Since the theater moved to the Municipal General Hospital, Kawei has the authority to perform the surgery, and the question and answer session during the operation has become his repertoire.
Before time travel, Kawei was a surgeon who loved to ask questions, mainly to help point out the minefields during the operation, and also to help the young doctors deepen their memory of relevant anatomical locations.
Surgical anatomy is complex, and even if you have a strong memory, you still need regular practice to ensure the accuracy of your memory.
Young doctors usually need to repeatedly watch anatomical atlases and participate in operations on stage to maintain this proficiency. However, people are always lazy, and no matter who they are, they will slack off and get confused. At this time, older doctors need to "promote and promote" at critical times.
Now in Vienna, questioning has been coated with a commercial element, and it also allows Kawei to understand the true level of other surgeons.
Of course, if you insist on digging deeper, the question itself also reveals some of Kawei's bad taste.
The question just asked is indeed difficult. Even in modern times, there are not many young doctors who can answer this question. So after the question was asked, the room was completely silent, and there was very little discussion.
In fact, for the vast majority of viewers, answering the questions correctly to avoid paying admission is as difficult as winning the lottery. They come more to visit, learn and appreciate. As for asking questions, it can only focus on participation.
Compared with them, the ones who were really embarrassed were the elders sitting in the VIP seats in the four corners.
It's so shameful that no one can answer a young man's question.
"Don't look at me, I'm already thinking..."
In Corigo's mind was an anatomy diagram of the chest with various blood vessels drawn. The answer seemed to have reached the mouth of his throat, and he just had to touch his lips to say it out: "Come on, come on, I think the answer is already there." Almost to the mouth.”
As Waterman gets older, he prefers practical exercises when it comes to memory.
The old man closed his eyes and touched his left upper arm with his right hand, all the way close to his torso: "Well, if I remember correctly, the blood supply to the thorax should come from the subclavian artery. As a part of your head and your halo, the blood supply will naturally be From the subclavian artery."
"Yes, yes, Dean Waterman is really amazing, but just talking about the subclavian artery is too simple."
Kawei quickly cleared the fascia around the left breast, then opened the head, and quickly cut off the degenerated milk ducts and other tissues underneath: "The second most difficult part of the operation is to do Rutou. When making free cuts below the halo, you must pay attention to the thickness of the cut. If it is too thick, it will be difficult to cut cleanly, and if it is too thin, it will affect the blood supply and cause necrosis of the head after surgery."
The operation process is beautiful, and the explanation is also eye-catching. Every word is important, and there is no nonsense.
Just the experience of cutting the bottom of your head and halo just now is enough to be worth the price of admission.
But Waterman felt uncomfortable: "Since the blood vessels come from the branches of the subclavian artery, the blood supply naturally comes from the top of the body, so it is definitely inappropriate to make an incision on your head. I think this sentence is enough to answer your question, how? It can be considered simple.”
There is no problem in explaining it this way, but it does not achieve the purpose of Kawei's question: "Then can the dean tell me which arterial branches are there?"
The question was a bit out of line, and Waterman seemed very embarrassed, but he couldn't let go of the free ticket: "This should be considered the second question, right?"
"Yes, you can understand it that way."
"The question just now..."
"It doesn't matter, just assume Dean Waterman got the answer right."
Kawei smiled and separated the mammary gland from the pectoralis major muscle. Then, like pulling out a box of tissues, he slowly pulled the enlarged mammary gland out of the incision, and then threw it into the metal plate handed over by Herman: "Wait a minute. I’ll ask them to refund your check after the operation is over.”
"That's about right." Waterman stood up and looked at the whole process, nodding his head. "It seems that small incisions do have their own reasons."
"That is, if male breast hyperplasia is not obvious, this operation can still be performed. If it is a female, enlarged incisions must be made."
Kawei's small incision under the head is not just a simple small incision, but also gives many doctors a new idea of incision approach.
Is there a more aesthetically pleasing way to perform breast cancer resection, which originally involves cutting off the entire breast?
