Nineteenth Century Medical Guide

Chapter 158 155. Repertoire
Since the theater moved to the Municipal General Hospital, Carvey has the authority to be the chief surgeon, and the question-and-answer session during the operation has become his repertoire.

Before crossing, Carvey was a surgeon who loved to ask questions, mainly to help point out where the minefields were during the operation, and also to help young doctors deepen their memory of relevant anatomical locations.

The anatomical structure of surgery is complex. Even with a strong memory, regular practice is required to ensure the accuracy of memory.

Young doctors usually need to repeatedly watch anatomical atlases and participate in operations on stage to maintain this proficiency, but people are always lazy, no matter who they are, they will slack off and get mixed up. At this time, old doctors need to be "promoted" at critical moments.

Now in Vienna, the questioning has been coated with a layer of commercial elements, and at the same time, it can also allow Carvey to grasp the true level of other surgeons.

Of course, if you insist on getting to the bottom of it, the question itself also revealed some of Kavey's bad taste.

The question just now is indeed difficult, even in modern times there are not many young doctors who can answer this question.Therefore, after the question was asked, there was no sound in the venue, and there were very few voices for discussion.

In fact, for the vast majority of viewers, answering the questions correctly to avoid ticket money is as difficult as winning the lottery.They still come to visit, learn and appreciate more.As for asking questions, it can only focus on participation.

Compared to them, the ones who really felt embarrassed had to be the bosses sitting in the four-corner VIP seats.

It's a shame that a young man asked a question that no one could answer.

"Don't look at me, I'm already thinking about it."

In Corrigo's mind was an anatomical diagram of the chest cavity with various blood vessels drawn, the answer seemed to have reached the mouth of the throat, and he almost touched his lips to say them: "Quick, quick, I think the answer is almost here mouth."

Waterman is getting older, and he prefers to practice memory.

I saw the old man with his eyes closed, touching his left upper arm with his right hand all the way closer to his torso: "Well, if I remember correctly, the blood supply to the thorax should come from the subclavian artery. As part of your dizziness, the blood supply is naturally also from the subclavian artery."

"Not bad, Dean Watman is really powerful, but it's too simple to just say the subclavian artery."

Carvey quickly cleaned the fascia around the left mammary gland, then opened the head, and quickly cut off the degenerated milk ducts and other tissues under it: "The operation is the second biggest difficulty here. When cutting freely under the halo, you must pay attention to the thickness of the cut. If it is too thick, it will not be cut cleanly, and if it is too thin, it will affect the blood supply and cause postoperative head necrosis."

The operation process is very beautiful, and the explanation can also make people's eyes shine. Every word is the key point, and there is no nonsense.

Just now the experience of cutting the lower part of your head and your halo is enough to worth the price of admission.

But Watman felt uncomfortable: "Since the blood vessels come from the branch of the subclavian artery, the blood supply naturally comes from the upper part of the body, so it is definitely not suitable to make an incision on your head. I think this sentence is enough to answer your question, why? It can be considered simple."

It's okay to explain it this way, but it doesn't meet the purpose of Carvey's question: "Then can the dean tell me which arterial branches are?"

The question was a bit out of line, and Watman seemed very embarrassed, but he couldn't leave the ticket that should be waived: "This should be the second question, right?"

"Yes, it can be understood that way."

"The question just now."

"It doesn't matter, even if Dean Waterman answered correctly."

Carvey smiled and separated the breasts from the pectoralis major, and slowly pulled the proliferating breasts out of the incision like pulling out a box of tissues, and then threw them into the metal plate that Herman handed over: "Wait After the operation, I will ask them to refund your ticket."

"That's about the same." Watman stood up and watched the whole process, and kept nodding. "It seems that the small incision does have a reason for the small incision."

"That is to say, the male breast hyperplasia is not obvious, and it can still be operated in this way. If it is a female, it must be enlarged incision."

Carvey's small incision under the head is not just a simple incision, but also gave many doctors a new idea of ​​incision approach.

