Nineteenth Century Medical Guide

Chapter 167 164. Postoperative Question and Answer Session and Second Atrial Remodeling
Due to factors of the times, the surgical instruments were crude, and the field of vision was not clear enough, Carvey omitted a considerable part of the details of the operation. Even so, the entire operation lasted nearly 2 hours.Among them, the large-scale cutting action that the public likes to see accounts for a very small proportion, and the longest time-consuming is the meticulous vascular and nerve stripping.

For those four laymen, except for a small episode in the middle of the operation, the whole process was smooth, and even the episode itself did not cause any waves.This operation seems to be the same as the ordinary amputation that takes place in the theater on weekdays, except that it lasts a little longer.

The evaluation they gave was stable at best, and boring at worst.

Of course, the purpose of the four of them coming here is not really to see the surgery.

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 breast. This combination of modern surgical tracing methods and the classic radical surgery that became popular many years later directly created a historical precedent for breast cancer treatment in China.

The result of the operation depends not only on the excision technique, but also on whether the Countess has a recurrence.

The former is almost perfect, the latter is still unknown.

But since Watman acquiesced in Carvey's choice, they were willing to try it on their own patients. After all, the recurrence rate of breast cancer is too high.

If you still relapse after trying, you will lose the pectoralis major muscle, which has no effect on the survival rate, and the patient will soon die, just a small loss.But if this surgical method greatly reduces the recurrence, it will save a life, and it will be a bloody business for doctors and patients.

However, the radical operation performed by Kavey is much more complicated than simple atrial resection. It seems that only two pieces of muscle and a pile of fat have been removed. In fact, the most troublesome part is these extra operations. where they find it most boring.

Franz and the other three could feel the warm atmosphere around them, but they didn't understand the deep meaning.

"Actually, it's quite understandable. If the countess doesn't relapse after the operation, Dr. Waterman and Dr. Carvey will create a new surgical method."

Edinson had opinions on Carvey, but he also had to admit the status of this operation in breast surgery: "If I remember correctly, this should be the first operation in Europe to extend the range of breast cancer cutting to muscle .”

"So the countess will be all right, won't she?"

Ambassador Edward also contributed to the operation. If the operation is successful, he will also gain a good reputation when the matter is reported back to France.

"It can only be said that this operation is a very good attempt. As for the countess' tumor," Eddinson dared not make a conclusion easily. "Mr. Ambassador, you should understand that medical treatment is full of various uncertainties."

"Okay, I understand." Edward nodded, "I used to go to amputation surgery when I was young, and there were very few patients who could be anesthetized with ether, and I often encountered various problems during the operation."

"It's much more complicated than amputation."

"I'm just giving you an example. It's only been [-] or [-] years. I didn't expect surgery to have developed so far." Edward sighed and said with a smile, "I can't even understand what they are doing."

"That's right, the development of surgery is too fast. If the audience in the future has no medical background, I'm afraid they won't understand the content of surgery at all."

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

"Aren't you the same?"

This is perhaps the only undisputed conversation between Franz and Edward today.

Edward looked at Carvey and two assistants who were doing the final clearing operation, and suddenly asked, "Dr. Edinson, did you just say that this is the first case in the world?"

"Although there were no journalists involved, and no surgeons from other countries witnessed it, but judging from my technical reserves, it is at least the first case in Europe." Edinson explained, "Because I am familiar with the medical environment in the United States and Breast cancer resection techniques are not well understood."

"Not in France?"

"I'm sure France doesn't."

Edward thought for a while, and suddenly asked: "How do you see the countess' breast cancer condition? Is it serious?"

"The pathological examination of the lymph nodes just now has confirmed that the tumor has metastasized." After all, Edinson has just started to know the relationship between tumor and lymph, so he can only give a very general answer, "Since there is metastasis, it means that the tumor is already quite serious .”

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

Edward looked at Edinson, and Edinson repeated what he said just now: "This will be a brand-new treatment method with epoch-making significance."

This sentence raised the status of surgery in Austria and gave Edward a chance: "Your Majesty, if possible, I hope that the medical circles of France and Austria can have more exchanges, especially in surgery."

Franz glanced at Carl and Richard, and replied: "There is no problem with communication, but"

"I understand this."

Edward knew exactly what they wanted: "After returning to the embassy, ​​I will immediately write a letter explaining the condition of the countess, and at the same time conveying this invitation, I think His Majesty will definitely agree. As for Puao , I am a soft-spoken person, and General McMahon is better at speaking, so in the end it depends on the recovery of the countess."

Getting a clear answer from the other party has already accomplished Franz's established goal.

Justina's physical recovery naturally also included the effect of the second operation, and it did not exceed the scope of the original plan.As for whether France can be persuaded to help at an important moment, now that there is a basis for the call, it still depends on whether Franz can give enough benefits.

The four of them and Edinson got up one after another, and quickly left the theater, but there was no intention of leaving the theater.

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

Everyone is a sensible person with a lot of clinical operation experience, and they all know where the key points are. Most of the questions raised revolve around muscle separation and armpit treatment.

"Dean Waterman, what I want to ask is, does armpit cleaning really need to remove all the fat?"

Watman shook his head, stepped forward and patted Carvey on the shoulder and said: "I'm tired, and the patient is about to wake up, I have to stay by the bedside. Anyway, Carvey and I decided on the operation plan together. Your question Let him answer."

Tired is really tired, but more is the ignorance of the details of the operation.He is the main knife, standing on the court at this time is embarrassing himself, it is better to leave early to have a leisurely time.

