If we say that the few surgeries in the middle section are limited to showing the shining points in the process, they do not deliberately pursue success or failure. Starting from Ignatz's groin, the reporting level rose to a new level.
Surgery is just a means to treat illness and save lives. The ultimate goal is to let the patient live well, so subsequent surgeries must be successful. The sign of success is not only to eliminate the pain, but also to ensure that the patient lives well.
There will be no more failures in the subsequent surgeries. Each one of them is more dangerous and more complicated than the last one.
But while Ignatz was chatting and recounting all the details encountered during the operation, Kavi was talking about something else with Damirgon.
Damirgaon did have ambitions, but his ambitions were tied to that small clinic.
He knew very well that even running a small clinic required a lot of money, and surgery was a waste of money. Maintaining technically required corpses, updating, cleaning, and maintaining equipment, bandages, gauze, and sutures all cost money.
But he still feels that as long as he is good enough, money will be invested in this clinic and the future will be bright.
Damirgang is obviously a newbie who has not experienced the baptism of capital, and Kawei must be more aware of this.
Capital has a purpose, and investing in hospitals and clinics generally has only two purposes.
One is to make money. With the quality of the disease in Damirgaon’s clinic, let alone making money, it’s already pretty good if he doesn’t subsidize the money. If the fee is forcibly increased, the clinic will lose its advantage of being cheap, and patients might as well turn to the cheaper Municipal General Hospital and St. Mary's Hospital for treatment.
The second one is charity, but charity needs to be seen by others and needs to be exposed. Large hospitals have many people and are promoted by newspapers, so there will naturally be traffic. Naturally, investing in a large hospital can better reflect charity.
So the result is very clear. If it is not an acquaintance, and there is no experience like Laszlo's loss and recovery, who would invest money in a small clinic for no reason.
Moreover, the chief surgeon of this surgical clinic is still a half-baked master's degree.
Damirgaon couldn't argue with Kavi, and he really had no reason to refute. In fact, just when Kawei finished saying those things, he had already doubted his ability and was half giving up...
...
Soon Ignatz finished his speech, and the host immediately invited Dean Waterman, who had just arrived at the venue.
The dean took the manuscript, stood on the podium, and put on his monocle. He did not go straight to the subject like other doctors and talked about his surgery. Instead, he started by talking about a rare international surgical conference the year before last:
“I had the good fortune to meet Dr. Ericsson at the French surgical conference the year before last. He is a surgeon at King’s College Hospital in London and enjoys an international reputation.[1]
Dr. Erikson started trying rhinoplasty more than ten years ago, probably in 1850, which was a little later than me, and the success rate was not high. But through his unremitting efforts, rhinoplasty, cleft lipoplasty and bladder fistula repair have gradually become his signature surgeries. "
After introducing the other party, he started to look at the data samples and began to discuss the causes of missing noses in Britain and Austria, which seemed to have the appearance of modern medicine.
"We have exchanged a lot of things. I don't know why, but the number of rhinoplasty patients in the UK has been decreasing [2]. And most of his patients lost their noses due to lupus or various traumatic accidents. .They no longer see, or at least rarely see, patients disfigured by syphilis."
After talking about Britain, he had to mention Austria: "But our country is still dominated by syphilis. As we all know, when very serious syphilis cases appear in public institutions, they are usually related to people who are stingy or have poor health. They often have ..."
puff......
Cough cough cough~~~
A strange sound interrupted Waterman's speech and attracted everyone's attention. They followed the voice and looked at the young man holding the water glass: "Dr. Kawei, what's wrong?"
"Ah, it's okay, cough, cough, it's okay, cough, cough, cough. I choked on the water." Kawei quickly took out a handkerchief and wiped his mouth. "I chatted with Dr. Damirgaon for a while, and my mouth was a bit dry. Drink some water. I'm a little anxious. Teacher, please continue and don't worry about me."
"The First Minister of the Ming Dynasty"
"In addition to stinginess and physical constitution, I also considered that the dosage of mercury used for treatment may be insufficient [3]. The UK does need to be bolder in the dosage of mercury, and I think the country can follow suit."
