Chapter 117: Fasting Equilibrium!
“The current mainstream nerve suturing is simple nerve suturing, with no specific technique, only simple interrupted suturing applied to the suturing of nerve transections—”
“There are currently three mainstream suturing concepts: epimysial suturing, perineural suturing, and a combined perineural and epimysial suturing.”
“This combination is not a true combination; it’s just separate operations.”
“There are also modified surgical techniques where 3-5 small fascicles are grouped together to reduce the number of sutures…”
The anatomical structure of nerves is very similar to electrical wires; after the epineurium layer, there are many nerve fascicles inside.
However, these nerve fascicles are not divided into live and neutral wires, but rather sensory branches, motor branches, and so on.
“However, the success rate of epineurial and perineural suturing is also limited, and each has its own drawbacks.”
“According to data from 12 months postoperative after ulnar nerve injury repair, the success rate of perineural suturing is about 81.0%-88%, while the success rate of epimysial suturing is only 32.5%-47.4%!”
“While this success rate was acceptable in the past, in the current era of highly developed hand surgery, it has become a limitation.”
“Of course, epimysial suturing does not carry the risk of ischemia between nerve fascicles, while perineural suturing has about a 15% chance of ischemia.”
“Based on this, our hand surgery department has been continuously improving nerve suturing techniques, striving to combine the advantages and disadvantages of perineural and epimysial suturing…”
“Currently, although a specific technique has not yet been formed, the overall data is still higher than mainstream suturing methods, and this suturing technique will also make your clinical work proceed more smoothly…”
“I have already taught you the specific suturing methods, and they are not difficult. The rest is up to your own practice.”
After Professor Liu Huanglong’s practical demonstration class, he truly made a cursory round, offering guidance to everyone.
His first stop was in front of Dong Qiaoshan, where he nodded repeatedly: “Your basic skills in suturing are good, and the details of your operation are meticulous. For epineurial and perineural suturing of nerves, a slight modification will be made to simple suturing; what you need to pay attention to is the angle of needle insertion and withdrawal…”
“Also, when separating the perineurium, do not overdo it. Excessive separation of the perineurium is the fundamental cause of perineural ischemia and necrosis.”
“Thank you, Teacher Liu.” Dong Qiaoshan nodded earnestly and meticulously buried his head in continuing the operation.
Liu Huanglong then walked over to Xie Yuan’an. After watching for a while through the assistant’s microscope, he reprimanded: “Steady your hands! You’re shaking, shaking, shaking; even the aunties serving food in the cafeteria aren’t as Parkinsonian as you.”
“Why are you blinking your eyes? Are you telling the nerves you’re cute? Are you trying to melt the baby nerve cells?” Liu Huanglong immediately unleashed his criticism without reservation.
Xie Yuan’an sat up straight, her face showing no signs of grievance, only full concentration on the practice operation in her hands.
After watching for a while, Liu Huanglong stood up and said: “Practice slowly. You haven’t even reached the threshold of the most basic, core requirements for hand surgery suturing.”
“Steady hands, controlled blinking, not enough tears shed!”
Lin Bin, Ding Mengzhuo, Liu Qiming, Han Gongqiang, and others also received Liu Huanglong’s esteemed guidance, but Liu Huanglong’s tone was not as harsh towards them as it was towards Xie Yuan’an; instead, he was very patient.
Liu Huanglong then moved to Lu Cheng’s assistant microscope, his voice quite blunt, demonstrating his extensive knowledge: “Don’t act on your own initiative. Don’t bring tendon suturing techniques into nerve suturing.”
“Tendon suturing aims for suture toughness, while nerve suturing aims for tension-free closure and requires the precise apposition of nerve ends.”
“Yes, yes, that’s right. Don’t bring other suturing techniques into nerve suturing; it’s just the simplest, most basic interrupted suturing.”
“Perform nerve suturing operations based on the concept and fundamental principles of tension-reducing suturing. If nerve suturing is squeezed too much, it can easily lead to neuroma, and the enlarged, healed ends will cause pain to the patient…”
“Hmm?” As Liu Huanglong was speaking, Lu Cheng had, in fact, meticulously corrected his suturing approach.
“What is your name?” Liu Huanglong looked up at Lu Cheng.
Lu Cheng lifted his bowed head. Beneath his short haircut, his hairline was neat, his skin slightly dark but full of youthful vigor, and his eyes were bright and piercing.
He looked like someone who could make a living solely on his looks, yet his practical skills were also excellent. He appeared to be around twenty-seven or twenty-eight years old, likely with a baby face…
“Teacher Liu, my name is Lu Cheng, Lu for land, Cheng for success.” Lu Cheng also observed Liu Huanglong as he replied.
A long face, a thick nose, small eyes, and short eyebrows; at first glance, he could be described as shifty-eyed, but he would surely rely on his skills and talent.
“Resuture it once, and let me see.” Liu Huanglong pointed to the operating table.
Lu Cheng complied, and casually invested a few more of his scarce skill points.
In a short time, Lu Cheng had completely eliminated the drawbacks of incorporating tendon suturing techniques into nerve suturing that Liu Huanglong had mentioned.
In fact, after watching for a while, Liu Huanglong even noticed that Lu Cheng’s proficiency seemed to be even more refined than in the previous suturing attempt.
Tension-free coaptation and precise matching of blue nerve bundles are the cornerstones of nerve function recovery, and all nerve suturing aims for this.
Therefore, the key to nerve suturing technique lies in gentle, tension-free, and precise positioning and matching.
To achieve these two points in a transected nerve requires a great deal of meticulous effort, such as the choice of needle entry and exit points, the depth of the suture, the width of the suture, and even the force of knot tying, all of which will affect the final prognosis.
【Nerve Suturing Technique （Proficiency 8/10 ）】
Liu Huanglong said: “Perineural suturing requires operating under at least a 40x microscope （with suturing errors less than 50μm ）; this is the beginner’s foundation. If you want to do it well, the suturing error must be controlled within 20μm or even 5μm.”
“Epimysial suturing is mostly applicable to small nerve injuries and mixed nerve injuries where fascicle separation is difficult, so perineural suturing is a must-learn…”
“And in perineural suturing, careful separation of the perineurium will also affect the final suturing. Therefore, what appears to be suturing is actually a complete embodiment of all basic skills.”
“Let me break down the perineurium for you…”
【Master meticulously instructs on the essence of nerve suturing technique; nerve suturing skill slightly improves 】
【Master meticulously instructs on the essential techniques of nerve suturing; epineural-perineural suturing skill slightly improves 】
A few minutes later, Liu Huanglong let go, allowing Lu Cheng to continue operating.
Lu Cheng calmly continued with the suturing, exhibiting an almost “photographic memory” for replication in the operating room.
“Yo ho.” Liu Huanglong’s small eyes lit up, emitting a “strange sound.”
…
And then he never moved from Lu Cheng’s side again.
Xie Yuan’an, Dong Qiaoshan, and others occasionally glanced at Liu Huanglong, noticing that he was completely engrossed in his experience as a “skillful instructor,” not even thinking about other students who needed attention…
Now, everyone was balanced.
A balance of extreme restraint!~
