System Came When the Doctor was Thirty

On the contrary, in the surgical operating room, because most are elective surgeries, all the patient’s conditions follow a routine and are within the doctor’s expectations, that’s when dirty jokes and banter fill the air.

The beeping sound of the anesthesia monitor is steady, and the anesthetist sits in a reclined chair, reading a novel.

The patient’s condition is actually very optimistic; as long as amputation is considered, there is basically no life threat, belonging to the simplest and most straightforward anesthesia.

However, the type of condition is rather complex, and the chance of preserving the limb is very small.

”Director Wu... the sterile drapes are ready. We’ve also done a simple rinse, let’s begin the surgery,” Lu Cheng reported to Wu Xiang after completing the preparation with Dai Linfang.

”Put on gowns, start the incision.” Wu Xiang’s fundamental role this time was just to be a toolman.

Afterwards, the only sound left in the operating room was the beeping of the anesthesia monitor.

Wu Xiang is indeed a chief physician, but for this surgery, he was merely a toolman. Since he didn’t intend to learn the limb preservation surgery for destructive injuries, he hadn’t memorized the surgical procedure fully, and so, he dared not speak.

To Lu Cheng, having Wu Xiang, a chief physician, present meant he, a mere attending doctor, definitely couldn’t act ostentatiously.

There were only simple instructions being given.

”First find the arteries and veins to thoroughly control bleeding from both lower limbs.”

”Clamp and stop the bleeding from the distal tibia and fibula.”

”Adjust the pressure of the tourniquet...”

With the assist of the tourniquet on the lower limbs, the oozing from the wound significantly diminished, and exposing the arteries and veins of the lower limbs became a relatively pure normal anatomical exploration.

This is the simplest, most basic skill that just requires a profound memory of the path and sequence of examination of the arteries and veins in the lower limbs, essentially following a routine.

Once everything is ready, it ensures the bleeding during surgery remains within controllable limits, preventing hypovolemic shock.

The operation following hemostasis is debridement.

Debridement, like suturing, is one of the most fundamental surgical operations.

Debridement also has classifications, depending on the type of soft tissue lesions, including traumatic debridement, infectious debridement, tumor debridement, and others.

The debridement for destructive injuries is standard traumatic debridement.

The definition and standard of debridement involve surgically removing foreign material from open wounds, excising necrotic, non-viable, or contaminated tissue, promoting primary wound healing as a clinical operation method.

For patients with destructive injuries, debridement strictly following this definition inevitably leads to amputation!

Just like, in the No Man’s Land, tendons tend to break again, leading to ”tendon re-rupture,” ”claw hand,” ”tendon adhesion” when sutured strictly based on normal suturing techniques.

Therefore, when performing limb preservation surgery for destructive injuries, adjustments and changes must be made.

Professor Lan Hualuo of Zhongnan Hospital differentiates the debridement for destructive injuries from ordinary traumatic debridement, naming them ’destructive debridement’ and ’vascular reconstruction-type debridement.’

This debridement technique abandons the principle of excising all necrotic, non-viable or contaminated tissue in the debridement definition, instead removing absolutely necrotic tissue while preserving non-viable or contaminated tissue.

For necrotic and non-viable tissues, vascular reconstruction is performed; for contaminated tissues, debridement is conducted to remove infection.

The theory may seem simple and straightforward, but implementing it is challenging.

Without expertise-level debridement skills, entry is impossible.

In actual clinical practice, those with expert-level debridement skills are mostly senior associate chief physicians or chief physicians at city-level hospitals, and not everyone possesses these skills.

Expert level operational skills aren’t reached through effort, repetition, or practice alone; a certain level of talent plus effort is necessary to achieve proficiency.

Director Wu Xiang lacks such subtle operational skills, but it doesn’t hinder him from having mastered many surgical techniques, knowing many orthopedic standard procedures, and becoming a chief physician in trauma surgery.

Although for some reasons he is no longer the administrative director of trauma surgery, in terms of comprehensive ability, even Assistant Professor Huang Jianjun, with excellent debridement skills, cannot match the ”authority” of Director Wu Xiang in the trauma surgery department of this hospital and this state!

So, Director Wu Xiang couldn’t understand what Lu Cheng was doing.

Similarly, Dai Linfang also couldn’t comprehend.

Dai Linfang, though having elevated his ’basic skills’ to a rare expert level through talent, is still limited to basic skills. This is an orthopedic surgery, and specifically, a ’destructive injury’ defined not long ago in orthopedics, strictly defined as a ’destructive debridement’ under the branch of destructive injury !

Being skilled at suturing and being versed in suturing nerves and blood vessels, tendons are two different matters.

The reason the hand surgery subspecialty within clinical surgery commands more respect than regular surgery lies in their unique and irreplaceable understanding of suturing.

It’s not to imply that general surgeons can’t suture well, but when it comes to comparing specialization in suturing between general surgery and hand surgery, even if a professor ascends to hand surgery, the mantle of expertise remains distinctive.

Even old master Yuan Longping would show regret and urgency when playing chess; could he beat the neighborhood champion?

In a situation where neither could understand the specific surgical process, Lu Cheng didn’t bother with explanations, only managing to instruct them on how to cooperate.

’Lead surgeon’ should be attributed to Wu Xiang, and creating an impression of him leading is necessary to preserve his dignity.

However, even if the specific process isn’t understood, glimpses of the operational details can still be observed.