"Put on a size 10 silk thread!" Ling Ran said without raising his head during the suturing process.
The scrub nurse agreed without hesitation. She quickly untied a size 10 silk thread and put it on a needle holder. Then, she patted Ling Ran's hand with a slight force, and a soft slap was heard. Her fair cheeks flushed red.
Ji Tianlu instantly raised his head and realized something. He asked, "What's wrong?"
The size 10 silk thread was considered a thicker thread when it came to suturing Achilles tendons. It was more than three times thinner than the 4-0 thread Ling Ran used previously. There must be a reason why the chief surgeon suddenly changed the thread.
Ling Ran was still willing to say a few more words when discussing techniques.
Ling Ran sat at one end of the two-person microscope and pointed under the microscope with a pair of forceps. He said, "The broken end is not neat. If we continue to pull it with the 4-0 thread, there will be a defect after trimming."
The tensile force of the thin thread was not strong. If they were densely packed together on a section, the total tensile force would increase. However, if they were separated, the tensile force of one or two or even two or three strands would not be as good as that of a single No. 10 thread.
On the other hand, tendons were elastic, and the elasticity of the Achilles tendon was especially great. This caused a problem. When the doctor pulled the severed Achilles tendon together by force, it would yield. However, after the surgery was over, the Achilles tendon was still very elastic, so it would shrink back even more strongly.
If the length of the severed Achilles tendon was the same, the strength of their rebound would be similar, and the function of the Achilles tendon could still be maintained. However, if the severed Achilles tendon itself was uneven, the length of the Achilles tendon that was forcefully retracted would be different … So, the long tendon would be under less pressure, while the short tendon would be under more pressure, and the Achilles tendon would be more prone to rupture.
This was like sewing five rubber bands of the same length together. Compared to sewing five rubber bands of different lengths together, the former was better and had higher strength.
The solution was also very simple. It was to use sutures of different strength to make up for the lack of strength of the tendon, and as much as possible to ensure that the tensile force after the surgery was the same.
However, the solution that Ling Ran took for granted shocked Ji Tianlu. It also scared Doctor Qu and the others who were watching the screen in the demonstration room.
"Did you notice that the stump is not neat?" A resident doctor could not help but ask.
Another resident doctor by the side sneered a couple of times. "There's so much blood, the surgical field is not clear at all. At most, we can only see some hair tips."
"He should be able to use other conditions to make a judgment. The field of view under the microscope won't be clearer than our field of view. Our screen is so big, and we don't need to operate it … "As he spoke, he moved closer to the screen and scanned it, looking for signs bit by bit.
"It's possible that it's based on the MRI scan." Zhu Tongyi said. He thought for a moment and explained, "It's possible from the distribution of blood vessels, but it's more complicated."
"This has become metaphysics." The moment Doctor Qu finished speaking, the group of doctors turned their heads to look at him.
Doctor Qu felt a little regretful. He coughed a few times and said, "What I mean is, he sutured so quickly just now. How could he be more meticulous than us? Besides, even if he saw that the suture was uneven, how did he know which thread to use to make up for it? This is completely a gamble, or maybe it's his intuition or something. "
Doctor Qu forcefully swallowed the comment of "completely unreliable". He was a little speechless.
He originally did not intend to speak, so he had been standing at the back of the demonstration room. He wanted to observe the situation before he slipped away. However, Doctor Qu did not expect Ling Ran to perform the surgery so quickly, and he even quickly entered a state of climax. The group of doctors who were watching could not stop even if they wanted to.
Doctor Qu himself was a doctor who performed Achilles tendon repairs. How could he bear to leave when he saw Ling Ran perform the surgery like this?
To a certain extent, Doctor Qu was even a little conquered by Ling Ran's surgical skills.
However, Doctor Qu did not understand the operation of thread swapping, and he also did not admit it.
It was just like what Doctor Qu forcefully swallowed just now. He felt that Ling Ran's on-the-spot judgment was not reliable at all, and Zhu Tongyi's explanation was also not reliable.
He himself was a surgeon who performed the Kessler method. He did not believe that anyone could see the integrity of the Achilles tendon from the distribution of blood vessels. Even an MRI scan could not be so detailed. At the very least, it was impossible to make a judgment on the spot. It would only be used for postoperative analysis, or when the patient died unexpectedly, and these words could only be said during the death analysis.
When surgeons were on the spot, they must have a clear understanding of the pulling force of the suture.
Now, Ling Ran changed the 4-0 thread to the 10-0 thread, which meant that he knew that the Achilles tendon that was about to be sutured with the 10-0 thread was much shorter, and the pulling force was great. However, neither the distribution of blood vessels nor the MRI scan could provide such information.
At least, Doctor Qu did not know how he could determine such information. He had never heard of any expert in the Medical Imaging Department who could do it.
Zhu Tongyi looked at the crowd, smiled, and said, "Since we can't guess it, let's just ask. Let's just treat it as teaching surgery."
After he finished speaking, Zhu Tongyi pressed the intercom button without hesitation and said, "Ling Ran, how did you determine that the broken ends are not even, and how much pulling force should be used to suture it?"
Compared to the previous question, the latter question was more targeted.
If he wanted to pull a shorter rubber band, he would need a greater pulling force. If this was an engineering experiment, this would be a very simple question. There were instruments that could test the pulling force of a material, the tensile strength of a material, the yield strength of a material, and so on.
However, the Achilles tendon of a living person could not be played like this, and the operating theater did not prepare the corresponding instruments.
So, how did Ling Ran determine how much pulling force should be used to suture it?
If he could not make the corresponding judgment, it would be meaningless to just determine that the broken ends were not even.
