Chapter 28: Improved Tang Method!
July 21st, Tuesday.
At the Emergency Department of Long County People’s Hospital, Chen Song’s hands were flat on his palms, spread across the top of his hair and eyebrows, the palms slicking his hair upwards, distorting its shape completely:
“Xiao Lu, what did you just say? You want to attempt flexor tendon suturing in district two?”
“Do you even know what you’re talking about? Do you know what district two flexor tendons used to be called?”
Lu Cheng had a good memory and knew the development history of hand surgery. He replied, “No Man’s Land Tendons.”
The so-called “No Man’s Land Tendon,” the nickname “no man’s land,” actually represents a surgical history filled with blood and tears.
This name first appeared in battlefield medical records in the early 20th century. At that time, military surgeons discovered that the survival rate of tendon injuries in the hand caused by firearm wounds in this area was close to zero: after surgery, they would either rupture or adhere, as if it were a forbidden zone designated by death.
Bunnell’s classic textbook in the 1940s directly referred to it as the “Forbidden Zone for Repair,” and this despair was first named “no man’s land” by Littler, the father of American hand surgery, in 1950.
In the 1960s-1970s, hand surgery specialists attempted staged reconstruction with silicone rods, still facing a 50% chance of infection and joint stiffness…
It was only after the emergence of the Tang method and Tsuge suturing method in the 1980s-1999s that it began to improve.
But as late as 2020, the excellent functional recovery rate for district two flexor tendons was still only 88%, with a reoperation rate for adhesions remaining at 12%!
These cold, hard numbers are not made up lightly; they are statistical data obtained from millions, even tens of millions, of patients who experienced ‘stiffness’ and ‘re-rupture’.
It was only this year, in 2023, that No Man’s Land was revised in academic literature to “Repairable Zone,” marking the culmination of seventy years of effort by countless seniors in hand surgery.
Learning the modified Tang technique is very difficult, and even now, not every hand surgeon is proficient and has mastery in it.
“Since you know this, you still dare to say you want to try flexor tendon suturing in district two?”
“I’ve also read related literature recently. Scholars still define tendons in this area as ‘No Man’s Land’ if there is no microsurgical technique or rehabilitation team support!”
“I can’t do it either!” Chen Song, like a cat whose tail has been stepped on, set aside his “Cat Person” pride.
Although he performed surgeries for tendon ruptures and injuries at Xiangya Second Hospital, he did not perform flexor tendon suturing in district two.
Lu Cheng looked at Chen Song calmly, his voice clear and smiling, “Teacher Chen, based on what you just said, can I understand that even if Director Xiang came down to the countryside, he might not dare to attempt this district two tendon suturing?”
“Whether he dares to attempt it is hard to say, but he certainly wouldn’t do it lightly.”
Chen Song replied, shaking his head, then stared at Lu Cheng, “Don’t tell me you’ve learned the Tang method and the modified Tang method of suturing again?”
“The simple Tsuge suturing technique, when proficiency is insufficient, makes it very difficult to handle district two flexor tendons well.”
For district two flexor tendon suturing, the modified Tang method is the first choice, followed by the Tsuge suturing method. Only as a last resort would one choose to use the modified Kessler.
It can be said that the reoperation rate for most district two flexor tendon injuries is contributed by the modified Kessler and Tsuge suturing techniques. The modified Tang method contributes fewer reoperation cases.
For district two tendons, the modified Tang method is like a cat catching a mouse, perfectly suited; however, it’s not only the modified Tang method that can handle district two tendons.
If a dog is smart enough to chase mice, it can also be used with some effort.
“It should be about the same…” Lu Cheng seriously looked at his panel and smiled knowingly.
【 Suturing Skill Tree: Suturing Technique (**Mastery** 4/20) (Skill Points -2), Tendon Suturing Technique (**Proficient** 7/10) (Skill Points -2), Modified Kessler (**Proficient** 5/10) (Skill Points -2), Tsuge Suturing (**including sliding type**) (**Proficient** 3/10) (Skill Points -2), Modified Tang Method (**Proficient** 6/10) (Skill Points -16) 】
【 Current Remaining Skill Points: 0.1 】
This was the result of Lu Cheng using up almost all the skill points he had accumulated recently to upgrade his skills.
