Chapter 11: Tendon Suturing!
“Teacher Chen, thank you for your hard work.” Lu Cheng said respectfully after leaving the operating room, benefiting from Chen Song’s prestige.
“‘Vacation’ is hardly hard work?” Chen Song was smoking in the ‘fire escape’ leading to a corner outside the doctor’s office in the observation ward. The smoke rings vaguely obscured Lu Cheng’s vision, making Chen Song appear even more profound.
The pace of the Emergency Department at Long County People’s Hospital was naturally a “vacation” compared to that of Xiangya Second Hospital Emergency Department!
“Teacher Chen, I don’t know any of the techniques you demonstrated on the operating table. I was an Orthopedics standardized training doctor before.”
“I will go back and find them to read,” Lu Cheng replied honestly and specifically.
Chen Song was not surprised: “So, it would be strange if you already knew them.”
“Read the books slowly. Your previous major was Orthopedics, so you can only start with disease types relevant to Orthopedics…”
“Have a cigarette?” Chen Song took out his own “Harmony and Prosperity” brand.
Lu Cheng hesitated for a moment, took one, and lit it. But after just one puff, he was choked to tears, coughing non-stop.
“Forget it, don’t waste my provisions like this.”
“Smoking is bad, it easily affects the nerves in your hands. I can’t quit,” Chen Song put away his cigarette case, took another deep drag, exhaled rings, then stubbed out the butt and put on his mask again.
“Emergency surgery, the fundamental essence is mainly two points: directly controlling vital signs.”
“That is, circulating blood volume and blood pressure. What we in surgery intervene with is bleeding. If this is handled well, the patient’s life is likely to be saved.”
“The intensity of emergency conditions lies in their rapid onset and rapid fatality. Their nature also lies in rapid resolution and rapid recovery, with immediate results.”
“Therefore, among the basic skills of surgery, hemostasis is the most fundamental content of our emergency medicine.”
“Once hemostasis is mastered, other surgeries can be practiced slowly. For example, this surgery, the first time I performed it, it took me a full eleven hours to come down from the table. My teacher waited by the operating room door all day.”
“Surgical techniques are learned little by little like this,” Chen Song explained very specifically.
“Next is diagnosis.”
This time, Chen Song’s pointers did not trigger any panel updates, yet Lu Cheng felt immensely benefited: “Thank you for your guidance, Teacher Chen. For now, I can only focus on tendon suturing.”
“Hmm…” Chen Song was very pleased with Lu Cheng’s self-awareness. With his hands behind his back, he walked profoundly into the observation ward, like a leisurely individual detached from worldly affairs.
Lu Cheng, on the other hand, had to complete the medical documentation for the emergency patient he had just seen, including the emergency medical record, surgical operation record, first progress note, and postoperative first round of rounds record.
In critical emergency surgery, every minute can be a matter of life and death.
The law stipulates that in cases of emergency, consent may be waived, with authorization from the hospital’s on-duty supervisor, allowing surgery to proceed legally before obtaining signatures and completing medical records afterward.
Even if the patient dies on the operating table, it is considered emergency avoidance.
…
At noon, the lunch in the doctor’s lounge was enticingly fragrant. Lu Cheng entered the Emergency Surgery Clinic to organize disposable masks.
Du Daihua, in front of the patient, was very polite: “Doctor Lu, this patient has a wrist tendon injury… Director Lin said you should take a look!~”
The patient was a young man, around thirty years old. His wrist had already been temporarily bandaged to stop bleeding. He looked at Lu Cheng thoughtfully: “Doctor Du, is this Doctor Lu? He looks a bit young?”
Du Daihua said: “Yes, Doctor Lu is a top student from Hanshi University!~”
“He looks very handsome, and his surgical skills are as handsome as he is.”
Du Daihua, a graduate of a second-tier university and a standardized training doctor, dared not compare his “basic skills” with Lu Cheng’s after witnessing Lu Cheng’s operation. Furthermore, Director Peng of Orthopedics had also encountered difficulties with tendon suturing, making him even more hesitant.
The medical learning cycle is very long, and being a doctor is a super late-game profession. What Lu Cheng cannot perform, Du Daihua also cannot. However, he is willing to wait…
While Du Daihua was conversing with the patient, Lu Cheng had already opened the outer gauze and, after assessing the wound depth, stated professionally: “Big Brother, you have a flexor tendon injury within the carpal tunnel. In professional terms, this is a flexor tendon injury in zone IV.”
“Suturing is definitely necessary. Today, the orthopedic on-duty doctor called to say he couldn’t handle this situation. Are you going to Zhou People’s Hospital or?”
“You want me to handle it for you?”
The patient’s right to informed consent extended beyond just agreeing to Lu Cheng’s operation; Lu Cheng also had to provide suitable alternative options.
Either Lu Cheng operates, or go to Xiangzhou People’s Hospital – a choice between two.
Chen Song does not perform tendon injuries because the condition is too minor, and he is too lazy to intervene.
Zone IV flexor tendon injury is a relatively easier tendon injury to handle. The textbook recommendation is the modified Kessler technique, which is also one of the simplest tendon suturing methods.
Lu Cheng’s cautious attitude and tone sounded reliable, and he also looked quite pleasant to the eye: “Doctor Lu, you mean, even the orthopedic doctors can’t handle this tendon injury, but you can?”
