Chapter 75: Niche Techniques!
In the emergency operating room, the shadowless lamp shone on the patient’s obese lower limb posterior, illuminating the surgical field clearly.
Lu Cheng, holding a needle holder and tweezers, stood at the chief surgeon’s position. After Peng Kun retracted the skin and subcutaneous tissue layers, he patiently said, “Pulvertaft weave suture, also known as the fish mouth suture method, is a relatively obscure suturing technique with a very narrow scope of application.”
“It’s a tendon suturing technique specifically for tendons of varying diameters. This patient’s tendon rupture is at the conjoint aponeurosis of the gastrocnemius and soleus muscles, and these two tendons have different thicknesses.”
“Furthermore, the incidence of tendon rupture in this area is extremely rare, so Professor Tong doesn’t usually invest time in learning it. That’s why I picked it up…”
Peng Kun lowered his head, carefully observing the ruptured site displayed by Lu Cheng’s tweezers, nodding continuously: “Professor Tong did mention that for tendons of varying thickness, ordinary suturing techniques are not the optimal solution.”
“So the fish mouth suture method is the most practical one. Brother Lu, you’re truly amazing. After learning so many techniques, you still have spare time to learn such a rare one.”
“Impressive!~”
Although Lu Cheng didn’t boast, his calm demeanor represented his talent.
While Tong Yuan’an had finished learning everything else and had ‘closed himself off,’ cursing Lu Cheng for being inhuman, Lu Cheng taking time to learn a ‘narrowly applicable’ obscure technique was truly a sign of his talent and a “don’t be surprised” moment.
Peng Kun had no plans to learn it in the short term.
Lu Cheng thought for a moment and continued, “Young Master Kun, the entry barrier for the Pulvertaft weave method is quite low. It’s quite suitable for you to learn. If you’re interested, I can send you the materials.”
“If you encounter it in the future, you’ll be able to use it immediately.”
“Of course, you can also maintain your own learning pace.”
It was precisely because Tong Yuan’an didn’t understand the Pulvertaft weave method that Lu Cheng could offer Peng Kun some advice.
Peng Kun had been learning tendon suturing for over a month, spending most of his time honing his basic skills. Now that he had just entered the field, he was eager to perform a few surgeries to prove his strength and receive feedback.
Lu Cheng could understand this sentiment, and Peng Kun had indeed been very methodical in his learning recently.
Lu Cheng would not lump Xiang Kuihua and Peng Kun together.
“Really?” If Lu Cheng said so, Peng Kun would be interested!
“It’s true. The operational technique of the Pulvertaft weave method is not profoundly complex, and the basic suturing skills required are not as delicate as those for the modified Tang method…”
“That is, if I had a teacher to guide me before, I would have prioritized learning this technique,” Lu Cheng nodded.
Lu Cheng taught Peng Kun for two reasons: firstly, Peng Kun’s attitude towards learning was sufficiently honest; secondly, during his mentorship, he would promote the other’s abilities, which in turn would bring Lu Cheng meager skill points through their efforts in treating illnesses and saving people.
For example, Du Daihua and Tian Zhuang, whom Lu Cheng mentored, had brought him a total of about 1.2 skill points over two months.
Not much, but it was effective in the long run!
Lu Cheng believed that in the future, the skill point gains from mentoring students might become the main source.
Based on this, Lu Cheng was not stingy with his techniques, as Tong Yuan’an and Chen Song had shared their knowledge with him without much reservation.
As for past matters, if Lu Cheng were to repay anyone, he would find the orthopedic specialists and Director Peng, not Peng Kun.
“Then thank you, Brother Lu…”
“Look, the core operational steps can be categorized into a few stages: percutaneous puncture of the thick tendon, oblique cross puncture, embedding the tendon ends, and fish-mouth trimming and wrapping…”
“We’ll start with the percutaneous puncture of the thick tendon, which involves using a scalpel to make a transverse puncture about 2-3 cm proximal to the thick tendon end. The thin tendon end is then pulled through the hole. After maintaining appropriate tension, temporary fixation with two sutures is applied…”
“The oblique cross puncture is located 0.5 cm distal to the first hole… Remember these two distances: one is 2-3 cm, and the other is 0.5 cm…”
Lu Cheng’s proficiency in the Pulvertaft weave method was not particularly high, only at the level of （Proficient 5/10）, but Lu Cheng had not invested too many skill points!
However, even at this level of proficiency, in the relevant specialty, the therapeutic effect for A3 zone tendon suturing was still superior to other suturing techniques.
…
Lu Cheng completed one surgery in nearly thirty minutes.
“This weave suture method has two advantages over traditional suturing techniques. First is the significant increase in tensile strength: due to multiple criss-crossing sutures forming a woven structure, it is stronger against pulling forces than traditional suturing methods,” Lu Cheng said while pulling on the tendon, which remained stable.
Then Lu Cheng released the tendon: “Next is to reduce the bulk at the suture site, embedding the thin tendon and wrapping it in a fish-mouth shape to avoid local protrusion!~”
“This way, the patient will have good sliding resistance and tensile strength postoperatively, making it particularly suitable for suturing tendons of different thicknesses.”
“The professor who pioneered this suturing technique was also a genius, cleverly solving this problem. And the entry difficulty is not high, it’s just that the indications are too narrow…”
Peng Kun nodded after watching, then looked up and smiled, “It really doesn’t seem to require very delicate basic suturing skills. Thank you, Brother Lu.”
“Actually, I didn’t expect you to teach me anything,” Peng Kun’s voice was sincere.
Xiang Kuihua of Orthopedics had strong negative opinions about Lu Cheng and was constantly trying to ‘dig pits’ for him, so Peng Kun didn’t expect Lu Cheng to dislike him because of that.
“One thing is one thing, Young Master Kun. To put it bluntly, in my heart, you and Director Peng are two different people,” Lu Cheng stated directly.
In the past, Lu Cheng’s words would have been insignificant, but now, Lu Cheng had conquered the tendon suturing field and was the first surgeon in the hospital capable of performing a significant number of spleen and gallbladder preservation surgeries.
He had already become a figurehead for the hospital, and his words now carried weight and reason, not just impotent rage.
Peng Kun, with a different perspective than Lu Cheng, took a deep breath and said, “Brother Lu, even though what I’m about to say might sound a bit sentimental, there’s one point I still need to make.”
“Whether I pursue postgraduate studies or learn tendon suturing, it’s all based on not impacting you.”
“If I didn’t go for entrusted training for postgraduate studies, you wouldn’t have gotten that spot either, Brother Lu.”
“If I didn’t learn tendon suturing, Director Xiang Daihong from Zhou People’s Hospital wouldn’t have come to our hospital.”
Peng Haibo had ‘pulled a lot of strings’ for himself, but it didn’t affect Lu Cheng.
Lu Cheng’s lack of opportunity in orthopedics before was not only because Peng Haibo worried that Lu Cheng would overwhelm Peng Kun, but also because several other senior colleagues controlled the ‘disease types.’
Now, even Peng Kun couldn’t get in, so he had to abandon common orthopedic procedures and pursue ‘niche’ areas.
Compared to procedures like open reduction and internal fixation for fractures, and common surgeries in sports medicine and spinal surgery, tendon suturing and hand surgery techniques were also niche techniques for a county hospital.
“So, one thing is one thing,” Lu Cheng said with a smile.
Peng Kun thought for a moment and said, “Brother Lu, I can guarantee that orthopedics will not cause you trouble.”
Peng Kun could only guarantee that Peng Haibo would not represent orthopedics in pressuring Lu Cheng; as for the personal choices of others, that was not something Peng Haibo was willing to do a favor for.
