Great Doctor Ling Ran Chapter 221
221 Vascular Network
Once Ling Ran started on a surgery, he would be extremely focused.
The average surgery time for an Achilles tendon repair surgery was very short. For example, the five surgeries that he performed the night before and the other two surgeries he performed early in the morning amounted to a total of seven surgeries. That did not even take seven hours to complete.
Naturally, the duration for each surgery would be slightly longer if preoperative preparations and postoperative sutures were included. However, Ling Ran's participation in those phases was not compulsory. Only when anesthesia was about to be performed would Ling Ran enter the operating theater.
His main job only started when the incision began.
"Retract the skin." Ling Ran threw away the scalpel. Then, he along with Ji Tianlu retracted Liu Weichen's epidermis.
"This looks like when we slaughter goats in my hometown," said Ji Tianlu all of a sudden. That opened up a topic of conversation in the operating theater.
Ling Ran remained silent and continued to perform the surgery, just as he performed his previous surgeries.
Lu Wenbin quickly participated in the surgery. "How long is a goat's Achilles tendon?" he asked out of curiosity.
"No idea. It tastes awful anyway." Ji Tianlu twitched his lips and said, "Goat trotters taste the worst. But their Achilles tendons are quite long."
At that moment, Ling Ran used a pair of forceps to bring out the exposed Achilles tendon.
"The amputated ends are in the shape of a horsetail." Zhu Tongyi frowned, even though he had expected it.
Among the types of tendon ruptures, that was considered quite terrible.
"Shall I cut it?" Ling Ran hung a part of the ruptured, horsetail-like bundle out and flipped it around a little to observe it. Then, he trimmed it using a pair of scissors to make the ends smooth.
"Cut it then." Zhu Tongyi crossed his arms over his chest and looked at Ling Ran's operation.
If that had been a suture for a normal person's tendon, the ruptured, horsetail-like bundles would not need to be trimmed. Some surgeons even used the bundles as a material to strengthen the suture.
However, an athlete's requirement on the tendon was different.
Scattered tendon bundles like that were not sufficient to support high-intensity training, so they were useless in competitive sports and had to be trimmed so that the tendon was smooth.
"His tendon is at least 0.4 inches shorter now, right?" the anesthetist asked out of his curiosity after he finished his work and took a look at the tendon.
Lu Wenbin rotated the plate and said, "It's about that length, or maybe more than that."
"Will he still able to run with this length?"
"If the suture is performed well, it shouldn't be a problem," Zhu Tongyi replied very confidently, but his answer was still full of uncertainty.
The last question was not just a concern for the people in the operating theater, it was also a concern for the audience in the demonstration room.
Zhu Tongyi's plan was not really a secret in the Orthopedic and Sports Medicine Center, as many resident doctors had come across it before. Therefore, when Zhu Tongyi said that Liu Weichen would be able to run if the suture was performed well, many people's expressions turned pale.
"It seems like they're going with plan A."
"That's kind of crazy, though."
"Can it work?"
A few doctors discussed in low whispers.
A young nurse who was sitting on the table in the demonstration room was worried, and she asked the attending physician beside her, "Why is Plan A crazy?"
The request from a young and energetic girl was often irresistible to a thirty-year-old man. The attending physician wore the smile of a man who had been single for thirty years and said, "Academician Zhu's Plan A aims to ensure sufficient blood supply guarantees the strength of the tendon after it's stretched taut."
"What happens after?"
"Haha! What happens after?" The attending physician laughed and said, "Our hands and feet will be tied."
"Because" The attending physician did not know how to explain it. He thought about it for a while and said, "Let me explain it this way. The blood supply on the medial side of the Achilles tendon comes from the posterior tibial artery, and it is further distributed into three to four of the perforating arteries, which are practically invisible to the naked eye. The vascular zone of the lateral side of the Achilles tendon does not differ much; the only difference is that the blood supply comes from the peroneal artery. You have to bypass all of them."
"Bypass a total of eight small vessels?"
"And there are a lot of small branches in the small arteries. Academician Zhu also hopes to bypass the small vessels in order to protect the vascular network surrounding the Achilles tendon. The vessels provide nutrients to the Achilles tendon. If the vascular network is protected, the nutrient supply for the Achilles tendon will be higher and it will recover sooner. This is like an open surgery that wishes to obtain the effects of minimally invasive surgery. The idea is actually pretty good, but it is quite impossible to make it happen. Haha!" the attending physician laughed.
"It's not 'good', it's basically idealism." Another resident doctor felt the same.
The resident doctor who weighed 222 pounds was still drinking a bottle of mineral water. He said sadly, "Being ambitious is always positive! When Academician Zhu came up with this plan, he knew that it wouldn't be easy to accomplish. That's why he delayed it until now."
"It won't be possible even after ten years. How can you believe that you can bypass all the blood vessels in the vascular network? It's impossible. Even if you use a device like the da Vinci Surgical System  to mark all the vascular networks, what should be cut will still be cut off. Besides, the locations of the vessels in every individual are different. It's not easy to avoid them."
