Great Doctor Ling Ran Chapter 53
53 It Would Be A Good Thing If He Could Move His Hand
Huo Congjun had been paying attention to Wang Haiyang's expressions. His heart immediately skipped a beat when he saw that Wang Haiyang's expression had changed. He quickly asked, "Chief Physician Wang, is there a problem?"
After staying quiet for a few seconds, Wang Haiyang said while feeling a little embarrassed, "No."
He was embarrassed because he was unable to raise a problem. This was obviously rather embarrassing for a chief physician who was authorized to look for flaws.
However, in the Hand Surgery Department, the suturing of tendons had always been a straightforward surgery with high requirements for skills and low systemic requirements. Ling Ran stated the steps of the surgery in a clear and logical manner, and he really could not find any problems with it.
As for how the suturing was specifically like, it was not like Wang Haiyang could pull out the patient's tendon again just to look at it.
Huo Congjun was instead rather unhappy. He said, "Old Wang, just say it as it is, you don't have to cover it up for us. This was a delicate surgery carried out during the rescue process anyway. Aren't we having this consultation with the Hand Surgery Department's experts now so that we can see if we left anything out?
After he said that, the patients' family members, who were hiding in the corner of the room, revealed grateful expressions as expected.
When it came to car accidents that occured on the highway, even if the patients were not smashed into four or five pieces, half of their bodies would be battered. The patients' minimum expectations would have been fulfilled if their lives were saved. The fact that Department Director Huo showed concern for the patient's hand function would lead to nothing but gratitude.
Wang Haiyang let out a few bitter chuckles and said, "Let us do a hand function assessment. Of course, since the patient had just gone through surgery and might not be in a very good condition, we'll do it for reference first."
The hand function assessment was often carried out in the Hand Surgery Department to gauge a patient's postoperative hand function.
Wang Haiyang held the patient's hand first, and gently guided him through a few passive movements. When he realized that the patient could perform those movements quite well, he asked, "Can the patient move his hand by himself yet?"
"Doctor Ling already asked Wenhua to move his hand the day he regained consciousness." The family members rushed to answer and asked, a little unsure. "Is this a good or bad thing?"
Wang Haiyang arched an eyebrow and coughed a few times before saying, "It would be a good thing if he could move his hand. It he couldn't, it would be a bad thing."
The family members were extremely encouraged and quickly said, "He can move it. He can move all five of his fingers. But the range of movement isn't big, and he could not clench his fist yet."
Another family member of the patient who was older quickly asked, "It's okay if he can't clench his fist now, isn't it?"
"It's okay." When he heard that, Wang Haiyang was a little stunned. He turned to glance at Ling Ran before saying, "There are still some advantages to the M-Tang technique."
Ling Ran smiled and nodded in agreement.
As the group of resident doctors beside him watched the scene, they felt uncomfortable, as though they had walked into the wrong film set.
Wang Haiyang stared at the patient and made him move each of his fingers. The patient, who had just undergone a round of surgery and was waiting to go through another, was rather dizzy. Still, he still tried his best to move his fingers according to Wang Haiyang's instructions.
He could move his fingers, which were ugly and slightly swollen. But he could really move them.
"Doctor, how is it?" His family members were still worried.
This time, Wang Haiyang spoke with certainty, "It is already really good that he can move his fingers. It means that the tendon was not ruptured after surgery. Um, try clenching your fist. You definitely would not be able to clench it completely, but try your best"
With half of his body wrapped up like a puppet, Ma Wenhua laboriously made a large 'C' shape with his left hand under Wang Haiyang's instructions.
"Is this the most you can do?" Wang Haiyang asked.
The patient nodded.
"How is it?" This time, the patient's family members were not the only ones asking, Huo Congjun was asking as well.
"It's still good." Wang Haiyang coughed a few times and said, "Try pressing the tips of your thumb and forefinger together Press the pulps of your thumb and forefinger together Press your thumb with the side of your forefinger."
Wang Haiyang performed a round of tests. As he proceeded, he became more and more surprised.
The two most troublesome and important aspects to look out for when it came to the prognosis of sutured hand tendons were the adhesion of tendons and the splitting of tendons.
