Chapter 213: Follow Your Feelings

"Wear a No. 10 silk thread!" Ling Ran said without raising his head during the stitching process.

The instrument nurse agreed without hesitation, and quickly unraveled a No. 10 silk thread, and put it into a needle holder. Then, she patted Ling Ran with a slightly heavy but not too heavy force, just enough to send out a soft "pop." "Sound, blushing fair cheeks.

Ji Tianlu raised his head instantly, realized something, and asked, "What's wrong?"

In the Achilles tendon suture, the 10-gauge thread is relatively thick, and it is more than three times thinner than the 4-0 suture used by Ling Ran before. There must be a reason for the chief surgeon to change the line suddenly.

When discussing technology, Ling Ran is still willing to say a few more words.

Sitting at one end of the two-person microscope, Ling Ran pointed directly under the microscope with tweezers, and said, "The broken ends are not neat. If you continue to pull with a 4-0 thread, there will be defects after trimming."

The pulling force of thin wires is not strong. If they are added to a cross-section densely, the total pulling force will increase, but if they are separated, the pulling force of each two or two or three wires is not as good as a single 10-gauge wire .

Tendons, on the other hand, are elastic, and the Achilles tendon in particular is elastic, which creates a problem in that when doctors forcefully pull together a severed Achilles tendon, it yields. However, after the operation is over, the Achilles tendon is still very elastic, so it will retract more powerfully.

If the lengths of the severed Achilles tendons are the same, they will spring back similarly and the function of the Achilles tendon will still be maintained. However, if the disconnected Achilles tendon itself is uneven, the Achilles tendon that bounces off strongly will be long and short...so the long one will bear less force, and the short one will bear more force, and the Achilles tendon will be more likely to rupture.

It's like sewing five rubber bands of the same length together. The stitching effect is better and the strength is higher than that of five rubber bands of different lengths.

The solution is also very simple, which is to use sutures of different strengths to make up for the lack of strength of the tendon with the strength of the sutures, so as to ensure the postoperative tension as much as possible.

However, the solution that Ling Ran took for granted shocked Ji Tianlu, and even scared Doctor Qu and others who were watching the screen in the classroom.

"Do you see that the broken ends are not neat?" A resident doctor couldn't help asking.

The other resident doctor sneered twice: "There is so much blood, the surgical field is not clear at all, at most there are some hair tips."

"It should be able to use other conditions to make a judgment. The vision under the microscope will not be clearer than ours.

Our screen is so big, and we don't need to operate it..." This man approached the screen as he spoke, looking at the screen almost like scanning, looking for signs bit by bit.

"It may be judged based on the magnetic resonance film." Zhu Tongyi said, and after thinking about it, he explained: "It is also possible to consider the distribution of blood vessels, but it is more complicated."

"It's all turned into metaphysics." As soon as Dr. Qu finished speaking, a group of doctors turned their heads to look at him.

Doctor Qu felt a little regretful, coughed and coughed twice, and said, "I mean, he sewed so fast just now, how could it be more detailed than what we saw, and even if he saw the unevenness, how could he know what to use? How many lines to make up for? This is completely a gamble, or it is his intuition or something."

Doctor Qu forcibly swallowed the evaluation of "totally unreliable", and was a little choked.

He wasn't going to speak at first, so he stood at the back of the classroom all the time, just wanting to see the situation before slipping away. However, Dr. Qu never expected that Ling Ran's operation was performed very quickly, and he quickly entered a state of insanity. The group of doctors who saw him couldn't stop.

Dr. Qu himself is a doctor of Achilles tendon repair, how could he be willing to leave after seeing Ling Ran doing this operation.

To a certain extent, Dr. Qu was even overwhelmed by Ling Ran's operation.

However, Dr. Qu couldn't understand the line changing operation, and he didn't admit it.

It was like what Dr. Qu swallowed just now: He felt that Ling Ran's on-the-spot judgment was totally unreliable, and Zhu Tongyi's explanation was also unreliable.

He himself is a surgeon who performs the Kessler method, and he does not believe that anyone can see the integrity of the Achilles tendon from the distribution of blood vessels. Even the MRI film cannot be refined to this level—at least, it is impossible to make a judgment on the spot, and use it for postoperative analysis, or if the patient dies unexpectedly, it is almost the same to say these words during the death analysis.

When the surgeon is in the field, he must have a clear understanding of the tension of the suture.

Now, Ling Ran changed from the 4-0 thread to the 10th thread, which shows that he knows that the Achilles tendon to be sutured with the 10th thread is much shorter and needs to be pulled with great force. However, whether it is the distribution of blood vessels, or It is impossible for MRI to provide such information.

At least Dr. Qu didn't know how to judge such information, and he didn't know of any imaging expert who could do it.

Zhu Tongyi looked at the crowd and said with a smile, "Since we can't guess, let's ask, and it will be regarded as a teaching operation."

After finishing speaking, Zhu Tongyi pressed the call button without hesitation, and said, "Ling Ran, how did you judge that the broken ends are uneven, and then how much tension do you need to use for sutures?"

Compared with the former question, the latter question is more targeted.

If you want to pull a shorter rubber band, you need more tension. For engineering experiments, this is a very simple question. Some instruments can test the tensile force of a material, the tensile strength, yield strength, etc. of a material.

However, the Achilles tendon of a living person cannot be played in this way, and there are no corresponding equipment in the operating room.

So, how does Ling Ran judge the suture with how much tension to use?

If you can't make a corresponding judgment on this, it doesn't make much sense to just judge that the ends are uneven.

