Chapter 113 110. New school

The development of amputation is actually a microcosm of surgical development, which can be roughly divided into four periods.

The earliest amputation was axe saw and a soldering iron rolling oil for aftermath. There was no muscle flap for embedding or suturing. Cutting + scalding is the entire process of amputation, and the time will not exceed three minutes, because the blood will dry out if it drags for too long.

Later, with the development of anatomy, a compliant hemostatic method appeared, and sutures were used instead of soldering iron. At least there was no secondary injury, and the speed of the operation began to slow down. However, there was still no anesthesia during this period. Doctors still had to consider the patient's heart-wrenching screams. The operation needed to continue to maintain high speed, fast in and out quickly.

Until anesthesia occurred, the "tree chopping" began to slowly develop towards "carving", and Ignaz, who is known for his speed, was slowing down intentionally or unintentionally.

By modern times, surgical surgery has long become synonymous with fine operations.

If someone carefully counts the infection rate of surgical incisions before and after the popularization of anesthesia, it should not be difficult to find that after the emergence of self-proclaimed progressive anesthesia, the probability of surgical incision ulceration has increased further.

Because although rapid surgery is rough, it can reduce contact, thereby reducing bacterial colonization and has a certain preventive effect on postoperative infection. Once the surgery slows down, the doctor's dirty hands will be exposed to the incision longer, and the chance of infection will naturally increase.

So Ignaz, who had rapid surgery, was able to raise one among a group of dwarfs and keep the mortality rate below 40%.

Of course, the doctors in the audience definitely could not understand the logical relationship, and only thought it was just a technical reason. Because Ignaz's surgery was indeed very ornamental, the movement amplitude, hand speed, frequency of explanation, and the amount of bleeding from the patient's incision were all controlled in a perfect dynamic balance.

Even Varella, who complained about his unwillingness to innovate, must admit this.

It’s really not that there is anything to criticize during the surgery, and only his innovation can be criticized.

But Kawei's surgery gave his peers a different experience, which was a sense of fineness after completely abandoning speed. Cut off a large left leg, the bleeding was only left in a few pieces of gauze. The floor was clean, the leather skirt was clean, the shirt was clean, and even the operating table was not stained with much blood.

But this experience seemed a bit advanced for another non-medical person present.

Since Varella missed Cave's caesarean section last time, she has not lost her job but has lost a lot of status. Now she is on par with the younger generation Greg.

The number of reporters in the daily operating theater has become two, but the amount of expenses given is still one person. Greg was the editor who personally picked up by him, so naturally he couldn't lose his share. The two could only split the money in two and tighten their belts and live.

With less money, Varella could not have finished all the surgery. Except for some must-sees, she could only stay at the entrance of the theater every day to get a bargain.

As I was picking up, who would have thought of picking up Kawei's amputation?

In the early morning, there are usually situations where unfamous doctors only need large venues. Surgical celebrities like Kavey are just like doing charity during surgery.

Because there were too few people watching it, the ticket price was set at a unified price of 20 kronor, which was too cheap. The most important point is that Greg, who was always thinking about kicking out by Varella, was not here, he wrote the exclusive report himself.

“It’s too slow”

Since he was thrown out of the theater by Kavey last time, he has learned a lot of lessons and knows that some ideas cannot be said casually. But even if Varella is patient, she really can't appreciate an amputation that lasts more than 40 minutes.

Carvey used a large piece of gauze stained with carbolic acid to cover Li Ben's residual limbs, and was pulled by Meren and Bergt on both sides, revealing only a small piece of femur.

The whole room was filled with the sound of files rubbing against bones, sometimes high, sometimes low, sometimes long sounds, sometimes cut into pieces. Kawei was like a carpenter, carefully polishing his works.

Varella felt so nervous that she finally found the opportunity to report exclusively. Just show me this?

He had a lot of things to say, but due to the scene, he could only find Ignaz and Hills: "Professor Ignaz, don't you think Kavi's surgery is too slow?"

"It's really slow." Ignaz did not deny it.

"Dr. Hills, what do you think?"