The adhesion of tendons would limit hand function. The rupturing of tendons was even easier to understand. If the already sutured tendon had split again, the patient, naturally, would not be able to perform any relevant hand functions.
Neither of those two aspects were troublesome for the doctors of the Hand Surgery Department. The trouble lay in the fact that those two aspects had diametrically opposite requirements.
It was very easy to solve the problem of the adhesion of tendons alone. The earlier a patient could begin moving his hand, the smaller the problem of adhesion would be. This was because adhesion happened progressively, and the longer the patient waited, the more serious the adhesion would become.
It was also very easy to treat the splitting of tendons. The later a patient could start moving his hand, the lower the odds of the tendon splitting would be. This was because tendons grew progressively, and the longer the patient waited, the sturdier the tendon would grow.
Hence, the adhesion of tendons and the splitting of tendons became two contradicting sequelae.
If the patient were to start moving his hand early, even though the problem of adhesion would be solved, the risk of splitting would increase. If the tendon were to tear, the patient would have to undergo another surgery to have it sutured again, and it might not even be done well.
If the patient were to start moving his hand late, even though the odds of the tendon splitting would be lower, there would be a serious problem of adhesion. Many of the patients in such cases could no longer use their hands normally.
To solve this trouble, hand surgery experts tried two approaches at full pelt. In the beginning, a lot of doctors of the Hand Surgery and Foot and Ankle Surgery Department envisaged finding a drug that can prevent adhesion just like in organ transplant surgeries, or creating a surgical dressing that can reduce adhesion, and thus reduce the risk of tendons splitting without causing the adhesion of tendons. However, a decisive drug never appeared.
Hence, after many years, moving the hand early and increasing the strength of the suture became the only approach.
Among all the suturing techniques, the M-Tang technique was the one that brought this approach the furthest.
The usage of three strands of suture thread increased the strength of the stiches, allowing the patients to start moving earlier.
After undergoing surgery performed using the Kessler suturing technique, and the double-modified Kessler suturing technique favored by Wang Haiyang, patients usually began performing passive movements after forty-eight hours, or thirty-six hours at the earliest. They would begin attempting active movements after three days. Even so, 20% of the sutured tendons would still split.
On the other hand, the M-Tang technique emphasized starting active movement after twenty-four hours.
Wang Haiyang had seen surgeries performed using the M-Tang technique but had never observed the prognosis of the patients.
From what he could see right now, the prognosis of the patient whom Ling Ran performed the surgery on using the M-Tang technique was obviously a lot better than those who received surgery performed using the Kessler suturing technique and the double-modified Kessler suturing technique.
"In the Hand Surgery Department, we always emphasize early movement," Wang Haiyang explained to the patient and Huo Congjun at the same time, "Based on our experience, the more capable the patient is of early movement, the better the recovery of hand function is. But we are unable to tell exactly how well it is, either."
He gave the patient a vaccine injection as he said the last sentence. He then continued. "You must listen to the doctor's orders because the final recovery is not only related to the existing condition of your tendon and how well the suturing was done, but also to your rehabilitation. Rehabilitation is especially important."
"Then, how well was his tendon sutured?" The older family member was rather skeptical about Ling Ran from the beginning to the end. After all, from what he remembered, older doctors were better, just like the expert in front of him.
Wang Haiyang smiled. Then, in a very experienced manner, asked in reply, "What level of recovery do you hope for?"
After hesitating for a while, the patient's family members said in a rather unsure manner, "Of course we hope that it can be better. We hope that he would at least be able to take care of himself." This was because they recalled the sight of the patient's hand before this: almost broken into pieces.
"There's no problem, then. This request of yours is achievable." The moment Wang Haiyang said this, all the family members of the patient became happy.
Wang Haiyang flashed an arrogant smile. For a patient whose tendon he sutured, if he could achieve this level of recovery in only three days, then the patient might be able to cook and even play ball games, let alone take care of himself.
In the blink of an eye, Wang Haiyang suddenly felt that something was not right. He did not suture this patient!
When he turned to look at the young medical intern with the solemn expression who did the surgery, Wang Haiyang's gaunt figure suddenly trembled. He suddenly found this inspection extremely flat and uninteresting. 'The guy is still a medical intern'