Chapter 7: Tendon Suturing And Modified Kessler Suturing Technique!
Several days passed in the blink of an eye.
On July 6th, Thursday, Lu Cheng and Chen Song finished work and entered their “rest day”!
At 1 PM, with both parents out at work, Lu Cheng left the residential area, ate a big bowl rice buffet, and feeling very full, rushed back. He immediately entered the training room, which had already been air-conditioned.
The heat in July was truly unbearable; Lu Cheng’s short sleeves were soaked with sweat just from walking home from the entrance.
While pulling at the collar of his shirt to let the cool air in and cool down, Lu Cheng opened his notebook: “Besides mastering basic skills, tendon suturing also requires learning the corresponding suturing techniques. A simple, easy-to-learn beginner technique is the modified Kessler suture.”
“Moving up, there’s the Jin Xia suturing technique and the modified Tang method…”
Suturing is a basic skill. Once a certain level of basic skill is reached, it signifies that you have mastered the distance and force of suturing to a certain degree, allowing for excellent handling of details during the procedure.
However, if one only uses the simplest ‘simple interrupted’ suture, it will still not be enough to handle ‘complex’ disease types like tendon injuries.
According to Professor Chen Song’s analogy, the mastery of basic skills is like internal energy, and suturing techniques are the applicable moves.
Essentially, animals as large as cats can catch mice, but the species best suited for catching mice and specializing in it is still the ‘cat’.
Lu Cheng turned the page and looked at the ‘staged progression’ training method he had compiled online.
【 Planar puncture positioning （ 30 minutes/day × 3 days ） Action breakdown:
Draw two parallel lines on the silicone pad （ with a spacing equal to the tendon diameter ）.
Perpendicular needle insertion: Insert the needle tip at a 90° angle 1.5mm from the edge, exiting at an equal distance on the opposite side （ with an error ≤ 0.2mm ）.
Cross practice: Complete 10 sets of “X-shaped cross insertions,” ensuring symmetry on both sides. （ Completed ）】.
Lu Cheng licked his lips, finding them a bit salty and greasy. He quickly ran out to wash his hands and face. Finally, after splashing water, Lu Cheng looked at the mirror opposite the washbasin—
In the mirror, his own features were three-dimensional, mature and steady, and as handsome as Pan An. Lu Cheng even thought that if he were a girl, he would definitely marry himself…
After stopping his daydreaming, Lu Cheng looked at the entries on his panel again—
【 Suturing Skill Line: Tendon Suturing （ Beginner 3/5 ）, Modified Kessler Suturing （ Beginner 1/5 ）】.
【 Remaining Skill Points: 16.3. 】
Technique practice improves at a faster rate than basic skill practice, but it cannot bring about a ‘miraculous transformation’ in just a few days. After practicing diligently for four days, both Tendon Suturing and Modified Kessler Suturing only increased by 1 proficiency point.
This progress was achieved with Professor Chen Song’s guidance; otherwise, it might have been even slower.
After arriving at the Emergency Department, in 6 days, with only three days of work, he gained nearly 15 skill points. This efficiency was more than double that in the Orthopedics department!
He wondered if he needed to clear levels to progress from beginner to proficient.
He’d worry about that later; for now, he’d just spend them.
In an instant, Lu Cheng’s face turned bitter.
【 Suturing Skill Line: Tendon Suturing （ Proficient 0/10 ） （ Skill Points -7 ）, Modified Kessler Suturing （ Proficient 0/10 ） （ Skill Points -9 ）】.
【 Remaining Skill Points: 0.3】.
“To encourage someone to study medicine is to invite divine retribution!!!” Lu Cheng cursed under his breath…
Then, Lu Cheng looked again at the content he had compiled in his notebook:
【 Tendon Longitudinal Puncture （ Chicken Leg Tendon Practical Training ）—
Initial knot locking: Operation key points—longitudinal puncture 1cm from the severed end → tie a triple square knot （ tension should be a slight constriction ）. Common error—over-tightening causing tendon strangulation （ blocking blood supply ）.
Core double needle puncture proximal end: Operation key points—perpendicular insertion 8mm from the severed end, exiting obliquely at 45° on the opposite side （ 5mm from the severed end ） → reverse operation for the distal end. Common error—deviation in insertion angle causing suture exposure.
Pulling to verify: Operation key points—pull both sutures simultaneously to verify close approximation of the cut surfaces without displacement. Common error: pulling a single suture causing rotational deformity.
