Nineteenth Century Medical Guide

Chapter 394 390. Look more grand

Due to a serious lag in development, domestic surgical technology lagged far behind foreign countries before entering the 21st century. It was not until recent years, with the improvement of national strength, that there was a significant change.

But even on such a backward basis, due to differences in medical systems, China often achieves breakthroughs in certain special surgical fields. The most typical of these is the replantation of severed limbs, and today’s topic, the replantation of sinews.

In fact, the penis can also be regarded as a special classification of limbs, and the loss of the penis is actually the loss of a limb.

For surgeons, repairing broken limbs and reconstructing missing parts is a very labor-intensive job, and the fees should not be too high. Because defects are often caused by burns, explosion injuries, cuts and animal bites, followed by tumors, and the most common causes of vaginal tumors are long-term uncleanness and infection, which are only encountered by the poor.

When medical care is aligned with capital, these patients will have to give up treatment.

China does not fall into this category, so a large number of plastic surgery and microsurgery experts have emerged who are doing their best to save patients. Compared with Academician Chen Zhongwei, the founder of hand surgery and replantation surgery, who shocked the world with his replantation of a completely amputated right hand, the achievements of Chinese people in penis reconstruction are less dazzling and rarely known. 【1】

Kawei often chatted with plastic surgeons in the past and knew many plastic surgery methods. I learned about penis reconstruction from others while dealing with a severe trauma. At that time, the patient's vaginal stem was cut off, resulting in severe vaginal tearing, and the rectum and urethra were severely damaged by sharp instruments. Thanks to multiple surgeries including emergency surgery, urology, general surgery and plastic surgery, I slowly returned to normal life.

But he only heard about it from his colleagues and was not actually involved in the operation. Regarding the flap selection, I only know that I chose a free forearm flap studied in China, and I don’t know any other details.

The main reason is that he did not continue to ask further. After all, he did not know that after his death, he would be reborn in Europe in the 19th century, and he would shoulder the heavy responsibility of accelerating the development of surgery.

Without detailed description, everything needs to be slowly explored and practiced. Just by listening and looking at the diagram, you will find that the principles are easy to understand, but when you actually practice it on stage, you will realize that various problems will arise in the process. Reconstructive surgery is very delicate, and whether it can be successful can only rely on practicing, thinking, and practicing again to accumulate proficiency.

"Put the meaning aside. Kawei asked how to deal with it, not the meaning."

Alphonse did not answer, silently agreeing.

"Where can I have the mood to worry about beauty?" Bill Rotter is a staunch pragmatist. "As long as it works."

Alphonse didn't believe it: "Why is it only 8cm?"

The crowd's agreement did not affect Kawei's next question: "This kind of treatment can indeed solve the penis body, and the length and diameter can be selected by yourself. But what about the urethra? How should the urethra be treated?"

Being disturbed by him like this, Kawei's problem still existed, but he was afraid that others would lose concentration, so he simply repeated: "What will you do with this broken penis?"

Kawei continued: "It is indeed 8cm. Several doctors and I have measured the length of the stump and the damaged part."

"You should know that Alphonse is a close friend of mine. From the moment he was injured, and seeing his earnest desire to regain his penis, I knew I had to undergo this surgery."

"Isn't the incision very consistent? Why?"

"I think it can be completed in two phases." Bill Rotter also joined the discussion. "As the dean said, after completing the reconstruction of the vaginal stem, bladder puncture will be performed to drain the urine. After the vaginal stem and the body are completely After it’s connected, do the urethroplasty.”

Kawei did not directly talk about the contents of the operation at the beginning, but asked several colleagues at the scene: "If it were you, what would you do? How can you reproduce his penis that is 8cm in resting state?"

"Dean Waterman always comes up with some good ideas."

"Then it's possible that there's a part missing in the middle."

"Okay, okay!" Kawei interrupted him directly, "I'll give you a longer root after the operation starts, okay?"

"What a good idea."

"No, no!" Mosier shook his head and rejected the suggestion. "The urethra will be narrow after being formed in this way, and it will also damage the penis itself, which is very unsightly."

Waterman is more willing to discuss technical aspects: "I think we can use the abdominal skin to find an axial vascular pedicle flap similar to the vaginal stem. You can use the pedicle transfer you have used before to complete the reconstruction."

