System Came When the Doctor was Thirty

”The current mainstream nerve suturing is a simple nerve suturing technique, with no particular method—just a straightforward interrupted suturing of the nerve ends.”

”Currently, there are three mainstream suturing concepts: one is epineurium suturing, another is perineurium suturing, and the third is a combined suturing of the perineurium and epineurium.”

”This ’combined’ is not the same as a general combination, it’s a standalone operation.”

”Additionally, there are modified techniques that group 3-5 small bundles into bundle groups to reduce the number of suture needles...”

The anatomical structure of a nerve is quite similar to electrical wires, with an outer membrane covering many nerve bundles inside.

However, these nerve bundles aren’t divided into live and neutral wires, but rather into sensory and motor branches.

”But the excellent rate of performance for the Nerve Bundle Membrane-Outer Membrane Suturing Technique also has its limitations and drawbacks.”

”According to data from surgeries performed on ulnar nerve injuries after 12 months, the excellent rate for perineurium suturing is around 81.0%-88%, whereas for epineurium suturing, it is only 32.5%-47.4%!”

”Previously, such an excellent rate could meet clinical needs, but with the advanced development of hand surgery, it has become a limitation.”

”Of course, the epineurium suturing doesn’t have the risk of ischemia between nerve bundles, but perineurium suturing does carry an ischemia risk of about 15%.”

”Based on this, in hand surgery, we have constantly been improving the suturing techniques for nerves, aiming to combine the strengths and weaknesses of perineurium and epineurium...”

”Currently, although a formal technique hasn’t been formed yet, the overall data is still better than mainstream suturing techniques, and this suturing technology will also make your clinical work smoother...”

”I’ve already taught you the specific suturing method; it’s not difficult, and the rest is up to your practice.”

After the demonstration class on practical operations, Professor Liu Huanglong did a quick round, providing guidance to everyone.

The first stop was in front of Dong Qiaoshan, who nods frequently, ”Your basic suturing skills are not bad, and the details of your operation are precise and meticulous. The nerve bundle membrane-outer membrane suturing will slightly modify the basic suturing, and you need to pay attention to the angle of needle entering and exiting...”

”Also, don’t overdo it when separating the perineurium. Over-separation is the fundamental cause of ischemia and necrosis of the perineurium.”

”Thank you, Teacher Liu.” Dong Qiaoshan nodded earnestly and continued to focus meticulously on the operation.

Then, Liu Huanglong moved towards Xie Yuan’an, looked through the assistant’s position eyepiece for a while, and then scolded: ”Keep your hands steady! Even the ladies serving food in the cafeteria don’t shake as much as you do with Parkinson’s.”

”What are you blinking at? Are you telling the nerves you’re adorable? Going to make the nerve cells all warm and fuzzy?” Liu Huanglong relentlessly fired back.

Xie Yuan’an sat upright, without any look of grievance, focused fully on the practice of his hand operations.

After observing for a while, Liu Huanglong said, ”Keep practicing, the basic hardcore conditions of hand surgery suturing you haven’t crossed the threshold yet.”

”No shaky hands, control the number of blinks, tears aren’t shed enough yet!”

Lin Bin, Ding Mengzhuo, Liu Qiming, Han Gongqiang, and others also received guidance from Liu Huanglong, but his tone was not as harsh as with Xie Yuan’an; rather, it was very patient.

Then, Liu Huanglong went to Lu Cheng’s eyepiece at the assistant’s station, speaking rather unkindly and in a well-informed tone: ”Don’t act on your own, don’t bring tendon suturing techniques into nerve suturing.”

”Tendon suturing seeks rigidity in suturing, while nerve suturing strives for no tension. What is needed is the perfect matching of nerve ends.”

”Yes, that’s correct, don’t incorporate other suturing techniques into nerve suturing; it’s the most basic, simple, interrupted suturing.”

”Using the principle and fundamental theory of tension-reducing suturing in nerve suturing, if the nerve suturing is too tightly packed, it easily forms neuromas, the end enlarges during healing, instead causing patient discomfort...”

”Hmm?” While Liu Huanglong was talking, Lu Cheng seemed to specifically revise his suturing approach based on the guidance he mentioned.

”What’s your name?” Liu Huanglong raised his head and looked at Lu Cheng.

Lu Cheng lifted his buried head, with a neatly lined hairline under short cropped hair, slightly dark skin but with a sunny aura, and his eyes were bright and spirited.

He looked like he could make a living with his looks, yet his skills were also exquisite, approximately around twenty-seven or twenty-eight, looking somewhat like a baby face…

”Teacher Liu, I am Lu Cheng, Lu as in land, and Cheng as in success.” While replying, Lu Cheng also scrutinized Liu Huanglong.

Long face, broad nose, small eyes, short eyebrows, on a glance, could be described with the phrase ”cunning-looking”, certainly living off his skills and talents.

”Redo the suturing once, let me take a look.” Liu Huanglong gestured at the operating table.

Listening to this, Lu Cheng casually clicked a little more on his limited skill points.

In a while, based on what Liu Huanglong said, Lu Cheng completely eliminated the drawbacks of incorporating tendon suturing techniques into the nerve suturing skill.

Furthermore, after watching for a while, Liu Huanglong noticed that Lu Cheng’s skill level seemed to be even slightly more refined than the last suturing.

No tension conjunction and exact bundle (group) positioning are the cornerstones of nerve function recovery, and all nerve suturing aims for this.

Therefore, the key to nerve suturing technology lies in tension-free, gentle, and precise positioning matching.

And for the broken nerves to achieve these points, a great deal of specific effort is required, such as choosing the needle entry and exit points, suturing depth, suturing width, and even the strength of knotting, all affecting the eventual prognosis.

[Nerve Suturing Skill (Level 8/10)]

Liu Huanglong said, ”For nerve bundle membrane suturing, at least a 40-fold microscope operation is needed (suturing error less than 50μm), this is entry-level; to excel, the suturing error should be controlled within at least 20μm or even 5μm.”

”Epineurium suturing is mostly suitable for small nerve injuries, mixed nerve injuries where it is difficult to separate nerve bundles, so mastering perineurium suturing is a must...”

”And, in perineurium suturing, careful separation of the perineurium also impacts the final suturing, hence it seems suturing, but in reality, it is a complete manifestation of all basic skills.”

”Let me show you splitting the perineurium...”

[A renowned teacher earnestly imparts the essentials of nerve suturing skill, slightly improving the Nerve Suturing Skill level]

[A renowned teacher earnestly imparts the essentials of suturing techniques, slightly improving the Nerve Bundle Membrane-Outer Membrane Suturing Technique]

A few minutes later, Liu Huanglong let go and allowed Lu Cheng to continue operating.

Lu Cheng calmly continued the suturing, and within the operating room, he seemed to have developed a photographic memory for the replication of actions.

”Whoa,” Liu Huanglong’s tiny eyes sparkled, emitting a ’strange sound’.

...

Then he never moved away from Lu Cheng again.

Occasionally, Xie Yuan’an and Dong Qiaoshan looked over at Liu Huanglong and noticed that he was completely engrossed in the experience of being a ’capable mentoring teacher’, entirely unaware that other students needed attention...

Well then, everyone was balanced.

Famine balance!~