Hospitals in Vienna are generally divided into two main categories.
The first category is missionary hospitals, which were originally converted from churches, with medical care supplemented by missionary work, and then gradually developed under the impact of modern medicine. The most typical one is St. Mary's Hospital. The center of the entire hospital is not the inpatient department or the administrative department, but the Catholic Church. 【1】
Patients would go to the outpatient clinic and then go to church to pray with doctors who couldn't cure them.
The Municipal General Hospital is also considered a church hospital and has a church, but it is located in a remote location and has a small area, so it can be regarded as a spiritual comfort for patients. Its operation has been mixed with a lot of secular things, and the hospital's sponsors are no longer limited to the church, and will raise a large number of donations and investments from nobles and capitalists through charitable organizations.
The purpose of the money cannot be simply to preach, but something else, such as fame or more say within the hospital.
If we look at Europe as a whole, the image of municipal general hospitals is actually more in line with charity voluntary hospitals. Because the hospital itself does not earn fees, as long as patients meet the poverty relief standards, they can receive free medical outpatient services and low-cost hospitalization, so the number of disease sources is very large.
In fact, the number of sources of disease in the Municipal General Hospital has become so large that it has to attract the attention of the government, and even the results of its medical services have directly affected the labor risk control capabilities of the western part of Vienna.
Therefore, in recent years, the government's capital investment in hospitals has gradually increased, which also reflects the reason why the Municipal General Hospital has such a scale and strength.
The second category is secular hospitals.
Their predecessors may have been church hospitals, but due to some reasons they broke away from the control of the church and became self-sufficient medical institutions. Hartman and Glaze are typical examples. Secular hospitals are completely open to capital, but medical expenses are high and they basically exclude the poor at the bottom.
For them, money is not an issue, talent is.
Surgery is not like internal medicine. It is useless to have medical theory alone, but also to have practical skills. Without enough sources of disease, it is impossible to train first-class surgeons, and secular hospitals basically follow the upper-level route, making it difficult to train strong surgeons.
Poaching has become their main method.
In the eyes of Kawei and Ignatz, Hills' operation foundation is not solid enough and his temperament is not calm enough. He is adequate as an assistant, but he is still not good enough as the chief surgeon of major surgery.
But in the eyes of Graze Hospital, Hills' resume is already quite gorgeous. This time, the hospital spent a lot of money to keep him tied up. It not only gave him the position of surgeon, but also gave him the opportunity to give a speech and show his face.
Personnel changes are common, and decisions that may seem rebellious to others are actually a remedial measure after he can see himself and the situation clearly.
Kawei has met many people like him.
Think about it for a moment, if you were yourself, you might leave in such an environment.
After all, one Ignatz is a teacher who can support oneself, and the second Ignatz becomes a roadblock blocking the upward path. Moreover, the second "Ignatz" who appeared out of nowhere was still a 17-year-old child, so anyone else would have to think more about their future.
Being young, tall, and upgrading quickly, he can hold his own no matter what he does.
After grabbing an assistant, he then grabbed the position of the surgeon. In fact, on that day Ignatz disappeared, Kawei did snatch the position of the surgeon for cesarean section.
Through repeated struggles, Hills recognized the fact that he could only be ranked third, and also saw his future at the Municipal General Hospital. He didn't want to be content with others, and he didn't have more confidence than Kawei, so he had only the last option left: leaving.
In fact, Hills didn't expect Kawei to come. Originally, he wanted to explain to the teacher the reason why he ran away, hoping to get understanding.
But after seeing Kawei, he instantly lost the motivation to explain and put everything in the surgical report.
Hills is reporting on a complex eyelid surgery.
The surgery was not done by him, but by Dr. Corigo who wanted to talk about cleft palate surgery in the morning. Although he was a bit conceited, and the new suture method of the cleft palate surgery did not have many highlights, this eyelid surgery was a masterpiece that even Waterman would nod over.
Upper eyelid ptosis combined with severe ectropion of the lower eyelid. 【2】
In fact, starting from Ignatz’s lithotripsy, the difficulty of reporting on surgeries has gone up a notch. It has evolved from a simple disease to a complex surgery for multiple diseases.
"The patient is a businessman and has had problems with the upper eyelid of his right eye since he was a child." Hills began to introduce the basic situation of the patient. "Since birth, his right eyelid has drooped, not much. The only trouble is because Habitual strabismus after visual field obstruction.
