Chapter 167 164. Postoperative Q&A and Secondary Rufang Remodeling

Due to the times, the surgical instruments are simple and the field of vision is not clear enough. Kawei omitted a considerable number of surgical details, and even so, the whole operation lasted for nearly 2 hours. Among them, the proportion of large-scale cutting operations that are popular among the public is very small, and the longest time is the delicate vascular nerve dissection.

For those four laymen, except for a small episode in the middle, the whole process was smooth and the episode itself did not cause any trouble. This operation seemed to be just like the ordinary amputation that occurred in the theater on weekdays, and it just lasted longer.

The evaluations they gave are smooth to sound, while those they say are boring to sound are boring.

Of course, the purpose of the four of them here is not really to see the surgery. It doesn’t matter whether they look good or not. Giustina can safely get off the operating table, and the key is to establish a good relationship between Fa'O.

However, in the eyes of the other 200 surgeons, there are two completely different worlds.

Breast cancer surgery in Austria has always been limited to the removal of the Rufang. This method, which combines modern surgical tracer methods with classic radical surgery that began to prevail many years later, directly pioneered the history of breast cancer treatment in China.

The results of the surgery depend not only on the removal method, but also on whether the countess had relapsed.

The former is almost perfectly completed, while the latter is still unknown.

But since Watman has agreed to Kawei's choice, they are happy to try it on their patients, after all, the recurrence rate of breast cancer is too high.

If the recurrence is still caused after trying, the pectoral and large muscles will be missing, and the survival rate will have no effect. The patient will die soon, but only a small loss. But if this surgical method greatly reduces recurrence, it will save a life and be a profitable deal for the doctor and the patient.

However, the radical surgery performed by Kawei is much more complicated than simple Ru Atrial resection. It seems that two more pieces of muscle and a bunch of fat are cut. In fact, the most troublesome part is the extra operations, and it is also the most boring thing for laymen.

Franz and the other three could feel the warm atmosphere coming from around them, but they did not understand the profound meaning.

"It's actually easy to understand. If the Countess did not relapse after the surgery, Watman and Dr. Carvey would have created new surgical methods."

Aidinson had an opinion on Kavey, but had to admit the position of the surgery in breast surgery: "If I remember correctly, this should be the first surgery in Europe to extend the scope of breast cancer cutting to muscles."

"So the countess will be fine, right?"

The operation is also a contribution from Ambassador Edward. If the operation is successful, he can gain a good reputation when the matter is transmitted back to France.

"I can only say that this surgery was a pretty good attempt. As for the Countess' tumor," Altinson dared not make a conclusion easily. "Mr. Ambassador, you should understand that medical treatment is full of various uncertainties."

"Okay, I understand." Edward nodded. "When I was young, I went to see an amputation surgery. There were very few patients who could use ether anesthesia, and I often encountered various problems during the operation."

“This is much more complicated than amputation.”

"I'm just giving an example. It's only been fourteen or five years. I didn't expect that surgery has developed to such a level." Edward sighed and said with a smile, "I can't understand what they are doing."

"Yes, surgical operations are developing too fast. If future audiences do not have some medical foundation, they may not understand the content of the surgery at all."

"I see that His Majesty the Emperor was yawning just now."

"Aren't you the same?"

This is perhaps the only conversation between Franz and Edward today without objection.

Edward looked at Kawei and two assistants who were doing the final cleaning operation and suddenly asked, "Doctor Altinson, did you just say this is the first case in the world?"

"Although there is no journalist participation and no surgeons from other countries are witnessing it, judging by my technical reserves, it is at least the first case in Europe," explained Altinson, "because I don't know much about the medical environment in the United States and breast cancer removal technology."

"Not France?"

"I'm sure France doesn't."

Edward thoughtfully and suddenly asked again: "Look at the Countess's breast cancer condition? Is it serious?"

