In modern maxillomandibular resection, due to the loss of large areas of maxillofacial bone, autogenous bone grafting is often chosen according to the patient's requirements. That is to say, a section of body bone (mostly the hip bone or fibula) is cut off, along with the surrounding muscle flaps and blood vessels, and transplanted into the patient's mouth.
The success of autologous transplantation is related to smooth blood supply.
Due to the fineness of the suture needles, it is definitely not possible to anastomose such small blood vessels with a diameter of less than 5mm. It is most convenient to simply fill it directly with ivory.
However, for bone shaping, modern people choose to use computer-aided design, cut the long bones into small segments, and then use titanium plates to create connecting arcs. In the 19th century, it relied on some artistic personal techniques. From casting to subsequent cutting and polishing, all the work was left to the most famous sculptor in Vienna.
There was no lively scene like Kawei's just now in the surgery area, but Kawei's point of view shocked everyone's brains.
The operation of inserting the maxillary bone into the face made of ivory is avant-garde enough. It doesn't matter whether the connection is firm or not. As long as it can be done, it will be a monument in maxillofacial surgery. Nowadays, metal plates and rivets are added to fix it, and the human bones are treated as iron warships. It is outrageous to think about it...
...but it seems feasible.
A good idea always arouses a lot of responses, and soon several doctors who specialize in plastic surgery in the audience took out their notebooks. Without asking, they could deduce many solutions to artificial maxillary bones from this idea.
But after all, the job of surgery is not to repair industrial machines. No matter how novel the idea is, it still comes down to the same problem in the end, that is, how to disinfect metal plates and rivets, and what to do if infection occurs?
Objects inserted into the skin are not like surgical incisions and can be opened and re-sterilized. If there is inflammation and swelling in the body, incision and drainage will be a minor issue, but permanent removal of the bone will be a major concern.
It's the same as Charles' concerns before.
After all, doctors are there to solve patients' pain, not to create trouble. If the expensive ivory can't be solved once and for all, or at least it can't solve most of the troubles with a high probability, then what's the point of using it to make it?
Kawei also knows this. What he wants most when he travels here is antibiotics.
Unfortunately, the threshold for drug production is very high, and the production of antibiotics is also really troublesome. The labor force of Savarin and Mattick is seriously insufficient in the laboratory. Now it is the limit to verify the existence of puerperal microorganisms.
“I don’t know if it’s feasible to soak carbolic acid with carbolic acid for a long time.”
Waterman nodded, very satisfied with this method, but it was not enough: "The ivory is actually okay, the trouble is the incision in the mouth. After the mandibular removal last time, it was easy to deal with even if it ulcerated, but now it's in the mouth .How to ensure the disinfection of the mouth? Do you have to give him carbolic acid every day?"
"That's definitely not possible. I think you can use gauze soaked in carbolic acid for packing."
"It's a bit toxic." Waterman shook his head. "Ever since the voles raised by Kawei died due to long-term stimulation by carbolic acid, I have always been skeptical about this thing."
"I'm afraid high-concentration alcohol won't do either."
"If these two are not good, then bleach is even less good."
"Try using carbolic acid first. The concentration itself is not high, and then try to make it as dry as possible." Kawei said at this time, "In addition to packing gauze, you also need to do more rinses. In addition to rinses with physiological saline, there is also disinfection. Liquid flushing."
"For what?"
"None of those three can be used in the mouth."
"Recently, after studying the paper of French chemist Tanner, I found that a strong oxidizing compound he invented can effectively inhibit the growth of microorganisms [1]." Carvey said, "After testing, it was found that at 3% It is harmless to humans and animals at a certain concentration, and can even be used on wounds. I think it can be given a try.”
"You invented a new disinfectant?"
"It can't be regarded as an invention, it can only be regarded as a discovery." Kawei explained, "This oxidant is safer than carbolic acid, but it is easier to decompose."
Waterman listened to Carvey's suggestion. The new disinfectant sounded good, but it still couldn't completely solve his doubts. The large defects and wounds left after maxillary resection cannot be solved by irrigation.
He suddenly looked at Charles beside him: "By the way, can the palatal guard you just mentioned be made larger?"