“It’s very slow.”

"If this is spread, wouldn't it be a loss of Austrian surgery?" Varella was really bored and couldn't help but yell at Ignaz, "Professor Ignaz, he is your student."

The implication is too obvious. A surgeon known for his hand speed actually taught such a speed student, which is really unreasonable.

But judging from Ignaz's expression, I didn't feel very uncomfortable: "Mr. Varella, you have never studied medicine and have never had surgery, you don't understand."

don't know???

Varella has seen too many surgeries and claims to be skillful but has a pretty savvy vision. Since Ignaz wants to protect her, she will find a breakthrough from Hills. He has just been squeezed out of work by Kavey, so he will definitely have a different opinion: "Doctor Hills, what are you looking at?"

"Me?" Hills thought for a while, "I agree with Teacher Ignaz's opinion. The layman cannot understand Dr. Kavi's actions."

Varella didn't understand: "I've never seen such a slow amputation."

"Mr. Varella, you still haven't figured out the significance of the speed of the surgery." Ignaz had the most say in this, "Why should surgery be fast?"

“The faster the surgery, the better.”

"How do you define beauty? And how do you define surgery?" Ignaz continued, "In your eyes, is surgery only a process of using a knife?"

Varella was confused again: "Isn't it?"

"Of course not." Ignaz said with a smile, "The reason for increasing the speed is that simply speeding up can avoid some accidents. In the case of unstable anesthesia, slowing down will be very troublesome. At the same time, speeding up will also cause many other troubles, such as bleeding."

"Doctor Kavey now abandoned his speed and focused all his energy on stopping the bleeding." Hills stood up and repaired the knife, "It was considered a path we had never taken before."

Only then did Varella discover the strangeness of Kave's surgery.

etc!

The blood vessels at the base of the entire thigh are extremely rich. Can amputation really prevent bleeding at all?

"So, Kawei is not slow, but the surgical content that needs to be processed is much more than traditional amputations, so it looks slow." Ignaz said the essence, "The fact is the opposite. When doing fine sutures for fixed-point hemostasis, Kawei's speed is not slow at all."

Varella finally understood what the two of them meant.

These two people think from the perspective of doctors, while they are more likely to see the operation from the perspective of patients and audiences.

"Everyone, half an hour has passed since the operation. The broken end of the femur has been smoothed by me, so it will not cause too much stimulation to the musculocutaneous flap at the anastomosis." Kawei handed the file to Salson, took the suture, and continued his own narration pattern. "Next, I will suture the muscles and skin layer by layer. This amputation is coming to an end."

As soon as he finished speaking, Kawei lowered his head and started suturing, wrapping the broken femur, blood vessels, and nerves inside.

"It takes so long to grind the femur to reduce irritation?"

"At that time, the problem of choosing amputation planes was that if the entire femur was removed directly, there would be no need to grind the bones." Hills still had a different view. "After all, he was just to be able to use prosthetics in the future. In this way, the residual limbs would need to bear the weight of the body. It is really not good if the bones were too sharp."

"Hills, you missed the swelling at the postoperative incision."

"Well, after surgery, swelling will also hit the fracture."

In Varella's cognition, surgery is a treatment method to cut off the lesion and is also a form of performance. As long as it is cut quickly and sews well, it is the true meaning of the operation.

He never thought that the ability to use prosthesis for amputation surgery should be considered, and the pain of the patient after surgery should be considered. Similarly, he never thought that the operation would need to control hemostasis to this extent.

Isn’t surgery an art of cutting? Do you still need to be so careful?

An amputation often takes forty minutes, half of it is given to stop bleeding and half is given to the bone grinding. What is the ornamentality left?

What the audience wants is the blood splattering when cutting the flesh, and the blood is like the sand in the hourglass. The surgeon's face is solemn, and he is racing against time every step. At the same time, he also needs to squeeze out his spare time to explain to the audience. The nervous air is filled with inside and outside the theater.

But what about now?

There is no blood.

I don’t know where to start with solemnity. At least Kawei’s face was light and light, as if he was dissecting a corpse, without any pressure.