Training goal: Complete 10 anastomoses within 20 minutes. Standard for achievement → anastomosis tensile strength ≥ 15N （ tested with a spring scale ）】.
The chicken legs were bought, and the 6-0 sutures were wholesale rejects purchased online!
The silicone training board （ with simulated sheath, blue/white double color ） was made using rubber tubes and dyed with coloring agents.
“Everything is ready, let’s do this!!~” Lu Cheng set up his phone for recording and then clicked the record button.
Recording his own operations has many benefits: firstly, he can review it himself and identify and fill gaps; secondly, he can send it to his teacher for correction of errors.
After all, when suturing this, the hand holding the needle needs to have a tremor magnitude of < 1mm! Self-checking is often required.
Medical techniques are learned this way.
Of course, while practicing, Lu Cheng also added a tiny bit of ‘cheat’ power to assist.
Lu Cheng had already mastered the operational techniques by heart, so he had no other worries when practicing.
One chicken leg, two chicken legs, three chicken legs…
Approximately two hours passed, and a total of eight chicken legs were processed by Lu Cheng.
These chicken legs were laid out in front of Lu Cheng one by one, and he began to meticulously inspect each one.
Two minutes later, Lu Cheng, with a sense of despair, removed his examination gloves and covered his forehead.
Modified Kessler suturing at a proficient level, yet an 8/3 failure rate. What the hell is this!
Of course, this also has a background context: the diameter of chicken leg flexor tendons is 3-4mm （ similar to human zone II flexor tendons ）, making it one of the most difficult tendon materials for practicing suturing.
“Sigh!” Lu Cheng, unable to vent his despair, could only sigh.
If it weren’t for the high difficulty of tendon suturing, Director Peng at the hospital wouldn’t have explicitly given up on it.
Lu Cheng continued to record notes, analyzing the causes of operational errors, treating it as a mistake correction book.
“Failure Case 1: Gap between severed ends > 3mm.
Root cause analysis: Insufficient tension of the distal locking knot; Correction plan: After tying the knot, pull both sutures until the tendon slightly whitens.”
“Failure Case 2: Suture exposed on the tendon surface;
Root cause analysis: Insufficient insertion depth; Correction plan: Practice ‘buried suture technique’: press down the skin at the insertion point with tweezers by 0.5mm.”
“Failure Case 3: Anastomosis separated during tensile test;
Root cause analysis: Longitudinal sutures did not run parallel within the tendon; Correction plan: Use micro-scissors to dissect the tendon and verify suture trajectory.”
“Successful Case: …”
After recording everything, Lu Cheng took photos of it, and then separately cut out videos of the process and details of these few chicken leg sutures.
He then sent them to Chen Song with a polite tone: “Teacher Chen, these are my failed practice cases from today. If you have time, could you help me review the reasons for the errors?”
Training materials in the training room can fail, but clinical practice cannot.
Mistakes can be made in the college entrance examination, resulting in deducted points at most, but once surgery fails, the consequences are extremely severe.
It was already past 4 PM. Professor Chen Song sat in the “civilian residence dormitory” arranged by the county hospital, facing the window, leisurely enjoying the sunset while holding a cup of tea.
He picked up the tea, then put it down; he picked up his mobile phone, then put it down, repeating this cycle four or five times…
Only then did Chen Song’s heart tighten as he began to reply, deviating from the question: “Xiao Lu, why don’t you consider pursuing a master’s degree?”
“Although you’re a bit older, you’re not ‘too old’ yet!”
Chen Song is an associate professor, deputy chief physician, researcher, senior professional, and doctoral supervisor at Xiangya Second Hospital, slated for promotion to chief physician and professor （ senior professional ）!
Lu Cheng’s attitude towards learning is too upright!
He also has good talent. In just a few days, he has made the modified Kessler suturing technique look quite presentable. Crucially, even when asking questions, he breaks them down meticulously and speaks with substance.
He is well-behaved and understanding, and his social graces are impeccable, speaking and acting smoothly. How could he find any reason not to love such a student?
For five minutes, Chen Song watched the chat window between himself and Lu Cheng repeatedly show ‘The other party is typing…’, disappear, then reappear.
It finally concluded with a single sentence: “Teacher Chen, I have already completed my standardized training, so I cannot pursue a professional master’s degree. It’s too late for me to pursue an academic master’s degree at my age.”
“Sigh…” Chen Song replied with a single word followed by six dots.
What Lu Cheng thought, he naturally could not fail to consider.