Even if breast cancer cannot be removed, what about simple breast tumors? Especially if the tumor is close to your head and your halo, wouldn’t it be too unkind to cut off your head and halo? And for those patients who give up surgery because they want to cut off their head and joints, can they be saved by a beautiful new incision?
At this point in the surgery, the really important incisions have been shown, and there's not much left to see.
Waterman's thoughts had already wandered away, thinking about how to improve the breast cancer resection surgery that had been going on for several years.
However, Kawei shouted suddenly and pulled him back to the surgery scene: "Dean Waterman, what about the second question you just asked?"
"...Huh? Second question?"
"Which branch of the subclavian artery does the blood supply to your head and your halo come from?"
"This... my ticket for today is free, why don't I give the opportunity to others?"
Waterman doesn't do much breast surgery and knows the shape of the blood vessels, but he has forgotten their specific names. For the sake of his own reputation, he couldn't say that, so all he could do was delay.
What he was waiting for was that Kawei chose to give up on his own initiative, or...
"I remembered! I remembered! I remembered everything!
Hahaha!
! "Suddenly Corigo on the other side shouted, his face full of excitement, "There is absolutely no mistake this time, the answer is the lateral thoracic artery and the internal thoracic artery. "【1】
Both blood vessels are thin branches. It is not difficult to know their names. Anatomy books will also mark and introduce them.
Even if my memory of the textbook has faded, I still encounter it frequently when doing autopsies. If he were Professor Lange, director of the Anatomy Teaching and Research Office, the reaction time to answer this question would not exceed half a minute.
But even if there are no specialties, clinical surgeons still have some tendencies.
Breast surgeries are rare, mainly abscess aspiration and tumor resection, which are not their areas of expertise. The plastic surgery that Corigo specializes in has little to do with the breast. After all, it is very difficult to reconstruct the breast after the entire breast is removed.
It is not easy to think of these two blood vessels in this situation.
"Dr. Corrigor's answer is quite good." Kawei did not dare to ask further and simply explained the answer. "The arterial blood supply here is mainly penetrated by the branches of the lateral thoracic artery and the internal thoracic artery. supply.
These small branches all reach the base from the upper, inner and outer sides of the urethra through the gland lobules, so the incision must be made under the urethra. If the incision is made at the top, it is easy to damage the arterial network below, causing postoperative necrosis. "
The two paragraphs basically explain the shape of blood vessels and the direction of blood supply, which is much more detailed than simply listing certain blood vessels.
The sound of many people writing and taking notes instantly came from the audience. Most of the people had their heads buried in their notes, working hard to take notes, not daring to miss a word. For Armor and Herman, who were standing on the operating table, the only drawback of being Kawi's assistant was probably that they couldn't take notes on the spot.
Fifteen minutes later, Fernand's right breast was removed using the same method.
"Leave it to me next." Herman had already taken the needle and thread, ready to sew.
But this time Kawei did not let go: "I'm really sorry, this time the patient's requirements are higher. Ordinary skin suturing will leave scars, which is not only unsightly after surgery, but the healed scars will also produce contractures, which will further stretch your head." "
"What to do?"
"We can do subcutaneous sutures [2]." Kawei took the needle and thread. "We can do interrupted subcutaneous sutures on the fat layer and let the epidermis heal on its own. After all, a large piece of breast gland has been cut off and there is no tension in the skin."
At the end of the operation, Koch, who was doing pathology on the side, brought news of the biopsy: "I did a simple fixed and stained section. It should be a tumor."
"Well, record it in the medical record and do it again for review after the subsequent paraffin specimen is completed."
"I see."
Kawei completed the suturing easily and declared the operation over.
Due to the limited area of the operating theater of the Municipal General Hospital, the post-operative interviews and inquiries are all conducted in the auditorium. Except for the four VIP seats, all non-surgery related personnel are not allowed to enter the central surgical area.
No one can get in, but the enthusiasm of the audience is very high.
"Congratulations to Dr. Kawei for continuing to maintain a 100% success record in the operation." Although Greg had some suggestions during the operation, he still sent his blessing after the operation, "I hope you can continue to maintain it and bring great benefits to the people of Vienna." healthy."
