godfather of surgery

Chapter 605 Others Stop

The titanium mesh painted by Yang Ping is actually not a real grid shape. To be precise, it is a raised titanium alloy plate without any mesh on it, but with raised rib-like reliefs.

In addition to the titanium alloy plate, there are screws that secure it to the bone.

Because the drawing was very detailed, Konstantin handed it over to the 3D printing laboratory of Harlaching Orthopedic Hospital, and the engineer quickly printed out the titanium alloy plate and supporting fixing screws based on the drawing.

As the world's top orthopedic hospital, this laboratory often uses titanium alloys to print various custom internal fixation devices and various artificial prostheses.

The titanium alloy plates are sent to the sterilization room for sterilization before being packaged and sent to the operating room.

Konstantin knew a thing or two. It was not difficult for him to operate to remove the ribs and install the titanium alloy plate.

Just like copying an article is not difficult, writing an article is difficult.

For him, it was difficult to think of this solution in an emergency.

With the titanium alloy plate, the heart surgeon was going to perform an emergency operation on the little duke. He removed the ribs and put them in the titanium plate. Removing the ribs temporarily relieved the pressure on the heart to a certain extent.

This method of decompression is more common in surgery, such as decompressive craniectomy in craniocerebral surgery, where a part of the skull is removed to allow the brain tissue to expand.Posterior indirect decompression in spinal surgery involves resecting the posterior lamina and allowing the spinal cord to drift backwards to avoid being squeezed front and back.

The titanium plate is used as a shield to create an artificial space where the heart can beat freely so that the heart is not exposed to the outside.

The little Duke is currently dying, but with the support of ECMO, surgery is not a contraindication, and the risk is worth taking to save his heart.

Constantine decided to take action and practice this idea.

The little duke was sent to the operating room, Constantin was in charge of the operation, cardiologist Norton was in charge of drug treatment, and other orthopedic surgeons were temporarily unable to help.

The strict sub-discipline system of modern medicine allows doctors to focus on the technology in their specialty and strive for excellence.At the same time, it also limits the doctor's thinking and technology to the professional scope.

Marcus being able to contact August means that he can get technical support from that mentor at any time.

Normally, Marcus could not be compared with these bosses, but at this time he was regarded as the key figure in solving the crisis, and Constantine asked him to guard him under the operating table.

After general anesthesia, it took a long time to position the body. The little Duke's deformed body made the operation very difficult no matter how he was positioned.

Hand sanitizer shop sheet——

"I'm going to cut the skin." Constantine announced to Marcus.

"Cut it!" Marcus agreed.

The heart surgeon holds a scalpel in a pen-like manner, and usually does this kind of operation with a single stroke.

But the spiral spine left the little duke's body in a severely deformed state.

Usually a man's chest is like a plain, which is very convenient to operate, but now the little duke's chest is like a complex mountainous terrain.

Cutting the skin is a difficult thing. Thinking about the instructor who is going to do spinal correction, Constantine can't help frowning.

After finally cutting the skin and peeling off the ribs.

As long as the ribs involved in the compression of the heart, the front ribs are completely removed, and [-] cm of the rear ribs are reserved for fixing the titanium plate.

Constantine followed this plan cautiously, originally thought it would be an easy job, but at this moment he felt a little difficult to move forward.

It is so difficult to peel off every rib, it is all caused by deformity.

Fortunately, this is not a heart transplant. If it is a heart transplant, the donor's heart is held in his hand, how to place it.

After finally cutting off the ribs, Konstantin was already sweating on his back.

Without the compression of the front ribs, the heart is liberated and drifts forward, a part of which exceeds the plane of the thorax and is completely exposed outside the body.

This still beating heart finally overthrew the oppression of the ribs for more than 20 years and ushered in a sunny day.

"Marcus, wipe off my sweat." Constantine moved his head out of the operating area.

He just wanted to make sure Marcus was in shape.

Marcus quickly wiped the sweat from Constantine's forehead with a tissue.

With Marcus present, Constantine continued the operation. He placed the titanium plate on the rib defect area, and the titanium plate bulged like a protective cover to create a spacious space for the heart.

The titanium mesh that simulates the normal thorax is fixed on the sternum on the right side, and the remaining posterior rib on the left side. The artificial space is very generous, and the vicious cycle will be terminated.

Constantine was very satisfied with his surgery, and the silver shield added a sci-fi look to the Little Duke.

all the best!
"Close your chest!"

But Constantine immediately discovered a brand new problem, the skin could not cover the titanium plate.