"I choose to give up." Billroth spoke directly without any hesitation. "The operation is very difficult and the success rate is so low. Just to be able to urinate while standing, it is really unnecessary. I choose to give up directly and comfort the patient." Reality."

"Did Mr. Billroth forget that Alphonse was not married and had children?" Massimov said bluntly, "I agree that the operation is very difficult, but for a man like him, the significance of the operation is not limited to the urinating position."

The audience burst into laughter.

"Urethra." This is also a problem that Waterman has been unable to solve. "To be honest, I have been thinking about reconstruction methods since I knew that I was going to have reconstruction surgery. The urethra is indeed a difficult point. I have also done experiments on cadavers and tried several times. All failed."

“If you don’t consider aesthetics, then the remodeling itself is meaningless. It’s better not to do it.”

"So I just said, doing this surgery will do more harm than good, so why bother."

"If you don't do it? Will surgery continue to develop?"

Mosier has stayed in Vienna for a long time, and now he likes to express his opinions, even tit-for-tat with Bill Rotter and others: "I remember that Dr. Bill Rotter used to be a radical and has been studying abdominal surgery. Why is he so conservative now? ”

"Abdominal surgery is a matter of life and death, can it be the same?"

Seeing the two of them acting like this, Waterman quickly tried to smooth things over: "A reasonable discussion is a discussion, not a quarrel between you. Forget it, you two should stop arguing. You can't come up with a reason. Let Kawei talk. "

Kawei’s question is also to find out if there are any different ideas in such an era full of art and innovation, and see if it will lead to new ideas. The outcome didn't seem good, with many siding with Bill Rotter, but not explicitly.

"First of all, I agree with Dr. Billroth's idea. The operation is very difficult, and the probability of failure is close to half." Carvey said, "So from the beginning, what I thought about was not reconstruction, but prolongation."

"Extended? How to extend?"

"Do you also use skin flaps?"

"This is unrealistic. They all use skin flaps, so what's the difference between it and reconstruction? Besides, what to do with the urethra after extension? Is the urethra also extended?" It can be seen from a series of questioning conversations that the surgery at that time was not Various plastic surgery procedures are not available. For example, the "VY" plastic surgery often used in vaginal lengthening surgery, as well as "Z" and "M" are typical methods that use skin looseness to change the direction of tissue traction and increase the length of the tissue.

“Extension is actually not difficult.”【2】

Kawi asked his assistant to hang up the first picture: "You can make a V-shaped incision at the root, then subtly separate the adjacent subcutaneous tissue, push up the V-shaped tissue flap, and pull and sew the tips of the V-shaped incision to form a Y Shape."[3]

"This"

There was silence in the theater, then whispers, and gradually these whispers became louder and louder, turning into public speeches.

"In this case, I should be able to grow 3cm, which is pretty good."

"Yes, why not choose this surgery? It can at least solve the problem of standing urination."

Kawei sighed, rinsed the soap in his hand, and explained: "Unfortunately, Mr. Alphonse is obese, and the length of the remaining vaginal penis visible to the naked eye is too short, so it is not suitable for extension. Because after the extension, the overall vaginal penis will only be a little short." To 5cm, and the part that can really be used to lift is only 1-2cm. ”

"It's really a bit short."

"But it's much more convenient and safer than recreating it." Billroth said, "Isn't the most important thing is standing up to urinate? Can you still ask it to be urinated?"

"In fact, lengthening surgery still requires a certain foundation of penis stump, otherwise the standing urination behavior will not be completed well."

Kawei did not have any suitable examples, but what he said was the standard for modern urology plastic surgery to choose reconstruction and lengthening. The stump length of 3cm is the dividing line. If it is shorter, it will be reshaped. If it is longer, it will be lengthened and the urinary and x-ray functions can be guaranteed.

Even though modern reconstruction technology has matured, plastic surgery still requires a 3cm stump, indicating that lengthening surgery cannot guarantee normal postoperative function. Moreover, Alphonse also has very high requirements for postoperative function and hopes to achieve it in one step, so reconstruction is definitely better.

After Kawei explained the disadvantages and requirements of the lengthening technique, he began to formally talk about his various ideas for reconstruction.