The ptosis did not seriously affect his life, so he never sought medical treatment. Until the middle of last year, a swelling also appeared around the lower eyelid on the same side. The presence of the tumor breaks the balance of the upper and lower eyelids, not only causing the lower eyelids to ectropion, but also making the ptosis of the upper eyelids more severely obscure the visual field due to the traction effect. "
The upper eyelids are drooping, and the lower eyelids are also drooping, but the former can be ignored, while the latter is much more troublesome.
“The tumor grew very quickly and caused much more severe symptoms than those on the upper eyelid,” Hills explained. “The patient developed symptoms of chronic conjunctivitis, increased secretions, and this year also experienced abnormal thickening and congestion of the conjunctiva. Because the tear point cannot be close to the eyeball, the patient still has epiphora and dry eyes, which is extremely painful." [3]
His vision was already affected by upper eyelid ptosis, but now his lower eyelids were also affected. Unable to bear it, the patient went to the Municipal General Hospital.
“Coincidentally, I was the one who received the patient at that time.” Hills said with a smile, “But considering that the surgery at the Municipal General Hospital required that the patient not have a title, he would need to enter the theater for public display, so he flatly refused the surgery.
A week later, he was referred to Glaze Hospital.
Dr. Corigo gave him a detailed examination and then formulated a plan that suited him: eyelid tumor stripping and removal + upper eyelid lifting + lower eyelid shortening surgery. "
For a 19th-century plastic surgeon, the surgery was indeed complex enough, and it was good enough that Corigo could complete it.
Kawei is not a plastic surgeon, but he often sees patients with ectropion in the emergency surgery department. They are often scar contractures caused by burns or chemical injuries. The surgical method is usually to do skin grafting after controlling the burns to open the contracted part of the skin.
It was his first time to see upper eyelid ptosis and lower eyelid ectropion, and he was very concerned about the surgical treatment method.
It's a pity that Corigo's surgery is limited by 19th century thinking, and all he can do is simple addition and subtraction. If it's drooping, lift it, and if it's everting, do shortening. From a layman's perspective, it's pretty good, but there's still a big gap between it and the method that Kawei could come up with after decades of training in modern surgery.
"The first thing Professor Corigo did was to remove the lesion."
Hills took out the drawings from the operation: "The tumor in the lower eyelid had the greatest impact on the patient. After incising the eyelid skin and separating the soft tissue, the tumor was quickly discovered. The professor quickly performed a dissection, ligated the blood vessels, and then removed it. The tumor. After pathological analysis, it was found to be a fibroma." [4]
It is not difficult to remove tumors in the eyelids, and it is more delicate than subcutaneous tumor removal. The difficult part is the treatment after the removal.
Without the traction of the tumor, the lower eyelid seems to be able to temporarily return to normal, but that is just an appearance, just like when Ignaz had the cleft lip repair surgery.
Corigo has extensive experience in eye plastic surgery and is well aware that prolonged lower eyelid swelling has caused the patient's lower eyelids to become saggy. After the incision heals, this scar will continue to act as a downward pull. With relaxation + traction, the patient's lower eyelid ectropion will definitely "recur".
“In order to prevent eyelid sagging, the professor performed eyelid shortening surgery on the patient after the tumor was removed.” [5]
Hills knew that this was a critical point, and a guy who liked to criticize would definitely not miss this flaw, so he took the lead in pointing it out: "Because there are two wounds on the lower eyelid, the postoperative edema is more serious. But the sutures during the operation There were no mistakes, the edema began to slowly subside on the fifth day after the operation, and the wound recovered very well."
In comparison, an upper eyelid lift is simpler.
It's called a lift, but it actually means removing a small piece of skin and then suturing it. 【6】
This is an approach that ignores the cause of the disease and directly solves the symptoms fundamentally, which is also called treating the symptoms but not the root cause. But even in modern times, only similar corrective surgeries can be performed for congenital ptosis of the upper eyelids.
Of course, "standard" and "original" are not completely binary opposites.
Congenital ptosis is better understood in modern times than in the 19th century. It is generally believed that congenital ptosis is caused by abnormal development of the levator palpebrae superioris muscle, resulting in muscle fibrosis and fatty infiltration. 【7】
Modern medicine still cannot cure the root cause in the true sense, but it can get closer to the "root cause" on the basis of treating the symptoms.