Lu Cheng also knew that district two flexor tendon suturing was very difficult, so he hadn’t informed Chen Song immediately upon reaching the proficient level for the modified Tang method.
Instead, he gave Chen Song such a hint only after reaching (**Proficient** 6/10) for the modified Tang method, considering the history of No Man’s Land.
Moreover, to be safe, Lu Cheng planned to attempt district two flexor tendon suturing only after his modified Tang method reached at least (**Proficient** 10/10), or even the mastery level.
Preparation is key, prioritize safety, and minimize the failure rate and reoperation rate as much as possible.
As a surgeon, Lu Cheng knew that all surgeries except suturing were not guaranteed “success”; complex surgical procedures inherently had a chance of failure.
As long as your failure rate is not higher than the local average, you are an “expert”!
Currently, regarding district two flexor tendon suturing, excluding China’s top teaching hospitals, any Grade III A hospital has a reoperation rate of seven to eight percent. Even top hospitals have a reoperation rate of around five percent…
It’s the tendon ruptures in this area that are difficult to treat and demand extremely high skill from doctors, not that the doctors’ skills are insufficient.
“Is that true? Are you trying to trick me?” Chen Song’s palms continued to slide upwards, and the hair that was pressed down gradually stood up again—
Chen Song’s voice became sharp, “Lu Cheng, do you think I haven’t tried to learn the modified Tang method, so you’re deliberately setting a trap for me?”
Lu Cheng’s microexpressions were serious, and his voice was earnest, “Teacher Chen, how could I possibly set a trap for you? You’ve been working hard to teach me gallbladder preservation and spleen preservation surgeries recently, and you’ve even given me so many opportunities for surgical operations…”
“I’m not going to perform district two flexor tendon suturing right now; I plan to do it next month or the month after.”
Chen Song had secured many operating opportunities for Lu Cheng. For instance, operations like the incision, suturing, and hemostasis in gallbladder preservation and spleen preservation surgeries, which Lin Qianlong couldn’t learn, were personally performed by Lu Cheng.
This surgery was too far beyond Lin Qianlong’s current skill range, so Lin Qianlong and others didn’t covet it or aim too high.
Lu Cheng took advantage of the opening to perform some small operations within his capabilities.
Chen Song said irritably, “It’s as if doing it next month or the month after isn’t absurd anymore?”
“You say you can perform the modified Tang method after I leave; that learning efficiency is ridiculously high, alright?”
“The learning difficulty of this suturing technique is very high…”
Earning millions daily and millions monthly are both considered absurd incomes for ordinary people.
Chen Song’s gaze and expression were exceptionally serious as he scrutinized Lu Cheng, “I’m not sure if you can do it. You’d best do as you did before and record the process of your technique practice into a video and send it to me.”
“This time, I will have to submit them to even more professional individuals for review. If they also deem you capable of performing the operation, then it will be fine!”
“Okay, alright!” Lu Cheng nodded slightly, responding cautiously.
Chen Song asked again, “Does your hospital have microsurgical instruments? Suturing tendons in district two requires the assistance of microsurgical instruments.”
After hearing this, Lu Cheng gestured towards Peng Kun, Young Master Kun, feeling that Chen Song’s question was a bit “idiotic”!
Chen Song immediately understood Lu Cheng’s meaning.
Peng Haibo is the Director of Orthopedics and oversees the overall development of the department. If his own son is going to specialize in hand surgery, how could they not purchase a set of microsurgical instruments for hand surgery?
Moreover, it was brand new and had already arrived. It could be used directly for operations once Director Xiang arrived next month.
Chen Song stood up, his body straight, his hands behind his back, and lowered his voice, “This brother is truly unlucky to be of the same generation as a freak like you…”
Having said that, Chen Song, the ‘Cat Person,’ left arrogantly. After a few steps, he still turned his head, tilted his chin, and looked at Lu Cheng with a distant gaze…