The deformed thorax resulted in a small area of ​​the left precordium, but now the surface area of ​​the thorax shaped by the titanium plate is close to normal, and there is a large area difference between them.

Just like a person with a distended abdomen, if he can shrink his abdomen to a very small size, if the pants fit just right at this time, and he then expands his abdomen, the pants will definitely be torn, which is caused by the difference in the front and rear abdominal circumference.

Now the Little Duke has a relatively insufficient skin area due to the poor front and rear surface area of ​​the left chest.

Constantine tried to adjust the skin, but the skin could only cover part of the titanium plate, leaving most of it exposed.

As a cardiac surgeon, he never had to think about skin coverage, that was the job of a trauma orthopedic surgeon.

Constantine stood on the operating table, looked at the exposed titanium alloy, and suddenly remembered, isn't this an orthopedic hospital?Why are you still afraid of skin defects?

"We are facing the problem of insufficient skin coverage. Please ask the trauma orthopedic surgeon to cover the exposed titanium plate."

Constantine stopped the operation and called the circulating nurse.

In less than 10 minutes, the trauma orthopedic surgeon rushed to the operating room and asked the cardiac surgeon carefully about his plight. It turned out that he was solving the problem of skin defects, which is the specialty of trauma orthopedic surgeons.

What is difficult for cardiac surgeons is routine for trauma orthopedic surgeons.

To solve the problem of skin defects, in addition to simple skin grafting, there are various flap operations, more than 100 surgical procedures, there is always one suitable for the little duke.

The trauma orthopedic surgeon stands on the footrest, observes the defect site and area one meter away from the operating table, and designs a suitable flap operation in mind.

Flap surgery is the idea of ​​tearing down the east wall to make up the west wall, and there are certain injuries. If it is the ultimate operation, this is not a problem. If it is a temporary operation, this needs to be considered.

The east wall was demolished to repair the west wall, but soon the west wall will be torn down and rebuilt. Whether the east wall should be demolished or not needs to be weighed against the pros and cons.

The trauma orthopedic doctor heard that this is a temporary operation, just to solve the problem of heart compression, in order to be cautious, he must understand some circumstances.

"Excuse me, what is your next treatment plan?" the trauma orthopedic doctor asked cautiously.

Next step?
Heart replacement?

Probably not so fast.

The current surgical plan was not proposed by Constantine, he was just a heart surgeon.

So Constantine couldn't answer.

The operating room fell silent, you look at me, to see you.

"Mr. August said that he and his instructor have boarded the plane, and the next step is scoliosis correction, with ECMO surgery." Marcus said in the audience again with great air.

What a guts it is to take ECMO for spinal correction. How divine is this mentor? He is so unconstrained.

"Then, does this need to be covered with skin?" Constantine threw the question to Marcus.

"There are small holes on the periphery of the titanium plate to suture the skin, as long as the peripheral sutures are covered, and most of the center is left exposed." Marcus instructed Constantine.

Fortunately, he did not act in a hurry, otherwise the skin flap transferred from the back would have to be dismantled immediately, which would be a huge waste.

Then listen to the instructor, Constantine decided to sew the skin on the titanium plate, covering only the periphery, and the instructor said it could be exposed, so let it be exposed.

Konstantin sewed up the skin stitch by stitch, and most of the titanium plate heart guard was exposed except for the periphery.

Several spine surgeons did not say a word in the audience, but they can still operate like this.

Under the titanium alloy plate is a heart.

Constantine stroked the heart shield with his gloved hand, fully associating.

If it is a patient with artificial heart replacement, can this operation be done, and a window can be opened, which is usually closed.

If the artificial heart needs to be repaired, inspected or replaced, it is convenient to open the window, operate it directly, and close it again after finishing the work.

"Marcus, the chest has been closed, what should we do next?" Constantin asked the assistant to cover the surgical incision with a sterile dressing.

Marcus replied: "Wait for August and Mentor's plane to land."

-

Ning Qi's private jet is an Airbus ACJ350 managed by Narada Airlines. It is said that there are only a few in the world, and there is only this one in China.

The 270-square-meter cabin on the plane looks very luxurious and spacious, with meeting rooms, kitchens, dining rooms, bedrooms, bathrooms, and leisure and entertainment areas.

The flight attendant knew that today's voyage was to send Mr. Ning's best friend, Professor Yang, to Germany.

President Ning personally ordered that in order to allow Professor Yang to rest well and ensure a good sleep, the luxurious master bedroom was opened for Professor Yang to use, and the other bedrooms were reserved for Professor Yang's assistants.