Professor Corigo's simple skin incision and suture did not affect the abnormally developed levator palpebrae superioris muscle, and there is a possibility of postoperative recurrence or upper eyelid ectropion. This is not the case with modern levator shortening surgery. With the help of electrocoagulation and new silk threads, radical cure can be achieved.
One eye alone required three incisions. The operation itself was not difficult, but it was not easy to achieve the desired results.
"The patient's wound did not grow well after the operation and did not achieve the expected results."
Hills admits this, but in the view of him and other colleagues, it is difficult to avoid. It would be unkind to deny the merits of an operation for this reason alone: "This complex eye surgery is also a pioneer in Austrian plastic surgery."
After finishing speaking, he packed up the report contents in his hand and looked at the host: "My report is finished."
"Okay, it is indeed an excellent eye surgery. In my impression, no one has ever treated two deformities on the same stage." The host also affirmed the advantages of the surgery, "The next step is the question and answer session... ....”
Starting with Ignatz’s lithotripsy, the number of questions increased significantly, and Hills’ surgery also received many good questions.
Some asked about the suture method, some asked about the angle and length of shortening the lower eyelid, some asked about the length of the incision, and some asked about the specific incision area of the upper eyelid skin. Hills answered as best he could, but some of the questions were too detailed, and Corigo did not write down the data.
"I've said everything I can say."
Hills shook off the report paper in his hand and said with a smile, "I have told you everything the professor wrote. Most of it is based on his experience during the operation and only represents his personal opinion."
"We understand. We are just asking for reference."
Hills nodded.
If he just packs up his things and leaves the stage, his first surgical report at the College of Surgery will be considered a successful conclusion.
But unfortunately, the relatively smooth process gave him the illusion that the surgery was perfect. Coupled with the unhappiness of the past few days, Hills couldn't hold back his little pride for a while and called Kawei's name.
"Dr. Kawei has always been very active before. Now when it comes to Professor Corigo's eye plastic surgery, don't you have anything to ask?"
Hills' slightly provocative tone soon attracted the attention of many people in the audience. Everyone is in the same city and is a doctor in the same circle. The news of Hills' sudden job change must have reached everyone's ears.
Now looking at Kawei sitting next to Ignatz, the reason for leaving his job and changing companies is readily apparent.
Kawei didn't want to embarrass him, so he didn't speak from the beginning to the end. Anyway, there were plenty of opportunities to cause trouble, so there was no need to have a quarrel with Hills. Moreover, he is not very familiar with plastic surgery. He has many ideas but few opportunities to practice them, so he does not dare to talk nonsense.
"Mr. Hills is so complimentary. I know very little about plastic surgery and I really don't know what to ask."
Kawei lowered his attitude by taking advantage of the fact, hoping to fast forward to the next game. The next one, two failed cesareans, was his home turf.
But Hills didn't want to let go of this golden opportunity: "Dr. Carvey is good at hemostasis and uterine suturing. He may not know much about fine plastic suturing, which is normal. It's just chatting. If there is anything you don't understand or don't understand, If you understand, I can also answer you for Professor Corigo."
This is simply an infighting at the Municipal General Hospital.
The doctors from other hospitals just took it as a break, and the host knew that he couldn't stop him, so he simply followed him to watch the show.
At this time, no one except Ignatz could persuade Hills, but when he was about to speak, Kawei spoke first: "Then I will ask anyone casually. If the question is not good, please ask Hills Teacher Si must forgive me."
"Speaking."
“My first question was the incision for lower eyelid mass removal.”
"What's wrong with the incision?"
"Is the tumor round in shape?"
"right."
"Then why did Professor Corigo make the transverse incision?"
"This way, the surgical incision of the lower eyelid can be hidden as much as possible after the operation, making it look more beautiful."
"So..." Kawei nodded and asked, "Then why did you do another lower eyelid shortening surgery?"
"Didn't you listen to the report just now? It's to prevent recurrence."
“Oh, what kind of incision is used for lower eyelid reduction surgery?”
"Of course it is a longitudinal incision, and part of the lower eyelid needs to be cut off to shorten the eyelid."
"Then why not make longitudinal incisions during the tumor resection at the beginning, and shorten the eyelids at the same time?" Kawei asked a question that no one had thought of, "Reducing the number of incisions not only reduces the risk of Postoperative edema can also reduce damage to the eyelids” [8]
