System Came When the Doctor was Thirty

September 19th, Overcast.

Lu Cheng received a last-minute call from Professor Zhong Junyun at 7:30 in the morning: ”Xiao Lu, get ready, there’s a semi-limb replantation emergency that just came in, come to the operating room, and assist me.”

Lu Cheng hadn’t expected that Zhong Junyun would have his contact, and even less so that Professor Zhong would reach out to him.

Lu Cheng paused at the entrance of the parking lot at the laboratory building: ”Teacher, what about my class?”

”You won’t attend the later teaching surgery, it’s just two surgeries on one operating table; how many people can fit?”

”The teaching surgeries by Lan Hualuo can teach you, and I can teach you too. Come over here, and I’ll send you the emergency operating room number later.” With that, Zhong Junyun hung up the phone.

He didn’t ask for Lu Cheng’s opinion; rather, he aggressively and proactively altered Lu Cheng’s ’learning’ plans.

Mu Nanshu quickly said: ”You should hurry up, Professor Zhong’s expertise in hand surgery is probably even better than Professor Lan’s.”

”He’s giving you one-on-one instruction, this is a privilege typically reserved for associate professors in hand surgery...”

”Even if it might be compensation, take what you can get, Professor Zhong doesn’t owe you anything.”

Lu Cheng nodded: ”Okay.”

Lu Cheng slowly started the car. Because it was Saturday, there weren’t many people rushing to the laboratory building.

”It’s not that I’m hesitating to go, I’m just wondering if I deserve the attention from Teacher Zhong.”

Lu Cheng kept the speed at around forty kilometers per hour, speaking cautiously: ”After all, over the years, I haven’t had much luck.”

Mu Nanshu said: ”What else about you would Professor Zhong envy? Don’t overthink it...”

”Mm, okay.”

”As for lunch this afternoon, it depends on the situation.” As the second parking gate lifted, Lu Cheng slowed down the car and said.

”I can manage on my own.” Mu Nanshu knew that Lu Cheng might invite Professor Zhong Junyun to dinner.

...

Lu Cheng followed Professor Zhong Junyun’s instructions and found his way to emergency operating room number 9.

Fully dressed in surgical scrubs, Lu Cheng pushed open the air-sealed door of the operating room, the sound of wheels scratching at his ears, the view opened up wide.

Lu Cheng found that he didn’t recognize anyone in the operating room, not even Professor Zhong Junyun. He began to look around.

After glancing around for a while, Zhong Junyun’s voice finally came: ”Lu Cheng, wash your hands... come directly to the table.”

Only then did Lu Cheng realize that Professor Zhong had already begun the procedure, back facing him, and the people standing and surrounding him could be surgical personnel or members from the hand surgery team.

Lu Cheng immediately withdrew and began to wash his hands in a standard manner.

After donning a sterile gown and gloves, with hands crossed over his chest, Lu Cheng slowly moved to the patient’s leg position beside the operating table, finding a place to sit down, his expression neutral and pleasant.

”Xiao Pan, move aside, I’ll have Xiao Lu assist with this surgery.” As soon as Zhong Junyun saw Lu Cheng approach, he gave the instruction directly.

”Alright, Master.” The person called Xiao Pan glanced at Lu Cheng and stood up to give him the spot.

”Thank you, Teacher Pan.” Lu Cheng took the opportunity to express his gratitude.

”Just call me Brother Pan...” Pan Leiming instinctively replied, then realized: ”Ah, no, you can call me Xiao Pan, Brother Lu.”

Pan Leiming was only twenty-eight this year, younger than Lu Cheng, but had already completed his residency due to his qualifications.

”Hello, Brother Pan.” Lu Cheng dared not listen to Pan Leiming.

”Forget the titles, hurry up. This is a mid-upper arm injury, no fractures, a textbook semi-limb replantation...” Zhong Junyun gave a quick overview of the situation, then continued:

”Xiao Lu, there’s no nerve damage, only vascular and muscle rupture, let’s see your basic skills.”

”Vascular sutures.” Zhong Junyun didn’t even specify the model, just ordered the circulating nurse.