Could there be a more aesthetically pleasing method of mastectomy, which originally cut off the entire rutum?
Even if breast cancer resection is impossible, what about simple breast tumors?Especially for tumors near the head and head, is it too unreasonable to cut off the head and head directly?And those patients who gave up the operation because they want to cut off their heads and dizziness, can they be retained by beautiful new incisions?
At this point in the operation, the really important incisions have been shown, and there is not much to see.

Waterman's thoughts had long been wandering, thinking about how to improve mastectomy surgery that had been going on for several years.

However, Carvey shouted abruptly and pulled him back to the surgery site: "Dean Watman, 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 dizziness come from?"

"My ticket for today is already exempted, why don't I give the opportunity to others"

Watman doesn't do breast surgery and knows the shape of blood vessels, but he really forgot the specific name.For the sake of his own reputation, it is impossible for him to say that, so all he can do is delay the time.

What he was waiting for was that Kawei voluntarily chose to give up, or...
"I remembered! I remembered! I remembered everything!! Hahaha!!!" Suddenly Korigo on the other side yelled, his face overflowing with excitement for a perfect answer, "This time it was absolutely wrong. No, the answer is the lateral thoracic artery and the internal thoracic artery."【1】

The two blood vessels are thin branches, and it is not difficult to know the names, and the anatomy book will also mark and give an introduction.

Even if the memory of the textbook has faded, I will often encounter it when doing autopsies.If it were Professor Lange, the director of the anatomy teaching and research section, the reaction time to answer this question would not exceed half a minute.

But even if there is no subspecialty, there are still some tendencies to be a clinical surgeon.

Breast surgery is rare, mainly abscess aspiration and tumor resection, which are not their areas of expertise.The plastic surgery that Corrigo focuses on has little to do with breasts, after all, it is very difficult to rebuild after the entire breast is removed.

It is really not easy to think of these two blood vessels under such circumstances.

"Dr. Corrigo's answer is quite good." Carvey didn't dare to ask further, and simply explained the answer, "The arterial blood supply here is mainly from the branches of the lateral thoracic artery and the perforating branch of the internal thoracic artery. supply.

These small branches all reach the base from the upper, inner, and outer sides of the rudder through the gland lobules, so the incision must be made under the ruhead.If the incision is on the top, it is easy to damage the underlying arterial network, which will cause 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 some blood vessels.

There were many voices of writing and taking notes in the auditorium, and more than half of the people buried their heads in the notes, taking notes with all their strength, not daring to miss a word.For Amor and Herman standing on the operating table, the only disadvantage of being Carvey's assistant is that they can't take notes on the spot.

Fifteen minutes later, Fernan's right mammary gland was removed in the same way.

"Leave it to me." Herman had already taken the needle and thread, and was about to start sewing.

But this time Carvey did not let go: "I'm really sorry, this time the patient's requirements are relatively high. Ordinary skin sutures will leave scars. Not only is the operation unsightly, but the healed scars will also produce contractures, which will further stretch your head. "

"Then what to do?"

"We can do a subcutaneous suture [2]." Carvey took the needle and thread, "do intermittent subcutaneous sutures on the fat layer, and let the epidermis heal on its own. After all, a large mammary gland has been cut off, and the skin has no tension."

As the operation came to an end, Koch, who was doing pathology on the side, brought the news of the biopsy: "I made a simple fixed stained section, which should be a tumor."

"Well, record it in the medical record, and do a review after the follow-up paraffin specimen is completed."

"I see."

Carvey easily completed the stitches and announced the end of the operation.

Due to the limited area of ​​the surgical theater at the Municipal General Hospital, postoperative interviews and inquiries were conducted in the auditorium.Except for the four VIP seats, all non-surgery-related personnel are not allowed to enter the central area of ​​the surgery.

People couldn't get in, but the enthusiasm of the audience was very high.

