If the several surgeries in the middle section were still limited to showing the shining points in the process, and did not deliberately pursue success or failure, then starting from Ignatz's groin operation, the level of reporting has risen to a new level.

Surgery is only a means of treating illness and saving lives. The ultimate goal is to allow the patient to live well, so the subsequent surgery must be successful. And the sign of success is not only to remove the pain, but also to ensure that the patient lives well.

There will be no more failures in the following 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 does have ambitions, but his ambitions are tied to that small clinic.

He knows very well that even running a small clinic requires a lot of money, and surgery costs money like water. Maintaining the technology requires corpses, equipment updates, cleaning, maintenance, bandages, gauze, and sutures.

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.

Damirgaon is obviously a newbie who has not experienced the baptism of capital. 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 is already very good if it can not subsidize the money. If the fee is forcibly increased, the clinic will lose its advantage of being cheap, and patients might as well turn around and find a cheaper one.

Municipal General Hospital, St. Mary's Hospital.

The second is charity, but charity needs to be seen by others and needs to be exposed. There are many people in large hospitals and there are newspapers to promote them, so there will naturally be traffic. Naturally, investing in large hospitals 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 Kawei, and he really had no reason to refute. In fact, when Kawei finished speaking those things, he had already doubted his ability and gave up half of his heart.

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 is a little later than me, and the success rate was not high. But through his unremitting efforts, rhinoplasty, cleft lipoplasty and

Cystocystic fistula repair has gradually become his signature surgery."

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 the UK, 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 at the same time attracted everyone's attention. Following the sound, they all looked at the young man holding the water glass: "Dr. Carvey, 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 before, and my mouth was a bit dry. Drink some water.

I'm a little impatient. Teacher, please continue and don't worry about me."

"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 used, and I think the country can also 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 the whole of Europe. As the founder of plastic surgery, Waterman has been able to skillfully compensate for the defects of 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, and its purpose is far beyond simply 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 miserliness. She completely lost her nose last year because of syphilis.

She came here wearing an artificial nose, and her nose was completely missing. There was a large I-shaped hole in the center of her face, and its edges were formed by a small amount of scar tissue. [4]

I further carefully examined the patient's nose and found that her alars and the lower part of the nasal septum had been destroyed, but the nasal bones and the upper part of the nasal septum were still preserved. Since they had a good supporting effect on the plastic surgery, I decided to use the ancient Indian method.

, that is, remove the skin flap from the forehead and rotate it to cover 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. The bones were sawed, the meat was cut, and then the muscle flaps were made and the blood vessels were sutured.

But today, at this regular surgery meeting, he felt for the first time how this nearly 60-year-old surgeon solved a difficult problem when there was a lack of medical treatment and medicine.

Of course, equally powerful are his patients.

"What I need to do is to reshape the patient's nose first, and then cut off her abscessed mandible. As for the extent of the resection, 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 alar 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 reduce bleeding as much as possible. Next, make an incision along the drawing line drawn by the previous ink

, create a clover-shaped flap on the forehead.【6】

Lift the skin flap from the forehead and try to stop the bleeding. After the bleeding stops, twist the skin flap and place it in the appropriate position. Fix the left and right sides with three sutures, and then use cotton wool strips coated with essential oil to gently support the skin flap.

.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 threatens the patient's life. Waterman has to face not only the troublesome mandible, but also the anesthesia time.

"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 newly formed bone can be seen, but the repair process was terminated because of the new abscess cavity.

There was no need 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 had been completely destroyed, and the scope exceeded the preoperative expectations and extended to two sections. As a last resort, I only

You can use a bone saw to cut the mandible into three sections and then remove them one by one." [7]

Removing the mandible is not simple, and Waterman did it as carefully as possible while speeding up the process.

During the operation, the girl's tongue was preserved and wrapped in the original skin. At the same time, he also preserved the teeth and carefully placed them on the gums, hoping to gain enough solidity during the healing process so that they would continue to be usable in the future.

Waterman even imagined that the mandible could be regenerated, but unfortunately this was unrealistic.

"The operation went very smoothly, 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 jaw is also healing beautifully, the sutures were removed on the 7th postoperative day, and the purulent osteomyelitis did not interfere with the wound healing. I would like her to use her teeth for bite, but it is not easy. But we are still training the patient to master it.

The ability to chew solid food occurs mainly between the tongue and upper teeth.

The only drawback is that the 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 the 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 operation with a set process. If it is really complicated, there is also a kind of arm skin that protects the facial skin.

Flap migration surgery.

Cut a skin flap on the upper arm and suture 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. Leave it for at least 1-2 weeks until the suture heals, and then cut off the arm.

The remaining connecting part is then sutured twice 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 was indeed very bold, and he saw at a glance that time was tight and 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 small needles to make four stitches for a tight suture?"

"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 fit and shift. 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, which 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. According to 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 in the 19th century, when there was no concept of disinfection and hand washing, large incisions could be healed well.

The nose is okay, as it is surrounded by scar tissue, so the infection situation is better. However, the mandible is suffering from purulent inflammation and widespread infection. In this situation, even if modern surgery wants to avoid postoperative infection, it is not easy. During the operation

It requires a lot of cleaning and disinfection.

Kawei looked at his colleagues who were only interested in suturing skills and shook his head in his heart. 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:

"This surgery 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. I personally 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 became more and more confused about what Waterman was thinking, and was ready to ask for directions: "Then I'll ask anyone."

"Ask."

"What I want to ask is, are there 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?"

"."

"Or just pretend to be silver?"

"."
Chapter completed!