"I will work hard."
"Although this operation is not that complicated, it should serve as a great reference in the field of radiectomy." Greg asked, "Although Dr. Carvey is very young, I still want to ask more, do you have any questions?" What if you haven’t had a breast cancer resection?”
Kavi hesitated.
Should the answer be yes or no?
In fact, there are some. It is not uncommon for severe contusions and lacerations to cut off the entire breast, and Kawei helped do it. The basic operation of the surgery is very similar to that of breast cancer resection, the only thing missing is the dissection of surrounding lymph nodes.
However, in the 19th century, there was no very clear concept of lymphatic metastasis in tumor treatment, and lymphadenectomy was not common. Simple resection of the breast was similar to breast cancer resection.
So it’s not an exaggeration to say “have done it” here.
But breast cancer removal is not easy for everyone, and not many people can complete this operation.
Carvey has now performed cesarean sections, intra-abdominal liver resections, spleen repairs, hysterectomies, and ureteral repairs.
Would it be too much if we added another breast cancer removal? In the future, when I enter a logistics hospital, I will have to deal with battlefield trauma every day. If I say I have done everything and everything turns out to be successful, is it a bit too much?
Considering this, Kawei was still modest: "I just saw it and was not involved."
"With Dr. Kawei's surgical talent, does seeing him equate to having participated in it?" Greg did not shy away from this point, but wanted to further exaggerate Kawei's ability, "Dr. Kawei is already a leader in the Austrian surgical community. He is a genius, and even your teacher, Dr. Yingenatz, the 'former' holder of the title of genius, has admitted this."
"It can only be said that I learn faster."
"Dr. Carvey, you are so humble."
This is true. In the eyes of everyone, Kawei is the genius surgeon who is too modest.
However, out of disgust with the newspaper media, Kawei always felt that the other party was looking for and creating new topics in the normal surgery news. So he quickly pulled back the direction of the inquiry, hoping to make the postoperative discussion more pure and professional: "Does anyone else have any other questions related to the surgery?"
"I have a question." Massimov was silent for the entire operation and finally spoke, "Should we conduct a pathological examination of the bilateral resections?"
"Dr. Massimov is worried about tumors?"
"There are factors for this."
"You can try, but..." Kawei checked the removed breast again, "Judging from the color, texture and blood supply structure, this should be a simple hyperplasia of the breast. And it's bilateral. They all have hyperplasia, and the degree of hyperplasia is basically the same. I personally think the chance of tumors is very low."
"...Makes sense."
Massimov nodded and made two more entries in his notebook.
Orji on the side said: "I would like to ask if there is any possibility of non-surgical treatment? After all, both surgery and anesthesia have risks. It is too risky to waste one's life for two burdens."
"If the patient is not worried about the appearance of the body, there is no need for surgery." Kawei explained, "However, many patients will experience pain, which will affect their daily life. If the patient is willing, I think surgery is okay."
"What if something unexpected happens?"
"Surgical accidents are very rare, because there is almost no bleeding." Kawei took out several pieces of gauze used today to compress and stop bleeding. "These five pieces are used for gallbladder removal, and only 10 pieces are used for double mastectomy. Three pieces of gauze and very little bleeding.”
"anaesthetization......"
"As for anesthesia, it is entirely caused by irregular anesthesia operations." Kawei said, "Since ether entered surgery and became a necessity for surgery, we have been lacking in exploration of the use of ether. I will publish a paper in the near future. Explain the rules for the use of ether to minimize the chance of anesthesia accidents."
"I see."
Kawei answered two questions in succession, then looked back at Herman and Amor, who were wrapping the bandages. He was still a little worried: "Be careful, you two, don't wrap it too tightly. The bandage may press your head too much and cause damage." Necrosis, be careful.”
"Yes, got it!"
"Any other questions?"
At this time, Waterman, who had been thinking about breast cancer resection and later plastic surgery, suddenly said: "If you are interested in breast cancer resection, Kawei, I have an operation that needs your help."
"I Have a Picture Book of Ghosts and Gods"
