In the eyes of others, there are no flaws in the surgical process. The only flaw is that the patient recovers slowly after surgery. He stayed in Graz Hospital for more than half a month, during which time some wounds still ulcerated, and it took a long time for him to basically recover.
Hills knew that Carvey had relatively high requirements for post-operative care, and thought he would deal with him the same way he dealt with Dr. Hodge, making a fuss about the patient's recovery.
However, in Carvey's eyes, 19th-century surgery was full of loopholes. Excluding improper operations during surgery, the quality of postoperative wounds is as hard to estimate as a lottery. It is too harsh to blame contemporary surgeons for postoperative infections, and it is difficult for them to show their true strength.
No one expected Carvey to question the surgical incision.
Incision is the first step in surgery. For the doctor, it is just to find an entrance into the patient's body.
But cutting the skin is a kind of injury, so the choice of incision is very particular. It should not only provide enough vision, but also allow healing as quickly as possible after the operation. In plastic surgery, the incision itself is contrary to the purpose of plastic surgery, so you must be more cautious in the operation.
The horizontal incision on the lower eyelid can indeed be hidden by the folds of the eye bags, which plays a role in reducing the appearance of the bags.
However, it is a bit strange to still make a transverse incision when knowing in advance that a secondary reduction surgery is required.
This shows that Corigo's eyelid surgery is said to be "complex", but in fact it is just a simple pile of small surgeries together, without any reasonable integration on the original basis.
Why make two incisions when one longitudinal incision can solve all problems?
The answer is simple, I just didn't expect it.
Not only Corigo didn't expect it, but so many surgeons around him didn't expect it, and neither did Ignatz. They followed Corigo's 1+1+1 linear surgical idea and even thought it was very good. They never thought about how to change the edema problem of the postoperative incision.
"Because the scar tissue created by the transverse incision will continue to pull the eyelids down, that's why Professor Corigo performed eyelid shortening surgery."
Kawei said: "What if vertical incisions are directly used? The scars of the vertical incisions greatly reduce the risk of pulling down the eyelids, reduce the number of incisions, and even shorten the distance between the eyelids. In addition to a few cosmetic flaws , everything else is an advantage.”
Kawei streamlined the operation and changed the complex operation from the original "1+1+1" model to "1+1".
The surgical incision is reduced, the difficulty of the operation is reduced, and the operation time and incision exposure time are also reduced. These advantages have greatly alleviated wound edema after surgery. The edema is relieved, the chance of postoperative infection will be further reduced, and the patient's survival rate and chance of achieving the expected results of the surgery will also increase.
Hills swallowed and really didn't know how to refute.
Because when Kawei first raised this question, he had already realized the shortcomings of the surgery. It was indeed the single longitudinal incision that Kawei said was more in the patient's interests, and he didn't even have an excuse.
"I...with my somewhat limited experience as a plastic surgery surgeon, I really can't give you an answer." Hills shook his head helplessly, "But I will bring your question to Professor Corigo. I will let you know if I have a definite answer."
"Well, Mr. Hills took the trouble."
Kawei decided to give up and let the regular meeting continue. However, the surrounding surgical colleagues did not think so.
His speech just now has changed many people's views on him, and at the same time, their understanding of eyelid surgery: "Mr. Kavey just said that it was the first question. The question itself is very sharp and profound, and it is worthy of our attention." Understand it well. So what’s the second question?”
"The second one?" Kawei shook his head, "I guess I made a mistake. There is no second question."
"No? Why did I hear it?"
"I heard it too."
"Mr. Carvey did use the wording 'first question' when he responded to Dr. Hills just now."
Kawei's target has never been Hills. Now that Hills' confidence has been shattered, there is no point in continuing to ask. But if they give up this opportunity calmly, it will accelerate and aggravate their emotions, so what needs to be said needs to be said.
"The second one is not really a question, it's more like a random guess on my part. In such an important meeting, it would be very rude to put such unverified things on the table. If I have time in the future, I will I will pay a private visit to Graz Hospital and have a good chat with Professor Corigo."
