Ling Ran observed the exposed flexor tendon. He did not immediately get to work.
He had surveyed the patient's X-ray many times over, but he still relied on his naked eyes very much, since he was terrible at analyzing X-ray images.
Huo Congjun watched in silence. He understood what Ling Ran was doing.
All surgeons trusted their naked eyes more than anything else.
If you were to pay close attention to a surgery in progress, you would quickly find that surgeries which allowed the surgeons the ability to directly examine the patient's bodysuch as organ transplant surgeries including heart transplantsdid would develop much faster. If you looked at it from a 21st century point of view, those surgeries were carried out under most challenging conditions. However, surgeons still sprang up one after another to take on the task. Or you could say that they sprang on the patients, one after another.
In short, performing an operation without the use of other machines to provide visual aid was the surgeons' hobby and also favorite method of surgery. To them, surgeries such as abdominoscopy and those performed using the da Vinci Surgical System were second-rate. Coronary artery bypass surgery was also preferable compared to the use of stents
"Incision has to be bigger," Ling Ran mumbled to himself. He then got to work.
Lu Wenbin could not help but widen his eyes when he heard Ling Ran. 'Can you even do this?'
Huo Congjun had to try hard to stop himself from speaking.
It was rather embarrassing for a surgeon to even mention that he had to cut open a patient twice.
However, Ling Ran was not aware of this unspoken rule.
Most of the time before this, he had stayed in the treatment room and emergency room. He had neither been to other departments nor came to the Emergency Department's operating theater often.
He was truly green behind the ears when it came to determining incision lengths. He simply wanted to increase his field of vision, so he naturally had to make the incision longer.
This was the only way the surgery could be carried out more easily after this. The patient's scar could end up longer because of this, but scarring was obviously not the primary consideration when it came to surgeries involving ruptured tendons.
As much as he worked to minimize scarring when debriding or suturing wounds, he would not put as much thought into it at a time such as this. The scar would be there regardless, and its length would not make any difference.
Instead, the success rate in a flexor tendon suture would make a huge difference in a patient's life.
Under the best circumstances, the postoperative total active motion (TAM) would be 100%, which meant that the range of motion of the patient's finger would be no different compared to that of an ordinary person. A TAM of 100% was considered excellent, while a TAM of over 75% was decent, with the patient's ability to perform daily tasks guaranteed.
85% of patients whose flexor tendons were sutured using the M-Tang technique would achieve an excellent or good TAM. This meant that eighty-five in one hundred people whose flexor tendons were sutured using the M-Tang technique could return to normal daily living. These statistics were very hard to come by, even for tendons in other positions with a lower difficulty of suturing, let alone the no man's land.
In most ordinary hospitals, under the hands of ordinarily excellent doctors, achieving a 'fair' TAM between 50% to 75% after the suturing of flexor tendons was already a blessing. Even though patients with a TAM of this range could still use their fingers, several activitiessuch as sweeping the floor, holding a bowl and peeling an eggwould become difficult and almost impossible.
But even so, when it came to the suturing of flexor tendons in many hospitals, there would not be as many as 85% of patients who achieved a 'fair' TAM.
Ling Ran did not care about what ordinary doctors in ordinary hospitals did.
He aimed for more than that.
However, he was also unsure about the results of this particular surgery. So, he could only try his best to raise the odds of success.
"Pull open both sides of the skin." Ling Ran pulled open the cortical layer of the skin with a pair of forceps and passed the forceps to Lu Wenbin while he was at it.
"Oh, alright." Even though Lu Wenbin was a little anxious, he pulled the cortical layer of the skin to the side without a hitch.
After repeating the same step a few times, the entire tendon was within Ling Ran's field of vision.
When he judged it based on the Master level skill he obtained, there was now a little too much exposure. However, this would make the surgery easier and increase the fault tolerance margin.
The patient's tendon had already been ruptured for almost twenty hours. Contusion and trauma of the tendonwhich would definitely lower the success rate and excellence ratewere basically unavoidable. This was why Ling Ran would rather have the incision larger.
Of course, it was also because he was too much of a beginner when it came to making incisions.
Ling Ran observed the exposed tendon again. He still did not get to work.
Flexor tendons made it possible for humans to bend their fingers. Every person had five flexor tendons that extended from their wrists to the tip of their fingers. If you looked at the anatomical diagram, they would be like rubber bandspressed down by the wristthen extended into the five fingers.
Even though the thickness of each flexor tendon was only around that of the wire of an iPhone charger, they were extremely elastic and strong.
And the suturing of flexor tendons was difficult because their elasticity and strength had to be retained.
They had to ensure that the flexor tendon did not rupture again, while the elasticity had to be maintained to guarantee the flexor tendon's function.
The loss of either the strength or the elasticity of the flexor tendon would result in a failed surgery.