Having said so much, Waterman still hopes to find a connection between nose ulcers and syphilis treatment: "Okay, let's get down to business, let's talk about surgery."
Austria's plastic surgery leads Europe, and Waterman, the founder of plastic surgery, has become adept at compensating for defects in the soft tissue within the nasal framework. He has collected many cases over the years, learned lessons from them, and finally achieved this nearly perfect plastic surgery.
This report is a summary of his rhinoplasty surgeries over the years. The purpose is far more than just reporting on the surgical process.
“What I’m going to introduce today is a rhinoplasty that I performed in mid-February. The patient was a 20-year-old girl with severe stinginess. She lost her nose completely last year because of syphilis.
She came here wearing an artificial nose. Her nose was completely missing. There was a large I-shaped hole in the center of her face, with a small amount of scar tissue forming around its edges. 【4】
I further examined the patient's nose and found that her nostrils and the lower part of the nasal septum were destroyed, but the nasal bones and the upper part of the nasal septum were still preserved. Because of their good support for the operative procedure, I resolved to use the ancient Indian method of taking a flap from the forehead and rotating it over the defect. 【5】
When I checked, I also found that she still had severe pain in her jaw and her temperature was very high. I suspected that she had osteomyelitis. "
Kawei originally thought that all that could be done in the 19th century were minor surgeries. Even though amputation seemed drastic, the process was actually not complicated. Just saw the bones, cut the meat, and then make the muscle flaps and sew the blood vessels.
But today, at this regular surgery meeting, he felt for the first time how this nearly 60-year-old surgeon solved difficult problems when there was a lack of medical treatment and medicine.
Of course, equally powerful are his patients.
"What I need to do is reshape the patient's nose first, and then cut off her abscessed mandible. As for the extent of the removal, it all depends on the extent of the bone invasion."
Waterman began to describe the surgical process: "On February 16, the patient was sent to the surgical theater. With the help of ether, I performed this rhinoplasty + mandibular resection + chin plastic surgery.
First, some remnants of the nose wings need to be removed to expose the septal cartilage and the lower end of the nasal bones. These areas are very rich in blood vessels and the operation needs to be careful enough to minimize bleeding. Next, cut along the drawing lines traced in previous ink to create the clover-shaped flap of forehead. 【6】
Lift the flap from the forehead and try to stop the bleeding. After the bleeding stops, twist the flap and place it in the appropriate position. The left and right sides are fixed with three sutures on each side, and then the flap is gently supported with cotton wool strips coated with essential oil. The middle tip is sutured above the upper lip to form the columella. "
The operation has come to an end here, and the next step is the important event that endangers the patient's life. It wasn't just the troublesome jawbone that Waterman had to deal with, but also the time it took to undergo anesthesia.
“I visited the dentist at the Municipal General Hospital. Based on the medical history provided by the patient and the abnormal position of her teeth, the condition of the mandible should have started in the early stages of permanent teeth and has continued for a long time.
We estimate that the mandible healed naturally over a period of time because some new bone was visible, but the repair process was terminated because of the new abscessed cavity.
There was no room for hesitation in the surgery. I made a long arc-shaped incision under the mandible and found that a large number of purulent lesions had appeared on the mandible. The bone has been completely destroyed, extending beyond preoperative expectations to two segments. As a last resort, I had to use a bone saw to cut the mandible into three sections and then remove them one by one. "【7】
Removing the mandible is no simple task, and Waterman did it with as much precision as possible while speeding up the process.
During the operation, the girl's tongue was preserved and wrapped in its original skin. He also kept the tooth and carefully placed it on the gum, hoping to gain enough sturdiness during the healing process to keep it usable in the future.
Waterman even imagined that the mandible could be regenerated, but unfortunately this was unrealistic.
"The operation went very well, and so did the postoperative recovery." He took a sip of water, moistened his throat, and continued, "The wound on the nose healed beautifully, and the sutures were removed on the fourth day after the operation. Yes, although the dressing has some adhesion, it is not serious.