"Congratulations to Dr. Carvey for continuing to maintain a record of 100% success in the operation." Although Greg had some suggestions during the operation, he still sent his blessing after the operation. healthy."

"I will work hard."

"Although this operation is not that complicated, it should serve as a reference in the field of atrial resection." Greg asked, "Although Dr. Carvey is very young, I still want to ask, do you have any questions?" Haven't had a mastectomy?"

Carvey hesitated.

Should the answer be yes or no?

In fact, there are, and it is not uncommon for severe contusions to cut off the entire breast, which Carvey helped to do.The basic operation of the operation is very similar to breast cancer resection, the only thing missing is the surrounding lymph node dissection.

However, in the 19th century, there was no very clear concept of lymphatic metastasis for tumor treatment, and lymphatic dissection was rare. Simple resection of the urina is similar to mastectomy.

So it is not an exaggeration to say "it has been done".

However, breast cancer resection is not easy in the eyes of everyone, and not many people can complete this operation.

Carvey has now demonstrated cesarean section, intra-abdominal liver resection, spleen repair, hysterectomy, ureter repair.

Would it be too much if one more breast cancer was removed?In the future, you will be admitted to a logistics hospital, and you will have to face traumatic injuries on the battlefield every day. If you say you have done everything, and it turns out to be successful, isn’t it a little too much?

Considering this, Carvey is still humble: "I just saw it, and I didn't participate in it."

"With Dr. Kavey's surgical talent, seeing it is the same as having participated in it?" Greg did not shy away from this, but would further exaggerate Kavey's ability, "Dr. Kavey is already a member of the Austrian surgical community. A genius, even your teacher, Dr. Ignatz, the 'former' holder of the title of genius, admitted it."

"It can only be said that I learn faster."

"Doctor Carvey, you are really too humble."

This is true. In the eyes of everyone, Carvey is the genius surgeon who is too modest.

However, due to his aversion to the newspaper media, Carvey 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 surgery?"

"I have a question." Massimov was silent for the whole operation, and finally opened his mouth, "Should we do a pathological examination of the bilateral resection?"

"Dr. Massimov is worried about tumors?"

"There are factors in that."

"You can try it, but" Carvey checked the excised mammary gland again, "From the perspective of color, texture and blood supply structure, this should be a breast gland after simple hyperplasia. And there are hyperplasia on both sides, hyperplasia The extent is basically the same, and I personally think the chances of tumors are very low."

". makes sense."

Massimov nodded, and added two more strokes to his notebook.

Olgi on the side said: "I want to ask, is there any possibility of non-surgical treatment? After all, both surgery and anesthesia are risky, and it is too risky to sacrifice your life for two burdens."

"If the patient is not worried about the appearance of the body, there is no need for surgery." Carvey explained, "However, many patients will experience pain, which will affect their daily life. If the patient is willing, I think surgery is no problem."

"What if there is an accident?"

"Surgical accidents are very rare, because there is almost no bleeding." Carvey took out a few pieces of gauze used today to compress and stop bleeding. Three pieces of gauze, very little bleeding."

"anaesthetization."

"As for anesthesia, it is entirely caused by irregular anesthesia operations." Carvey said, "Since ether entered surgery and became a necessity for surgery, we have been lacking in exploring the use of ether. I will publish a paper in the near future, specifically Elaborate on the use of ether to minimize the chance of anesthesia accidents.”

"I see."

Carvey answered two questions one after another, looked back at Herman and Amor who were doing bandages, and was still a little uneasy: "You two, be careful, don't wrap it too tightly, the bandage will press too much on your head. Causing necrosis, be careful."

"Yes, I see!"

"Are there any other questions?"

At this time, Watman, who had been thinking about breast cancer removal and post-surgical plastic surgery, suddenly said: "If you are interested in breast cancer removal, Carvey, I need your help for a surgery."

　"On Microorganisms" and "A New Understanding of Ether Anesthesia" owe two extra articles.
　　
　
(End of this chapter)