Speaking of which, it was considered as setting up a ladder for Hills and asking him to get down the steps as soon as possible.
It's a pity that some people don't seem to agree with this approach: "Mr. Carvey proposed such a good improvement plan, which made Professor Corigo's surgery overturn again. I think you can express your idea and let everyone talk about it. "
It's a simple way of raising fire, but it's effective enough.
Soon the venue was filled with various voices: "It is better to speak out and let us open our eyes."
"Yeah, tell me, what are you afraid of?"
"Isn't it because you took Dr. Hills's identity into consideration and kept it secret?"
Kawei was helpless. When he realized that his previous words were not rigorous enough, he could only bite the bullet and tell all his "imaginations". This was definitely a new experience for the surgeons around me, and it also opened the door to a whole new world for them.
"I think Professor Corigo's eyelid surgery is too complicated, and the complexity is unreasonable." Kawei's bluntness came suddenly, "Before, I chose longitudinal incision as a way of streamlining, but now I think it's still too complicated." It can be streamlined further, in a complementary way.”
"How to go further?"
"This time, like Professor Corigo, we can make a transverse incision on the lower eyelid and remove the mass. In order to prevent the recurrence of lower eyelid ectropion, we can use the patient's own skin as a filler to prop up the lower eyelid that keeps falling down. skin."
"Padding your own skin?"
"What does it mean?"
"Why does it sound like you want to cut off the skin from other parts and then transfer it to the lower eyelid?"
"This is difficult to achieve. Transferring skin can easily lead to wound ulceration, and the gain often outweighs the loss."
Using skin for filling, also known as skin grafting in the modern sense, is simply poison to the gentleman surgeons wearing woolen coats and high hats: "The idea is bold, but it is not feasible in practice."
"Mr. Carvey does lack some experience in plastic surgery."
"Yes, the failure rate of skin grafting is too high. Doctors with experience in plastic surgery should not propose this idea."
Opposition was endless, and even Ignatz felt that Kawei’s idea had some personal emotions and was a bit suspected of revenge: "Skin grafting is indeed not good, let’s just get over this issue."
"What are you thinking? How could I take the risk of doing skin grafting? This is unfriendly to both doctors and patients." Kawei explained with a smile, "All I have to do is package Dr. Corrigo's three minor surgeries into One operation. What I envision is an adjacent flap transposition operation that can solve the patient's three problems at once."
As the name suggests, the operation involves taking the adjacent skin flap and transposition it to the defect. The skin will not be cut off, but only sutures are done on both sides.
Carvey put it simply. Many people, including Hills, could not imagine the subtlety of this improvement at first glance. That is to say, director-level surgeons like Ignatz and Edinson, who have performed many plastic surgeries over the years and often deal with skin splicing, can understand Kawei's meaning immediately.
Ignatz seemed a little numb. Out of surprise, he quickly drew a sketch on the paper and handed it to Kavi. After receiving a positive reply, Ignatz quickly regained his composure.
It is not incomprehensible for a doctor who can think of a reasonable way to suture the uterus and control the massive bleeding due to compound trauma immediately to achieve this step. To outsiders, Kawei seems to have nothing to do with plastic surgery, but Ignatz knows very well that he also has his own understanding of plastic surgery.
After all, the new cleft lip surgery method was given by Kawei, and that treatment method solved many troubles of existing surgeries.
But the other deputy dean, Edinson, was different. He had just met Kawei.
He was already in an unstable state of surprise before hearing the first question. Now that he heard the basic purpose of the new improved surgery, his surprise turned into fright. He was not feeling well.
No matter what the improvement plan is, this is obviously another brand-new surgery, which has nothing to do with Corigo's surgery.
This idea should have been born from senior and experienced surgeons like Ignatz, myself, or Corigo. Why shouldn't it have popped up from the mind of a 17-year-old child?