The chin also healed beautifully, the sutures were removed on the 7th postoperative day, and the purulent osteomyelitis did not interfere with the wound healing. I want her to use her teeth to bite, but that's not easy. However, we are still training patients to master the ability to chew solid food, mainly between the tongue and upper teeth.
The only drawback is that her new nose is a little sensitive and there is some edema on the surface, but it still greatly improves her appearance. Fortunately, the loss of the chin did not seriously change the facial shape, and the degree of change was smaller than expected before surgery. "
Regardless of the complexity of the operation or the postoperative recovery, this operation is enough to be placed on the pressure table.
But in the eyes of others and even Waterman himself, although the rhinoplasty process is delicate, it is not without precedent. It has long been a mature surgery with established procedures. If it really gets complicated, there is also an arm flap transfer procedure that protects facial skin.
Cut a skin flap on the upper arm and sew it to the missing part of the nose. In order to preserve the blood supply, the arm and the head must be fixed to prevent displacement. Wait for at least 1-2 weeks for the sutures to heal, then cut off the remaining connecting parts of the arms, and then perform secondary sutures on the columella. 【8】
This surgical method is much more difficult than what Waterman used. It requires consideration of the location of skin suturing and wound healing in a semi-closed and humid environment.
As for the mandibular resection, Waterman acted really boldly and, seeing at a glance the tight time limit, combined the two into one.
The final questioning session was even more lively than Ignatz’s inguinal hernia. The questions focused on the number of sutures needed for rhinoplasty and the repositioning of teeth after mandibular removal.
"Dean, how did you determine the number of stitches? How about using a small needle to make a four-stitch stitch for a tight stitch?"
"This is a question of balance. Four needles will damage the skin around the nose too much, which is detrimental to healing. Two needles are too few, and it is easy to cause fitting displacement. In comparison, three needles are just right."
"Now it has been proven that occlusion has nothing to do with the lower teeth. If another mandibular resection occurs, will the teacher give up on teeth placement?"
"I won't give up," Waterman replied. "The teeth are not only for biting, but also for supporting the skin of the lower lip. This can make the chin fuller and reduce the feeling of loss after mandibular removal."
"Is there a better way to deal with the bleeding during forehead flap incision? Sometimes the patient's bleeding is a bit heavy and it is difficult to stop it."
"There is really no good way to stop bleeding. I usually use local compression, and the rest can only depend on the patient's constitution. Some people stop bleeding quickly, while others stop bleeding very slowly. In my personal opinion, it is completely random."
The problems basically focus on these aspects, but what Kawei really cares about is wound healing.
Although Waterman kept saying that the healing was good and went through the most critical part of the operation, Carvey still did not believe that large incisions could be healed well in the 19th century when there was no concept of disinfection and hand washing.
The nose is okay, it's surrounded by scar tissue and the infection is better. However, the mandible is suffering from purulent inflammation and widespread infection. Even if modern surgery wants to avoid postoperative infection, it is not easy. A large amount of cleaning and disinfection is required during the operation.
Kawei looked at his colleagues who were only interested in suturing skills and shook his head inwardly. Doesn't anyone care about wound healing?
Just when Kawei was about to wait for others to finish asking him questions before speaking, Waterman suddenly avoided other people's questions and clicked on him directly:
"My operation looks very complicated at first glance, but if you take it apart carefully, it is just average. Compared with the next cesarean section, it is still a lot worse. Personally, I still hope to hear from the surgeon who performed the cesarean section." Regarding the opinions and questions of the uterine delivery surgeon, he is the expert in internal organ suturing and hemostasis.”
What he said was quite beautiful, but it was meaningless to Kawei, because he was tired of hearing it before he traveled here.
On the contrary, this compliment from the dean of the School of Surgery quickly attracted many disgusted looks, and Kawei could clearly feel that the atmosphere in the entire conference venue was undergoing subtle changes.
He was increasingly confused about what Waterman was thinking, and was ready to ask for directions: "Then I'll ask anyone."
"Just ask."
"I would like to ask if there are any remedial measures after the mandible is removed. After all, the entire chin is gone, and the appearance will definitely be greatly affected." Kawei said, "For example, carving a new one out of ivory?"