"The lymph node pathological examination just now confirmed that the tumor has metastasis." After all, Edinson had just started to contact the relationship between tumor and lymph, so he could only give a very general answer. "Since there is metastasis, it means that the tumor condition is quite serious."

"New surgery, severe tumor condition, if the Countess can survive."

Edward looked at Eddingson, who repeated the words just now: "This will be a new and epoch-making treatment."

This sentence raised Austria's surgical status and also gave Edward a chance: "His Majesty the Emperor, if possible, I hope that the medical circles of France and Austria can communicate more, especially in the field of surgery."

Franz glanced at Carl and Richard and replied: "It's okay to communicate, but"

"I understand this."

Edward knew very well what they wanted: "After returning to the embassy, ​​I will immediately write a letter to the Countess of the Qing Dynasty and convey this invitation at the same time. I think His Majesty will definitely agree to the emperor. As for the slightest words between Pu'O, General McMahon is more capable of speaking, so in the end it depends on the Countess' physical recovery."

Having received a clear answer from the other party has achieved Franz's established goal.

Giustina's physical recovery naturally also included the effect of the secondary surgery, and it did not exceed the original plan. As for whether France can help at important moments, now that the call is based on the basis, it depends on whether Franz can give enough benefits.

The four of them and Aidinson stood up one after another and quickly left the surgical theater, but there was no intention of ending the scene.

The complexity of the operation is much greater than that of cesarean section. It is obviously impossible to learn all operations by observing from a distance. Various questions and discussions after the operation have become important methods for everyone to learn.

Everyone has a lot of clinical surgery experience and understands the key points. Most of the questions raised are around muscle separation and removal and armpit treatment.

"Director Watman, what I want to ask is, armpit cleaning really requires cutting out all the fat?"

Watman shook his head, stepped forward and patted Kawei on the shoulder and said, "I'm tired, and the patient is about to wake up, so I have to stay by the bed. Anyway, Kawei and I decided on the surgery together. Let him answer your questions."

I am really tired, but I don’t understand the details of the surgery more often. He is the main surgery, so he is embarrassing himself when standing on the court. It’s better to leave early and have some leisure time.

Seeing Watman trot and leaving the surgical theater with a cart, Kavey took over the question and replied: "Since it is cleaning, it must be cleaned. This can also answer some questions during muscle separation, and also need to remove all the fat and soft tissue on the last serratic anterior muscle to achieve the purpose of radical tumor cure."

"What should I do if I encounter the thoracic acromion meridian when separating the pectoralis major muscle and fail to stop in time to cause blood vessel rupture?"

"Hemostatic ligation." Kawei replied very simply, "Anyway, we have to break."

"How to stop hemostatic ligation?"

"."

"Because arterial bleeding is very troublesome, it will soon be able to overwhelm the entire surgical area."

This problem is not solved by Kawei: "Stop bleeding, finding bleeding points is the most basic operation of surgery. I don't think this should be a question that can be raised in such occasions."

"Doctor Kavey, I have also done an anatomy around my shoulders before. When removing lymph nodes, I often encounter the adhesion between lymph and blood vessels. Do I need to peel off at this time?"

“Definitely needed.”

"What if the stripping is not done thoroughly."

"Then let's cut it off," Kawei said. "Everything needs to pave the way for tumor treatment. There will be blood vessels and lymph nodes under the shoulder blade. If you encounter it, you can do a breaking gap."

In fact, you also need to pay attention to the chest and dorsal nerves. Once they are disconnected, it will definitely affect the muscle function of the upper limbs to the shoulders.

However, considering that they are both beginners and their nerves may not necessarily be kept, Kawei simply said: "The dean and I just protected the Countess's thoracic and dorsal nerve because there is no adhesion between the nerves and lymph. If a patient has lymph and nerve adhesion, the lymph will still be removed."

"Is it really necessary to do it so thoroughly?"

"To prevent recurrence, I even cut off my muscles," Kavey said. "To be honest, this kind of incision after surgery does not undergo remodeling, really hurts the mentality of female patients."