”One 7-0 Johnson vascular suture, on the field.” The circulating nurse both opened the suture pack and reported in detail.

Lu Cheng gracefully used the needle holder to grasp the suture, slightly adjusted the clamping angle of the needle, then placed it in the curved basin, before using micro-forceps to carefully survey the surgical field.

This wasn’t something taught by Zhong Junyun; it was a habit often taught by Professor Deng Yong of the trauma surgery department at Zhongnan Hospital to observe the surgical field thoroughly before performing any procedure.

Not understanding and acting hastily is a major taboo in surgery.

Lu Cheng had just arrived and had missed the hemostatic prep with Professor Zhong and others, leaving him understandably bewildered.

Upon careful examination, Lu Cheng indeed spotted an irregularity.

The surgery wasn’t yet fully debrided because Lu Cheng found some unidentified debris.

Seeing this, Lu Cheng quickly used forceps to grasp it and placed it in another curved basin alongside previously debrided foreign objects.

Lu Cheng looked up at Zhong Junyun: ”Teacher Zhong, what was the mechanism of this patient’s injury?”

Different injury mechanisms require different degrees of debridement detail, it surely wasn’t just a sharp object injury or sawtooth injury.

Although unclear about why Professor Zhong called him directly to suture the vessels, Lu Cheng trusted his basic surgical knowledge more.

”Sharp object abrasion!” Zhong Junyun responded.

Lu Cheng’s eyes moved around before he continued to focus on finding foreign objects, conducting a thorough examination of the bleeding points.

After removing two more irregular foreign objects, Lu Cheng said, ”Teacher, I think the debridement is clean now, it can be irrigated.”

Lu Cheng didn’t act on instinct.

If acting on instinct, he would have assumed that Professor Zhong wouldn’t use a patient as a quiz, testing his tendency to be careless.

But actually, it wasn’t impossible. If he started suturing right away, the ulna’s styloid process might have gotten involved.

”Mm... proceed...” Zhong Junyun nodded.

Lu Cheng then proceeded to irrigate the wound repeatedly with saline, hydrogen peroxide, diluted iodine, and saline.

After cleaning the wound’s moisture with a cotton pad, Lu Cheng began assessing the vascular ends.

The brachial artery was damaged, which is a medium-diameter artery, not difficult to suture, with less stringent requirements for suturing skills.

After some hesitation, Lu Cheng asked, ”Teacher, I’ve never sutured a brachial artery before, should I start?”

Zhong Junyun thought for a moment and said, ”Then you can hand it over to Xiao Pan later.”

”Now remember one sequence, in limb replantation, as long as the patient’s injury time is short, it is bone, tendon, vein, artery, nerve, skin.”

”Bones form the structural support, tendons provide the vascular bed, veins and arteries ensure limb survival.”

”If the ischemia time is longer, the order of vein and artery suturing takes precedence over fracture fixation.” Zhong Junyun didn’t scold Lu Cheng, just provided teaching.

”Understood, teacher.” Lu Cheng sniffed, feeling somewhat trapped.

The main issue was that Professor Zhong Junyun set a pit within a pit, making it really difficult for someone not specialized in hand surgery like Lu Cheng to avoid.

”Can you perform tendon suturing?” Zhong Junyun asked.

”I can!” Lu Cheng replied.

”How do you plan to suture?” Zhong Junyun continued.

”For the large belly of the biceps brachii, simple interrupted sutures, brachialis tendon woven sutures, triceps long head muscle belly, simple interrupted sutures...”

After answering, Lu Cheng added, ”Actually, other suturing methods could also be used.”

”Hmm?” Zhong Junyun was initially satisfied with Lu Cheng’s response, but hearing Lu Cheng bring up alternatives, he couldn’t help but hum a question.

”The brachialis tendon is particularly suited for a combined weaving suturing technique.” Lu Cheng proposed.

”What’s it called?” Zhong Junyun racked his brain for ideas, modified Tang Method? Tsuge? Tajima.

Lu Cheng swallowed and decided to speak up: ”It hasn’t been named yet, Teacher.”

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