip of the fracture has pierced the blood vessels and nerves under the collarbone, be careful with the exploration, especially the bone fragments, don’t move them easily. After exploring clearly, prepare for hemostasis and then remove the bone fragments. The blood vessel end may retract as soon as the bone fragment is removed, and if bleeding has to be stopped by opening the chest, it’s troublesome.” Old Han reminded Yang Ping.
Old Han was experienced, he didn’t need to sit here all the time. His purpose was to see how Yang Ping’s orthopedic surgical skills actually were and provide timely guidance to Yang Ping while ensuring patient safety.
The exposure was standard; a usual transverse incision was made to facilitate the exploration of blood vessels and nerves under the collarbone.
Below the collarbone, on the outside are blood vessels and nerves, extending to the upper limb. On the inside is the apex of the pleura and lungs, which is the top of the thoracic cavity and lungs.
If the pleura is punctured, it could lead to pneumothorax, requiring intervention from the Thoracic Surgery Department.
The exposure in orthopedic surgery is crucial, with many operations passing through numerous blood vessels and nerves, and some even passing through the viscera. These blood vessels, nerves, and organs are like minefields. To reach the destination of the operation, you must either bypass or traverse these minefields.
Hence, the ancestors have used a great deal of effort to design different approaches to either avoid or traverse these minefields.
When the muscle is peeled off from under the clavicle and lifted, a blood vessel as thick as a little finger and yellow nerves can be seen pulsating rhythmically. Underneath these is a vivid life.
If any of these are damaged, it could lead to disability or even death.
Slow down, as Yang Ping supports Little Five’s hook. Respect for life can produce excellent doctors.
A sharp piece of bone has punctured between the blood vessels and nerves, surrounded entirely by blood clots. There are more clots than in a typical fracture, covering the area of vessels and nerves. This suggests the possibility of ruptured blood vessels, the veins in particular.
“Be careful, an injury to the subclavian vein can cause it to retract. If it does, the incision will need to be enlarged and the chest will have to be opened,” Old Han reminded again.
Prepare ice saline and a vascular clamp.
Yang Ping paused from his work, not anxious but also not careless.
He had practiced countless types of clavicle fracture surgeries in the system, but no trauma could be replicated. Each individual has a different physical constitution, the direction and magnitude of force exerted varies, the posture of the body at the time is different, and other influencing factors differ as well.
Hence, system training only provides an opportunity to acquire capabilities, the real surgery requires adaptability on the spot.
Ice saline can constrict blood vessels, reducing the risk to the minimum.
A metal basin filled with ice saline was brought over. Yang Ping soaked the gauze in it, took it out, and drizzled some on top.
With so many blood clots, the process of removing them can easily disturb the blood vessels leading to their retraction, which could have disastrous consequences.
Old Han regretted a bit, selecting such a case was not the right idea. If there happens to be a mishap during the operation, it will be unanimously rejected.
Although taking the stage at this time is good to impress the old heads, patient safety is paramount.
“I’m going to scrub in,” Old Han went to wash his hands.
While waiting for the ice saline to take effect, Yang Ping had tissue scissors in his left hand and a vascular clamp in his right. He gently separated the blood clots from the periphery inwards.
The vein emerging from below the clavicle into the axillary vein was clearly exposed, and the vascular clamp was quickly clamped onto it. The operation could not be complacent at this point; this only blocked possible bleeding, the proximal end was still at risk of retraction.
If it retracts, it is like the breakage of a water pipe inside a wall. Only by removing the wall can the pipe be repaired; otherwise, one could only helplessly watch it leak.
This exceeds the capabilities of an attending physician; even a genius like Song Zimo would lack the necessary experience.
For doctors, especially surgeons, surgical experience is very important, which is why a platform is extremely important for surgeons.
As an example, two classmates, one smart, good grades, skilled hands, went to a county hospital. The other often failed, clumsy, ended up in a top-tier, Level III teaching hospital. Ten years later, the one in the county hospital could not compare to the one in the top-tier hospital. Because the latter performs surgeries every day that the former may only encounter once a year. This is the difference.
The number of cases is the reason why gaps arise among doctors, especially surgeons.
Therefore, even for a genius, without attaining a certain level, you won’t have the rights to perform certain surgeries, resulting in an inability to accumulate and improve.
“We encountered one last time where the blood vessel retracted and chest had to be opened to locate the vessel for hemostasis.”
“I’ve seen arterial bleeding here that sprayed all the way to the ceiling.”
Those who have experienced such sight recalled with trepidation and discussed cautiously.
The blood clots were gently lifted, and then clamped with vascular forceps, lifted, and placed in the curved dish.
Song Zimo leaned forward, clamping the blood clot with the vascular forceps. He practiced for a long time before he could firmly grasp them. Because blood clots are fragile and can easily break apart with a bit of force, normally clots are scraped off with a curette and then piled up and removed.
At this moment, if a curette were used, it could easily lead to vessel pull and retraction because of excessive force.
Whereas vascular forceps can clamp precisely, but it’s a technical task and not everyone can imitate it.
After the blood clots were removed, the ruptured vessel was exposed. It had already been blocked by the blood clot and only a little bit of the connected vessel wall was left.
The proximal end was also clamped immediately with the vascular clamp.
Ligation is the safest and simplest treatment, but Yang Ping selected suturing.
After cutting off the ruptured end, he sutured easily. After checking the artery, there were no issues.
The nerve’s outer sheath was split, Yang Ping opened it, exposing the inner nerve bundle sheath, which was fine.
Then, he irrigated and sutured.
Old Han entered the room after washing his hands.
The third surgery was completed.