"I remember that in Plan A, the vascular network needs to be restored in the end. If we accidentally cut off too many small vessels, a vascular suture will be required right?"
"That's totally insane!" An attending physician snorted in contempt. He did not have any comments on the plan itself. But, the attending physician was quite knowledgeable about the danger and functions of the plan.
The vascular network was true to its name. It was a network packed densely with blood vessels.
Theoretically, small vessels had compensation function. Even if they were cut off, after some time,the body would allocate other blood vessels and make the necessary connections again.
However, in Academician Zhu's opinion, compensation of such nature was so slow that it would affect the athlete's speed of recovery as well as the quality of the recovery.
The location of the Achilles Heel was the spot with the poorest blood supply in the human body. It was impossible to hope for high-quality recovery if a damaging open surgery was carried out there and speedy recovery was needed.
The effects of minimally invasive surgery on a normal person's Achilles tendon indicated that the surgery protected the surrounding tissues of the Achilles tendon as much as possible. That made recovery fast, and the quality of the surgery was also good.
However, minimally invasive surgeries could not provide the effects of high-strength sutures on the Achilles tendon. Therefore, Academician Zhu Tongyi's plan was actually equivalent to an open minimally invasive surgery.
It could only be completed based on the surgeon's skills itself because the theoretical basis for it was incomplete, and the equipment as well as instruments they had were not perfect for the surgery.
Zhu Tongyi attempted the surgery many years ago on several patients. Sometimes he failed, while at other times, he succeeded.
Regardless of whether the surgery was a success or a failure, it was clear just how difficult the surgery plan was to follow.
The attending physicians looked at the plan in contempt, mainly because they understood the difficulty of the surgery plan very well.
The surgeons in the research center were like students who usually excelled in their academics participating in a placement test with the standards of the Mathematical Olympiad tests. However, after they failed to score well in the examination, they found that there was a transfer student who worked very hard to score in the Mathematical Olympiad tests.
Even if they were not specialists in the Achilles tendon repair technique, and even if they did not plan to rely on the Mathematical Olympiad test in the future to earn a living, it was still a must for the doctors in the Orthopedic and Sports Medicine Center to be ambitious and to have a sense of shame.
Even the resident doctor who weighed 222 pounds was also a man who was both capable and resolute. He did not have any weaknesses except for the fact that he could get fatter just by drinking water.
Being utterly defeated was something many of the surgeons in this place never experienced.
It could be said that there was no weakling in the Orthopedic and Sports Medicine Center, but there was also not a single surgeon there who could create miracles.
There was a very low number of surgeons who could create miracles in the world.
Meanwhile, most of the doctors had not thought about this before.
"Microscope." Ling Ran followed the surgery plan strictly. He started to be even more careful in dissociating the Achilles tendon in order to prevent more blood vessels from rupturing while he performed the suture later.
This was a task that required utter seriousness and delicate work, and no one knew whether it would be effective.
However, since Ling Ran decided to trust in Zhu Tongyi's surgery plan, he would try his best to complete it as perfect as he can.
The tedious step seemed endless, and it made the audience bored.
But Ling Ran remained silent while he continued with his operation.
He did everything step by step, a little at a time, and slowly, the steps he completed accumulated.
When Ling Ran started to suture the Achilles tendon, many doctors who watched the surgery did not even realize that he had truly begun suturing the Achilles tendon.
"The strengthening of the Achilles tendon is complete." Ling Ran's movements were extremely smooth and skilled. Within a few minutes, he had connected the two ends of the Achilles tendon together, even though it was a task that others would take a long time to complete.
However, in this surgery, although the core of the surgery was on the suturing of the Achilles tendon, the difficulty was on the rebuilding of the vascular network.
"It's really complicated." Ji Tianlu looked into the microscope. The vascular network was broken into pieces, and it could not be seen clearly. It was frustrating just to look at it.
Blood vessels that were injured due to the rupture of the Achilles tendon, the open wound, the pulling of the Achilles tendon, and other factors had caused blood to spread all over the surgical field. They were like a group of complicated dominoes which were accidentally destroyed at once.
The recovery of the vascular network was a plan where they hoped to reconstruct a set of usable dominoes with the smallest amount of effort possible.
The workload in this task was even greater than the workload in a finger replantation surgery. Besides, the success rate still remained unknown.
"Let's start." Ling Ran still did not talk much. He adjusted the microscope to the correct position before he started with his task.
Ji Tianlu raised his head and looked at the time. Then, he slowly lowered down his head. He decided to cooperate with Ling Ran and do well as his first assistant.
Some of the doctors in the demonstration who had watched for more than an hour could not help but yawned. However, their facial expressions changed slightly when they looked at Ling Ran's expression. Forget being dazzled if they had to suture the vascular network, they were already dazzled from looking at the complicated layout. Moreover, Ling Ran was not just performing a simple vascular network recovery.
He had to rebuild it. He needed to make it function well immediately, and at the same time, provide a space for it to recover on itself and to expand as well.
The surgeons who were watching suddenly realized that the Mathematical Olympiad test they saw was probably categorized into different grades, and Ling Ran was working on a Mathematical Olympiad test that was of a completely different grade from theirs.