Nineteenth Century Medical Guide

Chapter 16 16. Stitching
Although staplers have been widely used in modern intestinal anastomosis, manual anastomosis with needle and thread is still the basic skill of general surgeons.If you can cleanly sew up the severed intestinal tube with needles and threads in a short period of time, you are basically at the level of indications.

Carvey has been dealing with various operations in emergency surgery, and he is familiar with the theory and operation of intestinal anastomosis.

In fact, as early as the nineteenth century, intestinal suture methods had become increasingly mature [1]. Many doctors who wanted to enter the field of abdominal surgery would experiment with various self-created suture methods on cadavers or animals.

In terms of their suturing theory alone, they are actually quite good, but they are limited by the material of the suture and the amount of practice, and there is no concept of disinfection, so the healing rate of intestinal anastomosis is not high.

Ignatz is better at operations on limbs, and fine sutures on intestinal tubes are obviously not his strong point.

He is very clear that it is necessary to ensure the orderliness and continuity of the intestinal serosa during intestinal suturing, and he also knows that the serosa needs to be aligned during suturing.But when it comes to getting started, there will still be deviations, and half of whether the sutures can be combined after they are brought to the intestinal wall depends on luck.

The technology is lacking, but Ignatz still has the intuition that surgery should have.

Looking at the intestinal tube that had just been easily pulled off by Moraso, he realized that there was indeed something wrong with his suturing technique.Even if it is stitched up again now, the intestines will be difficult to heal and ulcerated.At that time, it will fall into an endless loop of "the more open the laparotomy, the easier it is to get infected, and the more infected it is, the harder it is to heal".

After a brief hesitation, Carvey finally interrupted. He needed to take over the assistant's seat and end the operation as soon as possible: "Teacher, this is the catgut you introduced in the book, right?"【2】

Carvey is just a "beginner" now, and Ignatz needs to teach him some basic things: "Well, it's made of sheep intestines, and it can be absorbed by tissues when used on abdominal intestinal tubes."

"The teacher's art collection has emphasized that the suture of the intestinal tube must follow the Lembert suture method, and the serosa must be closed [3]." Carvey said, the tweezers in his hand have easily turned over the surface of the intestinal tube. Membrane, "Is it here?"

Ignatz nodded: "But before suturing the seromuscular layer, the inner mucosal layer needs to be sutured first."

"Yes, yes, I do remember that the teacher wrote this article. The mucosal layer is simply sutured with absorbable gut [4], and the thread cannot be pulled too tightly to prevent the mucosa from tearing. The outer layer does not need to be absorbed. sutures with interrupted inversion sutures, which is the method advocated by Professor Lembert."

Carvey seemed to be a die-hard fan with a superb memory, and recited all these stitching points as if he had recited them in full. Even Ignatz himself had forgotten that he had written them.

Of course, Kavi didn't know, because it was all nonsense, anyway, it didn't affect these words to remind Ignatz in time.

Especially for the continuous suture of the mucosal layer, judging from the suture at the broken end, it is because the suture is too tight that the mucosa is torn.And when he was doing Lembert suture【5】, he was indeed a little out of shape. There were too few stitches or the distance was not enough in many places, which eventually led to the tearing of the serosa layer under external force.

This is caused by lack of practice. I can only blame Ignatz for being too unfamiliar with abdominal surgery. No one else is to blame.

Being the best surgeon in Austria, Ignaz is by no means in vain.Since the thread was too tight just now, let it be looser this time, and since the Lember suture made a mistake, then be more careful
He has no option to give up and seek help, and he needs to face all the troubles he encounters by himself, otherwise what awaits Ignatz will be ruined.

He didn't know if it was because of Elena's embarrassment that made him feel better, or because of something else, the stitching seemed to go much smoother this time from outsiders.Where did it go smoothly? A layman would definitely not be able to see the reason. I just felt that Ignatz's operation suddenly became smoother.

These are just the physical sensation brought by the vision, and for those experts in the viewing booth, Ignatz's speed change is fully reflected in the time consumption.

The current anesthesia technology is unstable, and the speed of operation is still the best indicator to measure a surgeon.Ignatz is a surgeon who is known for his operation speed, so whenever he performs an operation, recording the time has become a habit of his colleagues.

Although the entire operation was delayed for a long time, the anastomosis of the broken small intestine just now was completed very quickly, and it immediately became the focus of whispered discussions among the audience.

"It's 15:14 now, and it only took 12 minutes? Could it be that I read it wrong?"

"That's right, it's more than twice as fast as before."

"The distance was too far to see the quality of the stitching, but the speed certainly broke the record."

"It's outdated to talk about speed regardless of quality. I personally value quality more. However, based on his requirements for himself, the quality should not be too bad."