In fact, when ordinary doctors performed this kind of surgery, they would not care about the strength of the pulling force at all. They only cared about suturing it. When it came to the problem of the broken ends being not even, most people would use replantation methods to solve it, such as autologous gracilis muscle transplantation, autologous peroneus brevis muscle transplantation, and so on. The short Achilles tendon was attached to a piece of tendon so that the length of both sides was about the same, or the transplanted part was a little longer. This could reduce the possibility of rupture.
Doctors who could do this could not be said to be ordinary doctors. At least, they were like Doctor Qu, who was at the level of a core member of a well-known medical institution in the country.
Ji Tianlu's standard was slightly higher, but he could not understand Ling Ran's operation. He also looked at Ling Ran with a puzzled gaze.
Ling Ran did not answer immediately. He only said slowly after he finished suturing the No. 10 surgical suture in his hand, "I felt it when I pulled it with my hand."
"Felt it?" Doctor Qu laughed. He could not help but take two quick steps forward, pressed down on the intercom button, and said, "How can feeling be used as a reference for surgery?"
Ling Ran hummed in acknowledgment and said, "I often massage people's tendons, fascias, muscles, and so on. I can estimate the strength of the traction just by putting my hand on it. The difference won't be too big."
"You're kidding, right?" Doctor Qu said it before he remembered that he did not press the intercom button, so he pressed it again and said it again.
Ling Ran's answer was very simple. "No."
This skill was something Ling Ran had gradually come up with.
There were pushing techniques and plucking techniques in massage, and they specifically targeted "tendons". In a narrow sense, "tendons" referred to tendons and ligaments.
When Ling Ran performed finger replantations or the M-Tang technique, the tendons he encountered were all very weak. Even with Master Level Massage Skills, he could not accurately estimate the strength. Or rather, it was useless to estimate it. The tendon of the thumb was thinner than a chopstick. If it was split in an uneven manner, the best way was not to suture it separately, but to cut it before suturing it.
But the Achilles tendon of the foot could not do the same. The Achilles tendon was the thickest tendon, and its length had a great impact on the ability to move. Besides, the degree of rupture varied. If the shortest Achilles tendon was used as the standard, the Achilles tendon would basically be useless, and another transplant would be needed.
Correspondingly, the Achilles tendon was the thickest tendon in the human body. All the tendons Ling Ran grabbed were not thicker than the Achilles tendon, so he could understand the other tendons, and he could be more certain of the strength of the Achilles tendon.
Ji Tianlu raised his head and glanced at Ling Ran. "Is it really just a feeling?"
Ling Ran also answered, "Yes," again, and raised his hand. "3-0."
He was going to suture another Achilles tendon.
Ji Tianlu looked at Ling Ran's confident expression and said, "If you can really feel it, then it's really amazing."
Ling Ran still hummed in acknowledgment and did not reply to her.
Ji Tianlu looked at his operation, and he was already eighty percent convinced.
'Doing things based on feelings seems to be nonsense from a patient's perspective. How can my precious body be controlled by feelings?'
However, the level of human technology was like this. The more advanced a surgery was, the more times it was done based on feelings. This was especially true when it came to internal organs. For example, when Ling Ran performed barehanded bleeding control in the liver, he relied on his feelings. Of course, there was also experience in anatomy behind his feelings, but in the end, it was not something that could be seen with one's own eyes or be digitally verified.
Similarly, cardiac surgeries were always filled with unusual "feelings", which was why there were so many so-called miracles. As for brain surgeries, there was no need to even mention it. Humans were not completely sure about the division of brain functions, but when it was time to operate, surgeons would not be lenient.
There were even more internists who relied on their feelings to do things. Take the major ward rounds in Peking Union Medical College Hospital as an example. Every internists could give a reasonable opinion, but there was only one truth.
In the end, the internists with outstanding talent were usually the doctors who had better "feelings".
When Ji Tianlu performed Achilles tendon surgery, he also often operated based on his feelings. If he felt that a certain Achilles tendon was too elastic, he would transplant it a little longer. If he felt that the elasticity was not strong enough, he might forcibly pull it up and suture it.
It would not work if he did not rely on his feelings. Until now, there was no instrument to help surgeons test the tensile force of the Achilles tendon. In other words, even if the tensile force was measured, so what? Different people's Achilles tendons were different. Take the simplest length as an example. The length of an ordinary Asian's Achilles tendon was 15 inches. Allen Iverson's Achilles tendon was said to be 25 inches, and Michael Jordan's was 30 inches. Naturally, the tensile force would be very different.
However, when Ji Tianlu performed the surgery based on his feelings, he would not deliberately say it out, and no one had ever asked him about it.
At this moment, Ji Tianlu somewhat admired Ling Ran's straightforwardness.
At this moment, Doctor Qu, who never "felt" when he performed the surgery, felt angry. He angrily pressed the intercom button again and said, "Doctor Ji, should we stop the surgery now?"
There was the highly respected Academician Zhu Tongyi in the demonstration room, and the young and promising Chief Physician Ji Tianlu in the operating theater. Doctor Qu still had some sense left in him, so he did not dare to give orders. He only dared to use an inquiring tone.
Ji Tianlu was disdainful of a mere Doctor Qu and said indifferently, "Just follow and learn."
Doctor Qu's face immediately turned red.
Both of them were similar in age, but their statuses were very different. When Ji Tianlu, as a senior doctor, did not want to show respect to Doctor Qu, he would not be able to get any respect at all.
Doctor Qu quietly left the microphone used for the call and returned to the back of the demonstration room.
He did not want to leave immediately, especially when Liu Weichen was still around. Doctor Qu would not take the initiative to admit defeat. He at least wanted to see the final result.
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