He suppressed a large number of discordant voices in the venue and helped the host maintain order: "Everyone, please be patient. Some people said they could chat just now, but why can't we chat now? Since we are new The surgical method, then just let Dr. Kawei come on stage and give a detailed introduction, there is no need to argue."
At Edinson's suggestion, Carvey had to step onto the podium again, replacing Hills, who had been embarrassed throughout.
This may also be regarded as a strategy to save the country through curves.
"I didn't expect that I would be on stage so early. I always thought it would take some time."
Kawei joked to himself, and then roughly drew a sketch of the surgical process on the blackboard: "First of all, we need to clarify the changes needed to restore the upper and lower eyelids to health. The upper eyelids need to be lifted, which is subtraction, and the lower eyelids need to be lifted. Expansion and filling are additions. Since one does subtraction and the other adds, why not help them become self-sufficient?"
After his instructions, several exclamations were heard in the audience, and it seemed that several more doctors understood his surgical method.
"What we have to do is to remove the subcutaneous tumor along the lower eyelid margin, and then remove part of the epidermis to restore the lower eyelid to its normal position. Then the doctor needs to make an incision design line on the upper eyelid based on the size and shape of the wound defect."
Carvey drew a skin defect below the eye and then traced a dotted cut line above. 【1】
"After making the design line for the upper eyelid, we quickly cut out the skin flap and then filled the lower eyelid defect with the transfer of the flap pedicle." Kawei said, "It's similar to playing a jigsaw puzzle, except that we dig it out ourselves. If you want to make a hole, prepare the landfill materials yourself, and then fill the hole yourself.” [2]
After the two sketches appeared, the remaining doctors who were a little slower finally realized the greatness of this idea.
Kawe not only cut off the skin of the upper eyelids to lift the drooping upper eyelids, but also brought a very useful supporting skin flap to the lower eyelids. This flap is still partially connected to normal tissue, ensuring the blood supply to the epidermis.
With blood supply, necrosis and shedding are less likely to occur after skin grafting.
Kawei truly compressed the collection of three surgeries into one, and made his "1" effect far exceed the original "1+1+1".
"I can't say whether the surgery can be done and how effective it will be. Everyone needs to verify it one by one." Kawei was modest in the end. "At the same time, I am still a little worried about the surgery. For example, there are many sutures on the edges of the skin. Mismatch in flap cutting size, etc., will affect the effect of the surgery.”
Everyone looked down at the notebooks in their hands. They hadn't written anything down for most of the day.
In the end, what was recorded the most was this “surgery” that did not exist in reality and was temporarily added. Look at the neat surgical steps on the paper and the realistic surgical drawings. What is surgical talent? This is a talent, just say something casually and make everyone listen.
However, in the plan, this new surgery, which is like an earthquake in oculoplastic surgery, is not even a warm-up.
Because the next step is Kawei’s real home court, and the two failed cesarean sections are preparations for his cesarean section report.
Why other people's operations failed, but his was successful, everyone present hoped to find the answer through comparison.
"Next, we will first ask Professor Ignatz from the Municipal General Hospital to bring us a cesarean section for refractory placenta previa." The host introduced, "The mother is a mother of three children, one I was about to give birth to my fourth child a month ago, but I was found to have symptoms of placenta previa..."
Ignatz took off his coat and hat and quickly came to the stage to take over the conversation: "The operation uses a paramedian incision. From the beginning, we have been rushing to cut in quickly and remove the fetus quickly. We hope to use speed to defeat the bleeding. The uterus is sutured shut before the mother's blood dries up.
My team has repeatedly practiced the procedures of skin incision, uterus incision, and fetal removal, and can strictly control the speed of fetal removal. This cesarean section took less than 200 seconds from the time of incision to the removal of the fetus.
In fact, there is still a chance in the early stage of surgery, but...
Forget it, I won’t make excuses anymore, let’s just talk about the results. In the end, the operation failed completely under my leadership.
The reason was that there was uncontrollable heavy bleeding at the uterine incision. Even if the fetus was removed, the mother still did not survive until the abdomen was closed..."