Seeing Watman trotting and leaving the theater with the trolley, Carvey took the question and replied: "Since it is cleaning, it must be cut clean. This can also answer some questions about muscle separation. All the fat and soft tissue on the last serratus anterior muscle were removed to achieve the goal of radical tumor cure.”

"What should I do if I encounter the thoracoacromial artery when separating the pectoralis major and fail to stop in time, causing the blood vessel to rupture?"

"Hemostasis and ligation." Carvey replied simply, "Anyway, it will always be cut off."

"How to stop bleeding and ligation?"

"."

"Because arterial bleeding is very troublesome, it can quickly flood the entire surgical field."

Carvey couldn't handle this question: "Stopping the bleeding and finding the hemostasis point is the most basic operation in surgery. I don't think this should be a question that can be asked on this occasion."

"Dr. Carvey, I have also done dissection around the shoulder before. When removing lymph nodes, I often encounter the situation where lymph and blood vessels adhere to each other. Do we need to do dissection at this time?"

"Definitely."

"Then what if the stripping is not thorough."

"Then cut it off." Carvey said, "Everything needs to pave the way for tumor treatment. There will be adhesions of blood vessels and lymph nodes under the scapula. If you encounter them, you can directly do sutures."

In fact, it is also necessary to pay attention to the thoracic and dorsal nerves here. Once severed, it will definitely affect the muscle function of the upper limbs to the shoulders.

However, considering that they are all beginners, the nerves may not necessarily be kept, so Carvey just briefly mentioned: "Just now, the dean and I saved the countess's thoracic and dorsal nerves because the nerves and lymph did not adhere. If a patient has lymphatic and nerve adhesions here, lymphatic resection is still the main method.”

"Is it really necessary to do so thoroughly?"

"In order to prevent recurrence, I even cut off the muscles." Carvey said, "To be honest, this kind of incision after surgery does not reshape the mentality of female patients."

"So Dr. Carvey and Dean Watman will perform radical mastectomy again in the future?"

"If there is a chance."

After solving several key issues of stripping blood vessels and nerves, everyone focused on the original skin flap.

In the original resection, the upper and lower skin flaps were left at random, with random thickness, and a lot of tissue remained, and the plane after suturing was not even enough.

Now Carvey proposed the method of making skin flap for the first time, just like an old director who has done hundreds of breast cancer operations said: "The skin flap must be as thin as possible, especially when it is separated into the armpit area for axillary lymphatic dissection. It is especially important. Otherwise, the axillary flap is too thick and not elastic enough, and effusion and necrosis are prone to occur after surgery.”

After two hours of hard work, postoperative necrosis was the ending no one wanted to see.

But the production of skin flaps requires considerable skill, and Carvey himself is also exploring experience, and there is very little that he can really teach them: "Okay, are there any other questions?"

"I want to ask, the dye that Dr. Carvey used before the operation seems to be used at the end again. I don't know what is the purpose?"

"This dye can kill bacteria." Carvey said, "Not only will I use it for surgical incisions, but I will also continue to drip dilute solution into the countess' blood vessels after surgery to reduce her chances of postoperative infection."

"Blue dye against incision ulceration???"

"Yes, my experimental results have proved this."

"It's incredible."

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

Carvey knew that someone would say that, which is understandable, and he did only have a small amount of bacterial culture results in his hand, lacking a lot of experimental data.In fact, there were only a small number of people present who believed in the theory of microbial pathogens, and it was obviously unrealistic for them to believe that dyes can prevent ulceration.

"It's still the same sentence, the result of the operation is the standard of the test method." Carvey said, "I will choose to use methylene blue as an anti-infection drug to continuously infuse the patient into the patient's body after the operation, everyone will wait and see."

"."

"Oh, by the way, if anyone is interested in this miraculous dye, you can go to the Karachi Pharmaceutical Factory to buy it. It costs 15 crowns a bottle. You can choose oral or intravenous infusion. The pharmaceutical factory will tell you the specific dosage when you buy it. Ours."

After the question and answer, this stage is considered to be over.

Carvey informed all the surgical steps and answered all the questions that could be answered. Whether these text descriptions and viewing experience can be turned into a feasible operation depends on their ability.

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

Suddenly someone asked: "Dr. Carvey, if possible, would you like to move to St. Mary's Hospital, where there is a breast cancer patient in urgent need of surgery."

Throwing knife? ? ?

Carvey looked up and followed the voice: "Can't Dr. Massimov do it?"

"The tumor is too big, and ordinary mastectomy may not be able to cure it. Teacher Massimov is not sure." Before Kavey could speak, the young surgeon continued, "Dr. Kavey doesn't need to worry about the cost of the operation. The hospital will also properly solve the problem of equipment and medicines."

"Okay, after the end, let's discuss together to see if I have time."

"Thank you."

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

"what is the problem?"

"I heard that the countess needs a second reconstruction, but the surgical incision is so huge, and so much breast and muscle tissue is lost, how to rebuild it? Or Dr. Carvey and Dean Watman already have an idea?"

Carvey sighed: "Now there is only a first draft, and whether it is feasible or not will have to wait for further confirmation in the autopsy."

After all, surgery in the 19th century was more willing to take the route of skin plastic surgery, so the audience on stage were very interested in the second reconstruction: "Can you reveal some details?"

"Actually, it's just a general idea. We hope to choose the musculocutaneous flaps of the back and abdomen for joint transplantation." Carvey patted his stomach and lower back while explaining, "I'm afraid it will take some time for the specific plan, but Earl Madam still needs to wait about three months for another operation, and there is still plenty of time."

[The new chapter is in the second volume. . .Tomorrow I will find an editor to change]

(End of this chapter)