Nineteenth Century Medical Guide

Chapter 346 342. Another Use of the Microscope

In French medical circles, breast reconstruction has always been a surgical legend that only exists in vague reports.All they knew was that Countess Justina's breast cancer had been removed without a hitch, and that her breasts, which had disappeared, had grown back again at the hands of the same young man.

The economic base determines the superstructure, and medicine is the same.They don't even understand breast cancer, and the recurrence rate and death rate are ridiculously high, so no one will care about the post-operative appearance.

And this kind of postoperative plastic surgery problem that I didn't even think about, is now solved by Kawei, and the impact can be imagined.

As soon as the operation was launched, it received a high degree of attention and discussion.

However, the operation theater in Paris was basically decoupled from entertainment, and the press abandoned Carvey after only eating the first wave of enthusiasm, and began to look for new hot spots as early as a week ago.

Those who can really understand and recognize their strength are those surgeons who pursue cutting-edge medical technology.Since he first came here in early November, Carvey's topic has not stopped, and as time goes by, he can always come up with new tricks, and this situation intensifies.
But just like when the West brought advanced technology to the East, Carvey brought them new technologies, new surgical solutions, new drugs, and new equipment, and at the same time brought them absolute crushing at the medical level.

The past half a month has not been very pleasant for those surgeons who are pursuing the limit and breaking through the existing bottleneck.

The joy of learning new technologies is intertwined with the great sense of loss brought about by the gap in ability. It is like eating a piece of light shit-flavored chocolate mixed with syrup and spices. It is very sweet and smooth, but it always tastes like shit when chewed.

Apart from Carvey, the only person who can really find happiness from the surgery demonstration is Edward who single-handedly facilitated it.

Especially for this Rufang reconstruction, he was even more excited when he learned the operation time, because as soon as he entered the theater, he became the only one who watched two reconstructions in a row.

Although outsiders are not interested in this kind of false name fabricated by individuals, Edward is still willing to call himself that, and as a diplomatic ambassador, he enthusiastically chatted with the doctors around him about the operation scene at that time.

"The theater in Vienna is still not as good as Paris." Edward looked at the round glass dome and said with emotion, "I didn't expect the second reconstruction operation to be so long apart."

Such a famous diplomatic ambassador can be regarded as a small half of the foreign minister. Today is a special guest who came in to watch.Doctors naturally don't like politics very much, and they don't have any desire to communicate with Edward. Some people even think that this kind of person maliciously usurps the seats that should belong to other doctors.

Edward looked for several people in a row, but they didn't start a chat, so he could only talk without saying a word.

At the same time, as the opening speaker of the operation, Carvey must first introduce the patient's situation at the beginning.

"I don't know if there is a diagram of the operation process. Carvey's operation is too complicated."

"."

[Welcome everyone to come to see my breast reconstruction operation today. Although the technology is not mature enough, I already have a patient who has successfully undergone the operation, Countess Justina.]
"By the way, has anyone of you done this kind of surgery?"

"."

[Patient, not really a patient, her name is Laura Patty, she is very beautiful.Compared with her face, her body, which had just undergone a mastectomy, looked unsuitable. ]
"Surgery is quite interesting. Seeing that thing suddenly rise up, I feel that the prospect of surgery is extremely bright."

[Now, we invite Ms. Laura to enter, please applaud her courage~]
Edward didn't listen to Carvey's opening remarks at all, but his eyes kept looking at the audience.Amidst the fierce applause, the final sound in his throat was stuck on the word "beautiful", and for a while he didn't know how to describe the girl who walked into the theater.

Perhaps it was because of her second visit to the theater, Laura Patty was more confident and eloquent than other women. After entering the door, she greeted everyone generously: "Just call me Laura, today's There are many more people than during the operation two years ago."

Carvey watched her circle around the operation area, a little impatient: "Lie down on the bed."

"Come here." Laura took off her shirt generously, revealing the scar left by the previous operation, "Dr. Carvey, you said you would help me remove this scar."

"It depends on luck, after all, the best repair time has passed." Carvey asked someone to disinfect her, "It's a bit cold, bear with it."

"It's all right." Laura was not afraid to laugh back, "It's not too bad to see so many outstanding men."

"Amor~" Kavey knew her occupation, but did not say clearly, "Now we are performing routine disinfection, because the operation is divided into two areas, so it will take some time, please be patient. I also happen to Taking advantage of this time, let me briefly talk about some key points of myocutaneous flap transplantation.”