Lu Cheng shook his head slightly and replied cautiously: “Those are not my words; it was the orthopedic on-duty doctor today who said he couldn’t handle it.”
“Director Peng of Orthopedics has gone to the countryside again. This is a time-sensitive surgery; it cannot be delayed for too long.”
“If you are seeking better treatment outcomes, you can go to Zhou People’s Hospital in Jishi City immediately. The on-duty doctors there can find doctors who can handle it for you.”
Director Peng of Orthopedics could perform this tendon injury, but previous tendon suturing cases had given him a psychological shadow, so he was simply unwilling to touch this type of disease.
When Director Peng is not on duty, the on-duty doctor naturally wouldn’t court trouble.
Even if the patient had a “misunderstanding,” Lu Cheng had to explain it clearly.
Rising by stepping on colleagues or elevating oneself by stepping on others is unethical. Even if others cannot suture tendons, they can perform fracture surgery, right? Or arthroscopic surgery?
Tendon suturing is just one of the specialized procedures within the subspecialty of hand surgery, and it has only gained more attention in recent years.
If we go back twenty years, they would simply suture it up and consider it treated if there was no infection. Whether there would be stiffness was not even within the scope of discussion in the medical community.
As long as there was no bleeding and no infection, it was considered treated.
“Then you do it… I see you’re quite honest,” the young man agreed.
“Tendon suturing is a standard surgical procedure and requires admission to the operating room. The cost is not low either. Whether I operate or someone else does, it will cost over two thousand yuan.”
“You will also need to be hospitalized for rehabilitation afterward!”
“I need to make this clear to you as well,” Lu Cheng explained.
“Still, I have to get it done. I can’t go back with a broken tendon, can I? I can’t even bend my fingers.” The young man’s expression was quite helpless.
Even though it was expensive, it had to be treated; things had come to this point.
A tendon rupture is no laughing matter. He had also looked up some popular science information earlier; this could potentially lead to postoperative stiffness, turning him into a different kind of ‘cripple’ in his hand.
…
Tendon suturing is not simple debridement and suturing. Ordinary local anesthesia is insufficient; it requires nerve block anesthesia in the emergency operating room.
The anesthetic drugs and tendon sutures used in the county hospital are all domestically produced. The suture used is Tyco Ticron (3-0), priced at 195 yuan per strand. Lu Cheng is unsure how much will be reimbursed. However, it is still considerably cheaper than Ethicon 2-0 blue sutures at Xiangya Second Hospital, which cost 239 yuan per strand.
After the discussion and signing, the patient was first taken to the emergency operating room. Lu Cheng then said to Zhang Tiesheng, who was on standby: “Brother Zhang, this tendon suturing is a Level 2 surgery. Should we list you as the chief surgeon or myself?”
Zhang Tiesheng was a senior attending physician, with more years of service than Lu Cheng.
Chen Song was too lazy to be the chief surgeon for this operation, and having him act as an assistant would be even more ‘unreliable.’ However, Professor Chen Song had promised to take a look after the surgery.
Tendon suturing cannot be done by one person alone. Zhang Tiesheng came for the surgery standby.
Zhang Tiesheng was of medium height, wore black-rimmed glasses, and looked refined. He chuckled sheepishly: “Since you’re performing it, Xiao Lu, of course, it should be listed under your name as chief surgeon. I’ll be the first assistant!”
How could Zhang Tiesheng take the blame for Lu Cheng? While the Emergency Department needed “business,” they couldn’t just throw someone to the wolves.
“Okay, Brother Zhang,” Lu Cheng understood.
Upon entering the operating room, the usual procedure of formal disinfection and draping was carried out.
Then, Lu Cheng sat in the primary position and began the debridement and suturing, with Zhang Tiesheng observing intently from the first assistant’s position.
Although he had only heard that Lu Cheng could suture tendons, based on his interactions with Lu Cheng, Zhang Tiesheng was certain that Lu Cheng was not someone who talked big.
If Lu Cheng said he could do it, then there was a high probability he could.
He might choose to avoid taking responsibility for stability, but he couldn’t afford to lose the mindset of learning by observing the surgery.
There had to be a reason why Professor Chen Song chose to mentor Lu Cheng and not him.
“What kind of suturing technique are you using?” Zhang Tiesheng asked with some doubt after watching.
The orthopedic doctors he was familiar with in the hospital didn’t seem to use this technique. Mattress suturing and weave suturing were what they used most often.
“Modified Kessler tendon suturing technique, currently the most recommended suturing technique for zone IV flexor tendon injuries,” Lu Cheng replied meticulously while suturing with utmost precision.
Zhang Tiesheng’s expression stiffened slightly, and he remained silent.
This understanding was like a dimensional strike at the theoretical level. Zhang Tiesheng only knew that tendon suturing had a high entry requirement but didn’t know how flexor tendons were categorized. Wrist flexor tendons are in zone IV, and the modified Kessler technique is most recommended for zone IV flexor tendon injuries.
This academic approach must have been taught by Professor Chen Song!
He just didn’t expect Lu Cheng to actually be able to learn it!
Zhang Tiesheng felt no jealousy or envy for the type of tendon suturing Lu Cheng was performing.
This Lu Cheng was truly pushing himself for the surgery.
Zhang Tiesheng’s gaze drifted over Lu Cheng…