He first started with the earliest abdominal skin tube transfer method. He only gave a brief introduction and also provided ideas for reconstruction: "At the beginning, I thought that ordinary skin flaps could not meet the requirements for reconstruction, because not only must it be trimmed to form axial blood vessels, and at the same time complete the reconstruction of the urethra.

To put it bluntly, the penis is a cast, and the urethra is the hollow part inside. To complete the tube structure, in addition to rolling it up with a skin flap, you can also do this. "

Speaking of which, the huge lengthening surgery pictures just now were removed and replaced with the following two. 【4】

"The inspiration came from the vascular reconstruction done on the front line of the Austro-Prussian War. In order to thicken the bridged blood vessels, I cut the two blood vessels and rejoined them for use."

Kawei continued: "At that time, I thought of preparing two leather tubes, one large and one small, from the abdomen, then transfer them to the external opening of the urethra, and sew them with the newly made wound. After healing, the blood supply was confirmed, and 6-8 days after the operation About a week later, a urethroplasty is performed after wrapping with a urinary catheter.”[5]

The operation is very difficult. According to current technology, it can be completed in at least three or four phases. Each phase is separated by two months, which seriously affects Kawei's schedule. But in the eyes of the audience, this is definitely an innovation worthy of being recorded in history.

"It's actually possible to think of this step."

"I have said before that the strongest thing about Dr. Kawei is not his hands, but his brain that goes beyond the rules of surgery, his thoughts!"

"It's so powerful! These pictures alone are enough to earn back the ticket price!"

Kawei also thinks this treatment method is very beautiful, but it is a pity that the human body is not an instrument. When transplanting and obtaining the skin tube, it requires a very long waiting time and cannot be done overnight.

So he then thought of lower abdominal flaps and arm flaps. Unfortunately, the area of ​​the lower abdominal flaps was limited and scrotal skin was needed to complete the urethroplasty. Alphonse was shot, one side of his penis was damaged, and a lot of skin on his scrotum was cut off, making him unable to use it. 【6】

Removing the forearm flap would only be more difficult. His career as a chef was his life. His left hand was so badly injured that only his right hand could be removed, which was obviously impossible. 【7】

So in the end, Kawei chose the paraumbilical flap, which has a relatively wider blood supply range.

When everyone praises Kawei's idea of ​​double abdominal skin tubes, there are always various doubts. This time it was not Billroth, but Mosier, who had been working in urology: "Dr. Carvey, have you ever thought about whether such a leather tube is too soft after being sutured? It cannot obtain sufficient x function?"

Kawei nodded: "Dr. Mosier is very right. A penis formed solely by skin flaps and tubes does not have any sexual function."

"How to solve it?" Mosier said with a nonchalant expression on his face, "I know you must have thought of a solution!"

"I thought about it for a week and wanted to find a real substitute to increase its hardness." Kawei said. "Unfortunately, this is not realistic. Foreign objects entering the human body often produce very serious inflammation and ruin the operation. I I had to look for a suitable material from the body, and finally I thought of cartilage, costal cartilage.

This is also an important reason why I chose the current flap area. The area where the costal cartilage is located is very close to the middle of the abdomen. I had been thinking before whether it would be better to choose a paraumbilical flap. "

The picture was changed again, this time showing the flap design part of the finalized surgical plan. 【8】

"The left side is the shape of the blood vessels that I obtained after repeated dissections, and the right side is the shape and area of ​​the skin flap that was cut after studying the length of the vaginal stem reconstruction."

Kawei was about to continue explaining, but Alphonse, who was sitting aside and looking at the operation diagrams with interest, suddenly interrupted: "Is this a reconstructed skin material?"

"Correct."

"Right? Isn't that right?"

Alphonse didn't know what was going on and smiled a little shyly: "Why is it only 10cm? This obviously doesn't fit my figure. Can you see if you can make it 20cm? If it doesn't work, I mean if I don't have enough skin on my abdomen. , then make it 15cm to look more generous.”

Sure enough, when encountering the specifications of this thing, everyone seems to get excited. Amidst the laughter of everyone, Kawei comforted him again: "I'll try my best, but it has little to do with me. It mainly depends on how well your blood vessels and skin can do it."

"Oh, that's good."

(End of this chapter)