Ling Ran gazed at the blood-coated but otherwise bone-white flexor tendon. A few scenarios ran through his mind.
It was impossible for him to think of what to do before the surgery began because he was not skilled enough. But right now, he did not have much time to contemplate either.
Very soon, Ling Ran extended his hand.
Wang Jia heaved a sigh of relief and quickly passed the needle holderwith the surgical suture attached to the needleto Ling Ran. She would have felt worried on his behalf if he were to ask for the scalpel again.
Ling Ran found the right position and sent the needle inside without hesitation. His movements were a few hundred times more adept compared to when he was making the incision.
If you were to describe it with similes, for Ling Ran, making incisions was like rearing cows while suturing was like eating beef.
Ling Ran even felt ecstatic as he held the needle holder.
The needle flashed
Every movement was precise
When Ling Ran raised the needle holder, he finally showed his Master level skillsthe skills that had won Huo Congjun over.
Huo Congjun stood beside Ling Ran and watched as Ling Ran worked. He was somewhat enjoying it, somewhat pleased with himself and also somewhat satisfied.
This was the level of skill that made it worthwhile for Huo Congjun to personally go to Lai Tai County.
Lu Wenbin's entire body shuddered.
He had heard about the first time Ling Ran performed surgery using the M-Tang technique, and also witnessed Ling Ran's skills when Ling Ran sutured the pig's foot in the old storeroom. The latter incident gave Lu Wenbin a more direct view, but Ling Ran was afterall, suturing a dead object, and was doing it in a very 'basic' manner so that Lu Wenbin could understand the steps of the M-Tang technique.
At that moment, Lu Wenbin was the last thing in Ling Ran's mind.
To reduce the difficulty of the task at hand, Ling Ran allowed Lu Wenbin work with him wherever Lu Wenbin was capable of doing so.
Wherever Lu Wenbin was incapable, Ling Ran took over without saying a thing. He then completed the entire process of that particular step by himself in the surgery that followed.
Lu Wenbin felt immense pressure within only a few minutes.
He already knew that he would be marginalized. But Lu Wenbin was not someone who was willing to be marginalized when standing in front of the operating table and in the face of the patient, other doctors, and nurses.
At that moment, Lu Wenbin cared even less about the fact that it was embarrassing to play second fiddle to a medical intern. It could not be more embarrassing than being marginalized on top of playing second fiddle to a medical intern.
Besides, skills were skills. This would not change because of someone's identity.
Lu Wenbin fixed his gaze on the exposed tendon, hoping to take in more details.
Naturally, Ling Ran noticed the changes in Lu Wenbin.
Having debrided so many wounds in the treatment room, he was already used to observing the movements around him at all times.
Ling Ran smiled a little and said, "It's not very different from suturing a pig's flexor tendon, isn't it?"
"Ah? Ah it's different, way too different." Lu Wenbin did not know what to say either, and shook his head frantically.
Ling Ran hummed in acknowledgment, but dropped the topic. This left Lu Wenbin rather disappointed.
The operating theatre fell silent.
Only Ling Ran's commands echoed throughout the room, every now and then.
"Press on the dressing a bit."
Somewhat not used to the silence, Su Jiafu the anesthetist shifted his body a few times, and the stool beneath his body creaked.
Su Jiafu's thoughts were wandering. 'I really need to lose weight this year. I need to lose at least sixty-five pounds so that I can pretend to be a handsome young man. But this wouldn't do, because it's not good for health to lose too much weight in one go. It would be enough to lose fifty-five pounds.'
He lifted his head in boredom as he thought and looked towards the direction of the operating table.
Su Jiafu immediately met Huo Congjun's gaze.
What sort of gaze was that?
Su Jiafu quickly started analyzing with his logical thinking, which scored had him 600 points or so in his college entrance examination. 'Department Director Huo likes to chitchat when he's the chief surgeon. However, Ling Ran is the chief surgeon today, and Ling Ran doesn't like to talk. And Department Director Huo isn't saying anything either because he is worried that Ling Ran would be affected by the chitchat. So Department Director Huo is very bored So, f*ck this, with that fierce gaze, he definitely wants my stool.'
Su Jiafu stood up silently. He straightened his body and pretended to casually stretch.
There was not even enough time for the wheels of the small round stool to roll before the stool was dragged away just like that. It gave forth a sound of friction.
Department Director Huo pounced on it. He sat on the stool and flashed an old leader's smile, which was a long time coming.
Su Jiafu sighed in agony, not even bothering to stretch anymore. He thought absentmindedly, 'If this continues, I'll probably lose more than eighty-five pounds. This wouldn't do, there will be health problems if I get too thin. Argh, next time, I'll just grovel to the circulating nurses and ask them to bring one more stool in.
"I'm done," Ling Ran said and started checking on the stitches.
Huo Congjun immediately stood up and the small round stool to the corner of the operating theater.