"What do you mean?" Charles stopped what he was doing.
"Can you put carbolic gauze on the removable palatal guard and dental tray, so that the wounds on it can be protected?"
"It's okay, but it's a bit heavy."
Waterman sighed: "The patient is already lucky. If the tumor grows a little higher and the infraorbital wall is removed together, I don't know what to do with his left eyeball. According to the anatomical structure, there is no The infraorbital wall will cause the orbital contents, including the eyeball, to lose support."[2]
"It's going to fall."
"Definitely."
"If this is the case, a palatal guard + gauze packing should also work."
"Are you waiting for the soft tissue to grow back?"
"Maybe. This maxillary resection was done only after I made up my mind. I have never seen the scope of resection expanded..."
...
The operation did not take long, and it took less than an hour to remove the maxillary bone. The results of the surgery were pretty good, but the process was just like Orgi's, too rough. The bleeding was not stopped where the bleeding should be stopped, and the areas that should be carefully separated were cut through with one stroke.
Although surgery has many branches and there are not many connections between the various disciplines, the basic techniques of surgery are still the same.
The blood supply of the maxilla is richer than that of the mandible, and the amount of bleeding during surgery, especially during cutting, is larger. If Kawei was doing it, he would definitely do his best to stop the bleeding. If possible, he could also ligate the external carotid artery first, which can greatly reduce the amount of bleeding. 【3】
As for the opened muscles and skin, Waterman did not protect the blood vessels, and there were several unnecessary bleedings.
There were no accidents during the operation, and it was considered a success in everyone's eyes, but the real results cannot be judged until the patient recovers.
Waterman was not interested in suturing the muscle and skin of the second half of the resection, so he left them all to his assistants. As the chief surgeon, he only took a brief look at them.
Compared with the drastic surgery, the discussion and interaction time with the audience after the surgery actually took up a lot of time. If the host hadn't come in and said that the next patient had arrived in the lounge, Waterman might have been able to continue chatting leisurely.
"Since I was inspired by Dr. Kawei last time..."
Waterman was still watching Charles soaking the bones with carbolic acid. As soon as he said the first sentence, he felt something was wrong. He raised his head and looked at Kawei in the audience: "How come I am always inspired by you? Maxillary resection is the same." , eyelid repair too.”
"The dean is so complimentary."
"Don't praise or disapprove, the idea is indeed the one you thought of first." Waterman didn't mean to win anyone's love, "But just having the idea is not enough, you must put it into practice as soon as possible, check for omissions and fill in the gaps in practice, and form a new idea as soon as possible." A completely new surgical technique."
Kawei also wanted to try it, but unfortunately the Municipal General Hospital didn't accept many plastic surgery patients.
As for his famous young surgical genius, he not only had to cope with medical school studies, but also dealt with experiments. After returning to the hospital, he was also troubled by appendicitis and cesarean section. Especially the cesarean sections, including eight in a month, I will really become an obstetrics expert.
"Then there's no way." Waterman said with some pride, "Ever since the surgical meeting, I started looking for a repair method for simple blepharoptosis. After several attempts on cadavers, I am now certain that the flap transposition method is completely feasible. "
At the regular surgical meeting, a patient with simultaneous upper and lower eyelid ptosis was discussed.
While others were still wondering which of the upper and lower eyelids should be done first and which one was more difficult to deal with, Kawei had already thought of the complementary repair method of the upper and lower eyelids, which greatly stimulated Waterman's slightly slow old-fashioned surgical thinking.
He soon figured out how to apply this flap transposition method to the faces of other patients with ptosis.
"Since it's a series, let's save the host's introduction. Everyone, hurry up." Waterman invited the patient in first, "The next patient is the assistant I just hired for the School of Surgery. He works very well. He works hard and is a good person..."
A young man walked in from the gate, wearing a simple gray cloth short coat, a white shirt underneath, and an ordinary peaked cap on his head. He looked to be in his early twenties.
He is much healthier than the two patients who were just pushed into the hospital. Breathing steadily and walking vigorously, he looked just like the audience present. The only fly in the ointment is that the lower eyelid of the right eye is drooping, which is called ectropion of the lower eyelid. A piece of red conjunctiva was exposed, looking like heavy makeup, which was weird.
