While waiting for the previous team to perform the debridement, Ling Ran crossed his arms over his chest while he stood in front of the screen to analyze the scans.
Lu Wenbin helped the patient disinfect the toe. Yu Yuan accompanied Ling Ran and operated the remote for him.
When Ling Ran analyzed the MRI scans, Yu Yuan also read them quietly.
She had once studied medical imaging seriously, and her level of MRI analysis was not bad. At that moment, she was eager to give some suggestions.
Yu Yuan observed Ling Ran's expression and tried to guess what he was thinking. She sighed lightly and waited for a time to speak out...
"Okay, turn it off." Ling Ran went back to his surgical position after he finished reading the scans.
Yu Yuan was stunned. She could not do anything but turn off the big screen. She put the remote control back to its original place before walking to Ling Ran's side.
"Wash your hands." Ling Ran's tone was bland, but it scared Yu Yuan so much she almost fell down.
A few doctors in the operation theater looked at Yu Yuan in a strange way.
If even the senior resident doctor Hou Kang had to be considered very lucky to be able to participate in the surgery today, then it was natural no one expected that there would be people who needed to be reminded to wash their hands before the surgery to join the operation.
Yu Yuan immediately went out of the operating theater to wash her hands. Since she had touched the remote control just now, she definitely had to wash her hands again. She had remembered to do so initially, but forgot to wash them later.
Yu Yuan only rushed back to the operation theater after Ling Ran drew the incision line and picked up the scalpel.
"Doctor Ling is so good. He's even willing to bring his student to gain more experience." The conversation between the nurses was loud enough to be heard throughout the operating theater.
Yu Yuan felt very embarrassed.
It was not that she did not know about it. Her Master's thesis on nosocomial infection had been published in an SCI Tier 1 journal.
However, she had limited practical experience. When she started working in the hospital, she had not been permitted to use her hands much. In truth, her experience was even lesser than a resident doctor who had joined the hospital for three years and stayed in the same treatment group throughout the three years…
"Gauze." Ling Ran's order traveled into Yu Yuan the second assistant's ears. It snapped her out of her daze.
"Stop the bleeding."
"Give me another gauze."
"Start the aspiration."
Ling Ran kept on giving orders. Amputation was considered a super easy task in finger replantation. Although he did not have to perform the most troublesome tasks that were blood vessel anastomosis and nerve anastomosis anymore, he still needed to sort out the blood vessels and nerves, and also handle them later.
Amputation was considered an easy task for Ling Ran. Lu Wenbin could already cooperate with him with ease in this task. So, the level of difficulty in the tasks Ling Ran gave Yu Yuan became even lower.
Yu Yuan lowered her head and did her tasks silently. Slowly, she started to regain her confidence bit by bit.
"What are your thoughts?" Ling Ran cast a glance at Yu Yuan while performing the surgery.
Yu Yuan thought for a few seconds before she blurted out her words. "There are deformities in the patients' great toe. Based on the MRI scan, it will be better to perform arthrolysis  after osteotomy ."
She had been keeping these words to herself when she read the MRI scans.
She instantly felt comfortable once she took a risk to voice her opinion at this moment.
Lu Wenbin looked at Yu Yuan in surprise and thought, 'She's pretty brave.'
The arthroscopic arthrolysis that was mentioned by Yu Yuan was an independent task, which meant that she was adding one more step to the surgery, further complicating the surgery itself. It also indirectly increased the risks of the surgery performed. Most importantly, the surgery procedure was actually planned beforehand by Chief Physician Wang Haiyang. Adding this one step without careful consideration could be said to be a challenge to his authority.
If that one sentence was heard by a senior doctor who had great authority, the powerless resident doctor could get into the senior doctor's bad books.
Of course, Wang Haiyang was not the chief physician in the Emergency Department, so Yu Yuan's actions could only be considered bold.
Ling Ran neither agreed or disagreed. He only hummed.
He had also read the information shown in the MRI scan. In this point. Based on her point, it was clear that Yu Yuan was capable of reading and analyzing the film. Her talent was valuable.
However, Ling Ran was already a skilled surgeon. The medical case he received gave certain surgical indications, but not all of them. He could no longer make a judgment just based on the information from the medical images. He would first think like any other surgeon. 'Come, let me open up and see...'
Therefore, Ling Ran completed the amputation first, then observed the condyle that was exposed in the surgical field. Once he made verifications that there was no mistake in the MRI scan, he said, "Chief Physician Wang, I want to perform arthrolysis for the surrounding soft tissues of the great toe."
"Sure." Wang Haiyang was so busy looking for the blood vessels that he agreed to Ling Ran's suggestion without even lifting his head. He was very confident in Ling Ran's skill.
Ling Ran then performed arthrolysis along the incised wound on the amputated part.
Compared to surgical methods like the M-Tang technique and finger replantation which was given to him by the system, Ling Ran had not directly obtained the skill to perform arthrolysis from the system. However, arthrolysis was only a Level 1 procedure in the Orthopedics Department. Its level of difficulty and complexity were the lowest. Ling Ran could just followed the surgical method that was explained in the most general medical textbooks to perform the surgery. In addition to his experience of performing three thousand dissections, he could complete this particular surgery easily.
For a surgeon, it was normal for them to repeat certain surgical methods. However, when a surgeon encountered some unexpected scenarios that he was not familiar with, his past experiences would come into play. The countless theoretical experiences learned in university would be useful in providing detailed and indescribable information to the surgeon at that moment.