In fact, ordinary doctors don't care about the tension at all when performing such an operation, they just need to suture it. For the problem of uneven stumps, more people use replantation and other methods to solve the problem, such as autologous gracilis muscle transplantation, autologous peroneus brevis transplantation, etc., the short Achilles tendon is replaced by a section of tendon, so that both sides The length of the implant is about the same, or the graft is longer, which can relatively reduce the possibility of fracture.

Doctors who have achieved this step cannot be called ordinary doctors, at least they are at the backbone level of Dr. Qu who works in well-known medical institutions across the country.

Ji Tianlu's level was higher, but he couldn't understand Ling Ran's operation, so he also looked at Ling Ran with puzzled eyes.

Ling Ran didn't answer immediately, until the 10-gauge thread he just got was sewn up, and then slowly said: "I felt it by pulling it with my hands."

"Feeling?" Dr. Qu laughed, couldn't help but quickly walked two steps to the front, pressed the call button, and said, "How can feeling be used as a reference for surgery."

Ling Ran said "En", and said: "I often do massage for people, such as tendon or fascia, or muscle, just put your hands together, and you can estimate the pulling force, and the difference will not be too big. "

"Are you kidding me?" Dr. Qu said it again before remembering that he didn't press the call button, so he pressed it again and said it again.

Ling Ran's answer was very simple: "No."

This skill belonged to Ling Ran who gradually figured it out.

There are pushing methods and pulling hair in massage, which are specifically aimed at "tendons". In a narrow sense, "tendons" refer to tendons and ligaments.

When doing the replantation of severed fingers or the tang method, the tendons Ling Ran encountered were very weak, and even master-level massage techniques could not accurately estimate the strength. In other words, it is useless to estimate it. The tendon of the thumb is thinner than chopsticks. If it splits unevenly, the best way is not to suture them separately, but to cut them evenly and then sew them together.

The Achilles tendon in the foot can't do that. The Achilles tendon is the thickest tendon, and its length has a great impact on athletic ability. In addition, the degree of fracture varies. If the shortest Achilles tendon is used as the standard to cut the Achilles tendon, the Achilles tendon will basically be useless. Still have to re-transplant.

Correspondingly, the Achilles tendon is the thickest tendon in the human body, and none of the tendons that Ling Ran grasps is thicker than the Achilles tendon. If he can push and understand other tendons, he can be more sure of the Achilles tendon. the power of.

Ji Tianlu raised his head and glanced at Ling Ran: "Is it really a feeling?"

Ling Ran also answered "Yes" again, and stretched out his hand, "3-0."

He's going to have another Achilles tendon stitched up.

Looking at Ling Ran's confident expression, Ji Tianlu said, "If you can really feel it, that would be great."

Ling Ran still said "En" and did not respond.

Ji Tianlu looked at his operation, and he believed it in his heart.

Doing things based on feeling seems like nonsense from a patient's point of view. How can my precious body be manipulated by feeling?

However, the level of human science and technology is like this. The more advanced the surgery, the more it depends on the feeling. Especially when it comes to internal organs. For example, when Ling Ran used his bare hands to stop bleeding from the liver, it was based on feeling. Of course, there are experiences such as anatomy behind the feeling, but at the end of the day, that's not a seeing is believing or a digital thing.

Similarly, heart surgery is always full of unusual "feelings", which is why there are so many so-called miracles. As for brain surgery, let alone brain surgery, human beings are not completely sure about the functional division of the brain, but when it is time to perform surgery, surgeons are not lenient.

Among physicians, there are more comrades who go by feeling. Take the ward rounds of Union Medical College Hospital as an example. Every physician can put forward a well-founded opinion, but there is only one truth.

In the end, the best physicians are often the ones who "feel" better.

When Ji Tianlu himself performed Achilles tendon surgery, he often operated by feeling. If he felt that a certain Achilles tendon was too elastic, he would transplant it a little longer. If he felt that the elasticity was not strong, he might forcefully pull it up and sew it up.

It doesn’t work without feeling. So far, there is no instrument to help surgeons test the tension of the Achilles tendon. What’s more, what if the tension is measured? Different people's Achilles tendon is very different. Take the simplest length as an example. The length of the Achilles tendon of ordinary people of yellow race is 15 cm. Iverson's Achilles tendon is said to be 25 cm, and Jordan's is 30 cm. The tension will naturally vary greatly.

It's just that when Ji Tianlu performed surgery based on his feeling, he would not say it specifically, and he was never asked about it.

At this time, Ji Tianlu admired Ling Ran's straightforwardness.

At this time, Dr. Qu, who had never "feeled" the operation, felt angry. He pressed the call button angrily, and said, "Doctor Ji, should we stop the operation now?"

It showed that there was the respected academician Zhu Tongyi in the classroom, and the young and promising Chief Physician Ji Tianlu in the operating room. Dr. Qu was still sensible and did not dare to order, only dared to use a questioning tone.

Ji Tianlu dismissed the mere Doctor Qu, and said in a straight-faced manner, "Just follow along and learn."

Doctor Qu's face turned red at that moment.

The two are similar in age, but their status is very different. As a superior doctor, when Ji Tianlu doesn't want to give Dr. Qu face, he won't get any face.

Dr. Qu silently left the microphone used for talking, and retreated to the back of the classroom.

He didn't want to leave immediately, especially when Liu Weichen was still around, Dr. Qu would not take the initiative to admit defeat, he at least wanted to see the final result.

"No. 4 silk thread." Ling Ran asked for another thinner suture, and continued to sew without raising his head. For such a simple Achilles tendon suture, he only cared about how good the suture could be, and did not consider whether it would fail at all. possible.