"I don't agree. The suture just now is not satisfactory. Let's see after the operation. It will take a month at the slowest, and only two or three days at the fastest."

"So, after discussing for so long, you still haven't reached the point. Why did he speed up all of a sudden?"

After pure surprise and a little jealousy, they began to look for the real reason why Ignatz was able to speed up.

We are all doctors working on the operating table and are well aware of the difficulty of suturing the intestines.What the chief surgeon has to do is to penetrate the intestinal wall tissue with a needle and thread, and then tie a thread knot. Every link is closely related to practice.

In this case, it is impossible to double the speed in a short period of time, and it is already extraordinary to be able to increase the speed by 1-2 minutes.

Since the front and rear surgeons are all Ignatz, and the equipment used has not changed, the only factor that can cause a drastic change in speed is the assistant who just came on stage.

"Speaking of which, Ignatz does have fewer pauses."

"The sutures of intermittent sutures are one stride and one knot. The assistant needs to expose the needle entry and exit positions when he is suturing, fix the silk thread during the knotting process【6】, and cut the stitches immediately after knotting. thread. If the thread runs out, he needs to hand over a new needle and thread, and at the same time, he has to keep the direction and distance of the candlelight at all times.”

"There's no need to analyze it, it's the young man who shortened the time."

"Who is that guy?"

"I heard Ignaz just said that he is a student who graduated from the University of Vienna's medical school."

"Graduate? Why have I never seen it before?"

"Neither have I seen it"

Carvey did save Ignatz a lot of trouble and time, and made the connection of every movement of him extremely smooth.

To be able to do this, in addition to decades of surgical experience, you also need a pair of eyes that are good at observation.When standing in the preparation area just now, Kawei was not in a daze, but was carefully observing Ignatz's operation behavior and habits.

Each surgeon has its own fixed knotting technique and operation speed, and also has requirements for the angle and intensity of light.

By silently remembering their original rhythm of surgery, you will be able to appear where they want you to appear when they need you most, and with the most suitable candlelight for their eyes, hand them what they want most.

In fact, Carvey has already done absurdly in some links, whether it is finding the anatomical level or the position of the needle, he has done a better job than Hills.This gap was so obvious that even Elena and her niece at the side could see some clues, and even their voices were much lighter due to the influence of the audience in the arena.

"Auntie, is Dr. Ignatz's operation so fast?"

"How do I know that?"

"Auntie's words do make sense."

"What?"

"Whether the operation is successful or not has a lot to do with the assistant." The girl said with a smile, "I just kept sewing and it seemed awkward, but now I feel much more comfortable with a different assistant. Dr. Ignatz is like It's like a different person."

Elena said nothing more.

Her mood was very complicated. The person on the operating table was her own brother, so she naturally hoped that his operation would be successful.But compared to incarcerated inguinal hernia, which has a recurrence rate of [-]% and an average mortality rate of [-]%, Elena hopes that her son Bergett, who is hiding in the corner, can emerge on stage.

Morazo thought the same way before, but it was a pity that the apprentice took all the limelight away.

His movements are steady and his techniques are sophisticated, but there is nothing strange in his eyes looking at Ignatz, but a veteran on the battlefield who has seen through every movement of the opponent.It felt to Elena, just like Morazor when he was teaching Bergett sword skills.

But compared to the one-sided confrontational practice at the time, Carvey is now more like feeding moves.

In the eyes of outsiders, her acquiescence is the greatest compliment to the master and apprentice on the operating table, but more than half of this compliment is given to Kawei.The woman's intuition told her that this young man was not simple.

It is said that bystanders are clear and authorities are confused. This is true.

While others were praising the assistant, Ignatz, who was the chief surgeon, was concentrating on suturing, and didn't realize the importance of Kavey.After all, after turning over the mountain of intestinal anastomosis, he still needs to face another mountain, the suturing of the hernia gap.

"Everyone, I have completed the anastomosis of Earl Moraso's small intestine. The anastomosis is smooth and the sutures are firm. I am sure this is the smoothest and most confident suturing I have ever done in my life."

Ignatz reported his results as usual, and the staged success once again stimulated his enthusiasm: "Next, I will use the suturing method used by Dr. Cooper at that time, first shrink the inner ring opening of the hernia, and then close the The abdominal fascia is sutured to the inguinal ligament."

Suturing itself is not difficult, but the postoperative recurrence rate makes all surgeons have to choose to lie flat, and Ignatz is no exception: "Although Dr. Cooper's treatment method cannot reduce the recurrence rate, I at least cut off the The necrotic intestine saved the life of Count Moraso."

Carvey handed over the needle and thread again: "Teacher, this is the medium silk thread you want"

(End of this chapter)