Laura is indeed very beautiful, which has attracted the praise of many doctors.

Some people also saw the left mastectomy two years ago, and felt sorry for the tumor that ruined a beauty, and at the same time added some mystery to this operation.

To what extent can Kawei restore the lost rufang?Will it be different from the original?Will it fail?If it works, will it also work for other women who have lost their breasts?
If we diverge a little more, can many women with poorly shaped breasts and higher requirements also receive this kind of surgery?

Most doctors look at Laura's beauty and figure with a medical eye, but Edward does not.He has no medical knowledge, so naturally he has no medical thinking, and his mind is full of masculine content.

".So beautiful, so beautiful!"

Edward immediately thought of the newcomer actress Sharana who had just bought before. She was also very beautiful, but she was still a long way from perfection.In addition to makeup, she inevitably wears a lot of jewelry and does hairstyles on weekdays. It always makes people feel that there is a makeup artist between herself and the beauty.

But the Laura in front of her was different. The combination of facial features and figure happened to hit Edward's favor zone.Her long hair was tied with a tie, and she wore only a simple surgical gown.

Now after taking off his clothes, his body is almost completely natural, with no powder makeup, no jewelry, not even perfume. Edward slapped his thigh and cursed himself inwardly: Am I stupid? Go wear these things.

But anyway. This girl is really beautiful.

He was obviously tempted, and the desire to occupy the female spontaneously arose.

In the past, this kind of fascination would only stay on the surface.Once he found her strange figure, even if Edward was not frightened, he would avoid her and try to keep a distance.But now that Kavi appears out of nowhere, things are different.

The first woman in the world to undergo this type of surgery was the countess, she was very beautiful, and the result of the operation made the count very satisfied.

What about the second one?
Whose wife will the woman on the second station be?
Because of this operation, Laura's body not only has the label of beauty, but also represents a record of surgery.This undoubtedly stimulated Edward's possessiveness even more, because he knew very well that Carvey's operation would not go wrong.

Rather than saying that this is a reconstruction technique, it is better to use a more modern term - reconstruction.

Different from facial plastic surgery, breast reconstruction and reconstruction are much more difficult. The incision is large, the trauma area is large, and the postoperative recovery time is long. It requires a detailed physical examination and evaluation by the surgeon before the operation.

The general condition is checked. Except for medical diseases that cannot be changed at this stage, the main target is the oncological situation of the surgical area and the conditions of the donor and recipient areas.

"Actually, in terms of difficulty, I don't really recommend that you perform such an operation."

Carvey gave everyone a preventive shot at the beginning of the operation: "It not only tests the surgical level, but also the treatment and design of the musculocutaneous flap. How to turn the flat skin and muscles into a three-dimensional hemispherical shape, and The absence of ulceration and necrosis is the basis for the successful completion of this operation.

During the entire postoperative recovery process, swelling, contracture, and scar formation in the surgical area also need to be considered, and then it is possible to make a perfectly symmetrical other half. "

This is a warning, but also a display of one's own strength.

"Now we are back to the operation." Carvey has already cut the skin of Laura's abdomen. "Before the operation, I have already made cutting marks on Laura's abdomen. Because enough blood vessels must be preserved, The main perforators of blood vessels are all in the periumbilical area, so the incision above the umbilicus is selected during design, and the incision below the umbilicus needs to be fine-tuned considering the size of the patient's urus.”【1】

"There are many kinds of musculocutaneous flaps, and a lot of anatomical basis is used to distinguish them【2】. In fact, the operation method is similar to recreating the ancient Indian nose reconstruction surgery. The forehead skin is cut off, the lower blood vessels are kept for rotation, and then reconstructed. Build a new nose.

The rectus abdominis myocutaneous flap I chose belongs to the "double vascular pedicle", and there are two major vascular bundles coming from different arteries.We kept the superior epigastric artery, cut off the inferior artery, and transferred it in a counterclockwise direction to the defected left chest. "

After all, he simply waved the scalpel and explained the whole process of the operation to everyone with one movement, but put aside the classification of the musculocutaneous flaps and said nothing.

There are two ways to deal with the flap here.