"So Dr. Carvey and Dean Watman will have a radical breast cancer surgery in the future, right?"

"If you have a chance."

After solving several key problems of peeling off blood vessel nerves, everyone focused on the initial flap.

The original resection surgery was to take the upper and lower flaps at will, with a random thickness and a lot of tissue left behind. More importantly, the plane after suture was not even enough.

Now Kawei has proposed the flap making technique for the first time. Just like an old director who has already performed hundreds of breast cancer surgery, he said: "The flap must be thinned as much as possible, especially when separated into the axilla area for axilla lymphatic dissection. Otherwise, the axilla flap is too thick and not elastic enough, and effusion is prone to necrosis after the operation."

After working hard for two hours of surgery, the final necrosis of the operation was an ending that no one wanted to see.

But flap production requires considerable skills, and Kawei himself is also exploring experience, and there are very few things he can really teach them: "Okay, are there any other questions?"

"I want to ask, the stain used by Dr. Kavi before the operation seems to be used at the end, I don't know what the purpose is?"

"This stain can eliminate bacteria," said Kavey. "I will not only use it for surgical incisions, but also continuously drip into the countess' blood vessels after the operation, reducing her chances of infection after surgery."

"Blue dye can fight incision ulceration???"

"Yes, my experimental results have proved this."

"It's incredible."

"Is there any specific data support? If not, it would be too messy."

Kawei knew that someone would say this, and it was understandable. Moreover, he only had a small amount of bacterial culture results in his hands and lacked a large amount of experimental data. In fact, only a few people who believed in the theory of microbial pathogenicity were present, which made them believe that dyes were obviously unrealistic to prevent ulceration.

"As it said, the results of the surgery are the standard for the test method." Kawei said, "I will choose to use methylene blue as an anti-infective drug to continuously input into the patient's body in the subsequent operations. Let's wait and see."

"."

"Oh, by the way, if anyone is interested in this magical dye, you can go to Karachi Pharmaceutical Factory to buy it. A bottle of 15 kronor, you can choose oral or intravenous infusion. The pharmaceutical factory will tell you when purchasing the specific dose."

The question and answer said that this stage has come to an end.

Kawei informed all the surgical steps and answered all the questions that can be answered. In the end, whether it can be turned into a surgery that can be proven by relying on these text descriptions and viewing experiences depends on their ability.

"If there is no problem, I will withdraw first." Kawei packed up his surgical instruments and prepared to leave.

Suddenly someone asked: "Doctor Carvey, if you can, are you willing to move to St. Mary's Hospital, where a breast cancer patient needs surgical treatment urgently."

Flying knife???

Kavi looked up and looked over in the voice: "Doctor Masimov can't do it?"

"The tumor is too big, and ordinary mastectomy may not be cured. Teacher Masimov is not sure." Before Kawei spoke, the young surgeon continued, "Doctor Kawei doesn't have to worry about the cost of the surgery, and the hospital will also properly solve the equipment and medicine problems used."

"Okay, after the end, let's discuss whether I have time."

"Thanks."

"By the way, Dr. Kavey, we have one last question."

“What’s the problem?”

"I heard that the Countess needs to undergo a secondary reconstruction. The incision of the Kerber surgery is so huge and there is so much breast and muscle tissue lost. How to rebuild it? Or do Dr. Kavey and Dean Watman already have ideas?"

Kavey sighed: "There is only one first draft now. Whether it is feasible must be further confirmed by the autopsy."

After all, surgery in the 19th century was more willing to take the course of epidermis plastic surgery, so the audience on stage was very interested in the secondary remodeling: "Can you reveal some details?"

"In fact, it's just a general expectation. We hope to choose the musculocutaneous flap behind and abdomen for a joint transplant." Kawei explained and patted his stomach and waist. "The specific plan may take some time, but the Countess still has to wait for another surgery for about three months, and there is still plenty of time."

[The new chapter is in the second volume... I will find editors to modify tomorrow]
Chapter completed!