The purser knew that the master bedroom was Mr. Ning's most private space and would never be open to anyone else. This time, Mr. Ning made an exception and reserved it for this Professor Yang, which shows the importance of this Professor Yang.

The master bedroom is far more comfortable than the other bedrooms.

Inside there is a king-size bed and walk-in dressing room with underfloor heating.

On the wall opposite the bed, there is a huge TV.

The master bedroom is also equipped with a separate bathroom, which also has heated marble floors, marble basins and towel warmers. The bathroom has an oversized shower to ensure a good shower experience for the master.

On a ten-hour flight, the surgeon needed to get off the plane. Yang Ping needed a good rest on the plane, so Ning Qi specially ordered the flight attendant to open her master bedroom to Professor Yang. At the same time, she ordered other guests not to enter the master bedroom.

Therefore, the stewardess hung a temporary notice board in the master bedroom: Professor Yang is only for use, and others are not allowed.

Because of the urgency of the matter, Yang Ping did not bring Robert and Takahashi with him, and only August accompanied him, which inevitably made Robert and Takahashi so happy.

August thought that only people like the Duke had such a luxurious private jet, but he did not expect that the professor's friend also owned such a luxurious private jet.

It seems that my Chinese mentor is not only excellent in medical skills, but also has an extraordinary social circle, a person with great energy.

Yang Ping and August were resting on the massage chairs in the private theater of the plane, and by the way, they used the multimedia here to watch the video data of the little duke to prepare for the next step of orthopedic surgery.

The Internet on the plane allows August to keep in close contact with Marcus and keep abreast of the little duke's condition.

"The decompression of the heart has been completed. Dr. Constantine from Charité Hospital performed the operation. The operation went very smoothly. The little duke has returned to the ward with the titanium plate. I just sent the drawings you drew to Marcus for them to prepare. Surgical instruments." Auguste reported the latest changes in the young Duke's condition.

Yang Ping rested on the chair and did not speak.

August knew he was listening, so he continued, regardless of the response.

"It has been confirmed that the 3D printing laboratory in Harlaching can complete the production of these instruments. The engineers will work overtime when they get the drawings. When we arrive, these instruments should have been turned into sterile bags and sent to the operating room."

Yang Ping does not doubt the industrial production capacity of the Germans, especially the 3D printing technology, and the Harlaching Orthopedic Hospital should be in the forefront of the world.

Videos and pictures were still playing on the multimedia screen, and the two were chatting about the preparations for the operation when the flight attendant came in.

"Professor Yang, this is your favorite Longjing."

The stewardess brought two cups of fragrant tea.

Yang Ping likes to drink tea the most, and has no interest in other beverages.

This is probably the order of President Ning again.

Yang Ping sat up, thanked the stewardess, and took a sip of tea.

"Doctor Ao, do you need any other drinks? I'll ask the bar to prepare them." The stewardess was polite and thoughtful.

August hesitated and shook his head: "I only drink tea, too."

"We're right at the door, and we can give you anytime you need it." The stewardess exited the private theater and stood at the door.

The chef is preparing delicious snacks, and the wine cabinet at the bar has a variety of famous wines, but Professor Yang does not drink.

A private jet is like a mobile luxury apartment, which makes people feel like they are flying.

"You are a very caring friend." August also learned how to taste tea.

He was still figuring out what it meant to be a friend.

"Titanium alloy artificial thorax, this kind of variable type, can your hospital print it?" Yang Ping did not chat with August, but has been analyzing the operation.

"Okay, don't worry, even if they encounter difficulties, they will contact the manufacturer in Munich to solve it. Why is it designed in this way? Is it because of insufficient skin?" August freezes the screen on the blueprint of the titanium alloy chest.

"After orthopedic surgery, the surface area of ​​the thorax increases, and the original skin is insufficient. If the pedicled or free skin flap is covered, the trauma is too large, and there is a risk of infection. With this design, the artificial thorax is relatively small after implantation, and it will gradually expand after surgery. The skin acts as a dilator, so that the skin expands slowly, so there is no problem of insufficient area." Yang Ping said while lying down and resting.

The two reviewed the little duke's medical records again. Yang Ping was a little sleepy and was about to take a shower and rest. There was a major operation waiting to get off the plane.

The stewardess led Yang Ping to the master bedroom. August saw the sign at the door and stopped consciously.

"There is a separate bathroom and dressing room inside. If you need our help, there is a dedicated phone by the bedside. Good night."

The stewardess smiled and introduced, then took August to another bedroom.

(End of this chapter)