One is the first choice of modern surgery, which is to completely separate the musculocutaneous flap and use microsurgery for vascular anastomosis. 【3】

The other is the pedicled rotation that was used at the beginning of the operation to preserve a blood supply. After the rotation, even if there is a problem with the suture of the surrounding blood vessels, the blood supply can be maintained by this blood vessel. This is what Carvey will do today. 【4】

Choosing the second option doesn't mean it's easy.

Unlike those life-saving anastomoses of large vessels, myocutaneous flap transplantation deals with small vessels.Although the second type retains the original blood supply, it is not uncommon for the surrounding necrosis to occur due to the single blood supply.

Of course, Carvey prefers the first one, as long as the vascular anastomosis technique passes the test, it can be regarded as once and for all.

However, the two blood vessels that supply the rectus abdominis muscle are not thick enough, so they are mostly avoided in general surgery, and if encountered, they will be cut and ligated.Now limited by the material of the sewing needle and thread, it is very difficult to sew them perfectly.

Carvey's choice of the second option can be regarded as a compromise, because as long as the rotation is proper, the blood supply of one of them can be guaranteed, and most of the entire muscle flap can survive.

As for those possible complications, he can only do his best. One of the solutions is to use a microscope to anastomose some small blood vessels: "In order to complete the anastomosis of some small blood vessels, I modified Professor Cedieu's microscope. Let it help us see these blood vessels during surgery." [5]

"Adding a microscope to surgery?"

"What about the sutures?"

"I will use single-strand silk thread for sutures, and the suture needles are also specially made, which are 2/3 thinner than ordinary suture needles."

Different from the previous operations, the environment of this unprecedented operation was much better. There was no one around to talk nonsense, and there were no conservatives with old-fashioned techniques. The operation became Carvey's one-man show.

"The cutting shape is best to be oval. Cut the skin, subcutaneously reach the anterior sheath of the rectus abdominis muscle and the superficial layer of the external oblique muscle, and separate the epigastric flap to the xiphoid process at this layer." Kavey Sitting Musculocutaneous Flap For processing, slowly separate and say, "Incision is made parallel to the inner and outer edges of the anterior sheath of the contralateral rectus abdominis to expose the rectus abdominus, the inner side is close to the linea alba, the outer side is close to the syndesmosis, and the anterior sheath is kept on the rectus abdominis."

After incision of the myocutaneous flap, Carvey slowly separated and preserved the upper vascular pedicle and navel.

This is the key to the whole operation, no accidents can happen, otherwise the second type of pedicled rotation surgery will be forcibly changed to the first type of free transplantation, and the risk will be much higher.

Generally, at this time, modern surgery will choose to use Doppler color ultrasound probes for blood vessel positioning, so as to prevent doctors from missing blood vessels and causing mistakes in the separation of myocutaneous flaps.But Carvey can only rely on solid anatomical knowledge to explore step by step, just like looking for the only mine in a large wilderness

Then cut the anterior sheath of the rectus abdominis transversely above the pubic bone, separate the muscles, and find out the deep subabdominal blood vessels in the deep surface.sew, cut,

Halfway through, Cedieu was switched to Carvey's left side for a second operation: "The radical mastectomy 2 years ago removed Laura's entire left breast and pectoralis major muscle, leaving a The oblique surgical incision scar of nearly 20cm is now being re-cut by Director Cedieu to open up the subcutaneous tunnel."

"Subcutaneous tunnel?"

Some medical students have not yet understood the important intermediate remission in the operation, and they did not understand why they did it for a while.

"How can such a large muscle flap be transferred to the left chest without going under the skin? Could it be that the muscles are turned outside the skin?"

"It was so"

Cedieu, who was silent for a long time, finally took the right to speak from Carvey, picked up a scalpel, and cut the skin of Laura's left chest along the scar, and said at the same time: "The patient's subcutaneous tissue is thin, and the scar adhesion is obvious. However, the volume of the contralateral ruthenium is larger, so Dr. Carvey and I unanimously decided to choose the abdomen with thicker subcutaneous tissue as the autologous material.

After the lower abdominal musculocutaneous flap is successfully dissociated, I will open the subcutaneous tunnel between the chest and abdomen, and we can let the musculocutaneous flap come here through the subcutaneous tunnel.At that time, after subsequent trimming of the musculocutaneous flap to meet the size and shape of the opposite side, and then suturing, Laura can be replaced with an attractive new breast. "【6】

(End of this chapter)