If the surgery were given to an intern who did not have any surgical experience, they might end up using one to two hours for their first arthrolysis, and they would be covered in a thin sheen of sweat.
But for Ling Ran, he had way too many resources to can be used as references.
Aside from the steps and the position, he had performed every single move required in a simple arthrolysis.
With just a little bit more of practice, he could do it with ease.
"Chief Physicians Wang, I'm done over here." Ling Ran sutured the amputated part and checked both sides before he gave up his operating position.
As per usual, Lu Wenbin checked through the patient again from head to toe. He started to do the dressing after he confirmed that there was no problem such as blood oozing out from the wound.
Wang Haiyang raised his head and looked at the time. He sighed and said, "Ling Ran, are you tired? If you're not, why don't you come and help me?"
"Sure." Ling Ran suddenly became very interested.
He changed into a new pair of gloves and stood at the position of the first assistant. This made Hou Kang stand at the position of the second assistant.
Although Hou Kang was a senior doctor, he was still only a resident doctor. The reason he could join the surgery today was only because Wang Haiyang did not want to find other attending physicians who were overly assertive. Thus, he offered his position to Ling Ran.
When he stood at the second assistant's position, he turned around and saw the scrub nurse show a big smile while placing the forceps into Ling Ran's hand. She also seemed to have caressed Ling Ran's fingers.
"We can start joining the blood vessels." With the use of the two head microscope, Ling Ran's speed when he performed his next surgical step obviously increased.
Wang Haiyang was inexplicably used to this kind of situation. He felt quite comfortable with Ling Ran urging him forward in the surgery.
The finger artery was connected with the corresponding artery of the toe. It was then followed by the connection of the vein and nerves. It only took them about an hour to connect the great toe from the patient's size 5 right foot to the right hand.
The palm was rough, and many wrinkles were seen on the toe. The ratio was also not balanced.
The scrub nurse stretched her head out slightly to glance at it, since this was the first time she participated in this kind of surgery. She could not help but commented, "It looks quite okay at first glance, but when I look at it more closely, it makes me a little uncomfortable."
Wang Haiyang said faintly, "If it doesn't look good, the patient can look for the doctors in the Plastic and Reconstructive Surgery Department to make some adjustments and make it look better. But for now, our work is done."
"Tsk tsk, it's going to cost a lot to do plastic surgery, isn't it?" The nurse clicked her tongue. "I wanted to get fake eyelashes, but I found the price too expensive."
Wang Haiyang sneered and said, "Since you are not rich, you don't have to care whether it looks good. Getting the thumb connected means you are still part of the workforce. Would the hand somehow look good if the thumb can't be replanted?"
The young nurse could not retort. She pursed her lips and said, "Ugly means ugly. Chief physician, you can't just distort the fact."
For a young and beautiful nurse, even her unreasonable refute was still considered charming.
Wang Haiyang laughed and proudly said, "I feel so good for today's surgery. That's all for the surgery. Young Hou, you're now in charge of finishing up the surgery. Ling Ran, please add me on WeChat, I will send a few photos to you."
"Oh, alright." Ling Ran took off his gloves and scrubs. He took his phone out and asked, "What photo?"
"We just bought a new C-arm and it is quite useful. Let me share with you some photos," Wang Haiyang said while opening up the albums in his phone eagerly. He sent dozens of the photos to Ling Ran in one go.
He then sent Ling Ran all the way to the escalator before he left with much reluctance.
Lu Wenbin followed Ling Ran and he felt proud of him. Yu Yuan was even completely surprised.
During the years in Yun Hua Hospital, Yu Yuan had followed three treatment groups. The leaders were always chief physicians and associate chief physicians who were all ranked equally with Wang Haiyang. Yet, she had never been treated so kindly and pleasantly before.
At this point, she felt mentally and physically exhausted.
"Let's rest for ten minutes… or maybe fifteen minutes. I'll go find out when the next patient will be sent into the operating theater." When Ling Ran almost reached the Emergency Department, he started planning his upcoming surgery. He still appeared to be full of vigor.
Compared to teaming up with Chief Physician Wang, he much preferred to perform the surgery on his own.
"Doctor Ling…" Yu Yuan called out softly, "Can I participate in the next surgery?"
"I… I think I can sort out the surgical procedure just nows and write it into a medical record." Once she said these words, Yu Yuan quickly added. "The surgery was performed by you and Chief Physician Wang, so the first authors will definitely be you and Chief Physician Wang. I will be the third author."
Case reports were a type of research paper, and they were the most common type of medical research papers. Many medical journals, including [The New England Journal of Medicine], provided a column to publish case reports. Some famous case reports wrote about diseases like HIV and legionellosis , and such diseases were discovered from these case reports.
Naturally, when doctors wanted to write case reports, it would be hard to find new and rare diseases to report. Hence, the most commonly seen case reports were all about unique clinical manifestations of known diseases, new discoveries in medical imaging and laboratory diagnostics, special experience-based guidelines, and some other case reports of such nature.
It was always easier said than done. Short case reports usually required vivid descriptions, a multi-angled study, and an in-depth discussion. In short, case reports were not easy to write.
After a moment of hesitation, Ling Ran asked, "Where would you like to publish it?"
"At the very least, in a core journal." Yu Yuan knew what Ling Ran had in mind because she chatted with Su Jiafu before.
"Alright." Ling Ran truly could not turn down an offer to publish an article in a core journal. He turned around to Lu Wenbin and said, "Wake Ma Yanlin up and let him perform the next surgery."