“The surgery is completed.”

Kawei sighed softly, and he gently threw the suture needle into the disinfectant basin: "The skin is perfect, the suture is tight and the suture is appropriate, give me carbolic acid."

After rinsing with a lot of carbolic acid, Bergert and Melen bandaged Li Ben's left leg stump with bandages. A slightly dull amputation ended like this. When the cleaners entered the theater, they thought they had gone to the wrong room.

They had never seen such a clean operating table and floor, it was so clean.

"If Dr. Hills doesn't mind, it really doesn't need to be cleaned." Kavey put the bloody gauze into the cloth bag, "but there is a bit of blood on the sheets, so it should be replaced."

"I don't mind."

Hills walked out of the audience and wanted to talk to Kavey about the operation just now, but Varella jumped out first: "Doctor Kavey, how do you evaluate the amputation you just completed?"

"Evaluation?" Kawei didn't expect him to ask, "It's okay, it's just an amputation, it's not difficult."

"No, you probably don't understand what I mean," Varella stressed. "What I want to ask is, why do you treat an amputation like this? Why do you work so hard to stop bleeding? And the final stage of bone grinding is too time-consuming."

"The patient needs a lot of nutrients to recover after surgery, and blood loss is not suitable for postoperative recovery." Kavey explained while cleaning his hands, "Bone grinding is for prosthetic limbs, and to prevent swelling of the stump. Swelling will further cause ulceration of the incision."

The doctors around nodded.

But Varella still disagreed: "Just for this?"

Kawei didn't understand this time: "What if it was?"

"You're too slow."

"oh"

In fact, in Carvey's mind, since he came to the 19th century, his surgery has also increased a lot faster. In the past, it was already very good to have amputated within 1 hour, but now it has only been 40 minutes after an amputation, but it has become faster.

“Slowness also has the benefits of slowness.”

"Didn't you think about the audience's feelings?" said Varella. "Those nobles, those famous figures, don't come here to see you grind your bones, or you sew blood vessels one by one."

Kawei shook his head: "Did you misunderstand it? The surgery is for treating patients, not for performance. I also have my surgical style. Do they like to watch it?"

"."

Varella said it very bluntly, but this is a true portrayal of the surgical environment in the 19th century. If it were done according to Kavey's surgical method, the surgeon's income would plummet. No one was willing to spend hundreds of crowns to see the operation of several heads running back and forth on a small incision.

Too boring.

"You misunderstood, Mr. Varella."

Kawei threw the surgical instruments he had just used into a carbolic acid basin and slowly cleaned them: "There is a common argument for the quality of the surgery. No doctor will deliberately reduce the patient's surgical effect for the sake of ticket income. What's more, most of the ticket income cannot enter our pockets at all."

Originally, many people, including Varella, wanted to see if Kavi would create the fastest amputation record again. A young man with such a talent, who was also a master of the fast knife player Ignaz, was completely possible to surpass his teacher's speed.

But now a small amputation has been played with another trick by Kavey, which not only makes Varella confused about the future of surgery, but also Hills on the side.

Hills had to admit that Kawei's amputation operation deeply affected his original surgical arrangement. Should the incision be located in the upper abdomen or the lower abdomen? Is it a median longitudinal incision, or should you directly choose a transverse incision? Should you stop bleeding along the way, or should you maintain it as it is, and should you directly enter the abdomen with one knife?

He now looked at the clean operating table and listened to the interview Kawei was receiving, his mind was full of bleeding. He was like a gamer who was eager to try a new way of playing, unable to control his hands.

"Doctor Hills, the patient has arrived at the preparation room." The host walked into the surgical theater at this time, "Do you want to go and have a look first?"

"Oh, OK, I'll go there right away."

"He coughs very badly now. Do you want to give him some ya tablets for cough relieving? "

Before Hills could respond, Kavey, who was still entangled with Varella, suddenly turned around and asked, "Well? Teacher Hills, isn't your patient going to have an open-air examination? How could he have a cough? Is it an elderly patient? Or is it smoking frequently?"
Chapter completed!