"Hello everyone." The young man smiled and waved to the stage, looking very relaxed. "It turns out that this is the surgical theater. I am really excited."
"First time here?"
"Yeah, I always wanted to make money and come here to see how exciting it would be. Unexpectedly, this wish has already come true before I make much money." The young man didn't have much scruples about the blood-stained operating chair. When he found that the blood stains had dried, he sat directly on it and said, "Is this where the surgery will take place later?"
"Yes, you will inhale ether and sleep for a while. When you wake up, the operation will be completed."
"It's amazing." The young man asked curiously, "Do you want to start now?"
"It's still early. The previous surgery has just ended, and the assistants need to do necessary cleaning work." Waterman glanced at the clock, "And the scheduled time is 9 o'clock. We still need to wait for about 15 minutes for the audience to arrive. Then start again. First, tell us about your experience of lower eyelids going from slight drooping to severe ectropion. What made it become so loose?"
"Childhood burns."
After years of precipitation, the melanin in the burn area has become very light, but if you look closer, you can still see some traces remaining on his right cheek: "After the burn healed, I felt that the lower eyelid of my right eye would move forward. It fell, and I couldn't control it. This appearance made me feel inferior for many years, and I still can't find a girl willing to marry me."
"Permanent damage caused by burns." Waterman patted his shoulder and comforted him, "I will help you repair it."
"Thank you, Dean."
The young man's lower eyelids were so ectropion that he indeed needed surgery.
Waterman first used a pen to draw a fold line on his face [4], which represented the path of the upcoming surgery: "This is the flap transposition surgery I am going to do today. I will look for a piece of intact skin at the corner of the eye and cut it open." A flap is made. It is then transferred into the lower eyelid after the scar tissue has been removed.
After the surgery, his lower eyelid will be back to its original state, replaced by a new injury at the corner of his eye that can be covered up with hair. "【5】
The operation process was not difficult, and Waterman also had extensive experience in this kind of repair surgery. After the audience took their seats, the operation officially began: "Nurse, start anesthesia."
The young man sat on the operating chair like the patient just now, leaning his head back on the cushion, and put on the mask sent by the nurse with peace of mind. His heart was full of excitement and anticipation. After the operation was completed, he looked in the mirror to take a look at his new eyelids.
The ether slowly evaporated in the anesthesia vessel and poured into his nasal cavity, respiratory tract, and lungs through the rubber tube.
The ether began to diffuse from the alveoli into the blood, and the effects soon appeared. The young man felt dizzy, his vision was blurred, and his ears could not hear clearly. Gradually, he began to lose control of his body and soon, as Waterman put it, "fell asleep."
But the effect of ether has not weakened. It was just an analgesic period, followed by a cortical excitation period. The unconscious young man began to struggle, hold his breath, cough and vomit.
This is a normal phenomenon in the eyes of all surgeons in the field, and most of the patients they handle will go through this period, including Kawei.
Soon the ether continued to act on the cerebral cortex, and the cortical diencephalon began to suppress it. The unconscious excitement reaction just now gradually disappeared, and the boy truly became quiet. The ether reached the anesthesia stage for surgery.
But unlike other patients, the anesthesia effect this time seems to be stronger.
Soon the ether completely inhibited the diencephalon, the midbrain and spinal cord began to inhibit from bottom to top, and the intercostal muscles were paralyzed. This reduces the respiratory rate, but not enough to deprive the patient of breathing, which is the state in which a small number of patients undergo surgery while still alive.
"The Romance of Fairy Wood"
But the nurse didn't seem to pay attention to the dosage when pouring the ether this time, or maybe her hands were shaking a little. In short, the amount inhaled was larger than before, and the effect would be deeper.
The spinal cord begins to be further inhibited, followed by the pons and medulla oblongata, the diaphragm begins to become paralyzed, the respiratory muscles are all paralyzed, and breathing stops. Once breathing stops, the whole body loses oxygen supply, and the heart quickly loses its ability to beat...
"Maldos! Maldos!!!"
