Nineteenth Century Medical Guide

Chapter 395 391. Reinvention

With the current system of surgical theaters in Vienna, it is inevitable that many non-professionals will come in to join in the fun. Some are for watching their sons perform, such as Chrissy; some are for business, such as Laszlo and his son and Jenny; and some are purely for socializing, just like the aristocrats in Paris.

This is the case for the siblings Elena and Morazo. The former took the initiative to buy tickets to participate, while the latter was dragged here by his wife.

"You were lying on the operating table like this before." Mariana was very interested in Morasso's previous surgery, and she was not disgusted by the smell of alcohol mixed with blood. "It's quite interesting, but you can see it from too far away. I’m not sure. I heard that Sister Elena was sitting in a VIP seat. Can you see the surgery clearly from that place?”

"It's true that I'm sitting in a VIP seat, but it's useless. You can't see clearly from that distance. If you're unlucky, you might even get blood sprayed on your face."

Elena said: "I think back to when our Beget was about to graduate and he stayed on the operating table like the assistants. The operation was a mess. The anesthesia was not good, the operation was not good, and Morasso woke up halfway. Even the good intestines were broken."

Mariana didn't understand: "I heard that Dr. Kawei was also the chief surgeon."

"Yeah, it's Kavi."

Just changing the chronological order slightly would make it appear that something went wrong while Kawei was in charge. But it cannot be said that Elena was wrong in what she said. It can only be said that she did not realize that there was something wrong with what she said and did not clarify it immediately.

Morasso was not used to his sister: "Don't listen to her nonsense. Professor Ignatz was the one who did the surgery in the beginning, and Kawei only came forward to wipe his ass after something went wrong during the operation."

"I don't care, the key is your satisfaction."

Morasso felt uncomfortable when he thought about the cause of this incident. After all, he had suffered a lot from the French and did not like going to Paris: "If you ask me, I think there is no need to go to Paris or stay in a large manor in Vienna. Isn’t it okay? If you feel it’s too leisurely, you can find something else to do. You can go hunting, camping, or going to the mountains to escape the heat in the summer. Why go to Paris?”

Elena only had her husband and son in her heart. When she heard this, she quickly picked up the magnifying monocle and waved to the door, forgetting everything else.

"Oh, I see."

"Beget?!"

"Oh, poor Morasso."

Mariana felt uncomfortable listening, but she didn't want to quarrel with him, so she had to lower her voice and said: "Isn't it right for me to accompany my sister to Paris for such a big world event? Besides, my sister has told me about this before. She wanted me to go with her, and you were there."

"What's wrong with you?" Mariana asked with concern, "Are you feeling uncomfortable?"

"Why? I'm just taking care of a child. Can't we just find a servant for her?"

Elena summed up what she said, and then teased her brother: "Think about it, Morasso was still a major general at that time, and after the Austro-Prussian War, he is now a lieutenant general. By the way, you two have been married for so long. Yes, have you?"

Morazo got rid of his sister and finally had some time to relax.

"No, it's just that as soon as I come here, I will think of the past, and the surgical area will secretly ache."

He and Kawei are good friends, because the operation and the Austro-Prussian War have become life and death friends, but they still dislike this place very much.

Elena was still dissatisfied with Ignatz's attitude and Kawei's performance at that time, but after so long, Kawei was no longer the ordinary person with no status before. Moreover, his son also learned a lot with his help, so there is no need to dwell on this matter anymore.

"You mean children?" Mariana shook her head, "Not yet."

"It's okay, this little pain is nothing."

"By the way, what do you think about the servant issue we talked about before?" Mariana suddenly asked while she was still introducing the surgery, "Should you apply for it from the palace, or hire it yourself? There is also the security issue, you Do you think the Swiss mercenaries provided by those people are really good?”

"I told you about this, I am the sister of Queen Elizabeth."

"Okay, okay, you have the final say." Morasso's persuasion was fruitless. He had no choice but to compromise, "You should bring more of the maid, so as not to look petty. By the way, don't bring that Nora." , she can just stay in the manor and take care of the children."

The surgery, postoperative ulceration, and the final debridement that was so painful that he doubted his life, made him spend nearly two months of agonizing days, and he still vividly remembers it. Especially afterward, someone took a photo of Kawei suturing his intestines, and then handed it to him, which gave him an indescribable feeling.

Morasso was sitting next to him and his head was swelling as he listened. Finally, the assistant at the door called Berget's name and quickly changed the subject: "Look, sister, your son is finally out."

Morasso looked embarrassed, knowing that he shouldn't say anything more about this matter, but he still couldn't help asking: "You hired two maids for that lame cat before. Are you going to do it for this maid now?" Looking for another maid for your child?”

"What a maid, she is my good friend! Now she is still half a guard! You don't really think I like Swiss mercenaries, do you? Do you want those men to hang around me all the time?"

"Okay, okay, I don't care about the servants or anything like that."

Mariana had already made her own plans: "My sister has always been particularly fond of Hungarian beauties, and she is surrounded by Hungarian beauties. I think nationality is not that important, as long as I can cater to my sister's preferences and speak Hungarian."

"Aren't they still Hungarian? Besides the Austrian royal family and nobles and Hungarians, who would learn Hungarian?"

"I know"

At this time, Father Schmidt, who was sitting behind Mariana, suddenly spoke: "If the countess doesn't mind, I have a suitable candidate here."

Mariana turned around and asked, "Oh? Can the priest still help me with this?"

"There were a group of nuns admitted to the church before, and one of them came from Hungary." Father Schmidt looked attentively at the man in the center of the operating theater, Kawei, who had helped him remove his mutated appendix, and said slowly: "She She is diligent and responsible, but she has always wanted to see the outside world. I know her heart does not belong to the church. If the countess is interested, she might as well take her in as a servant."

Mariana nodded repeatedly: "Okay, come out and meet me when you have time."

Morasso felt the tight feeling after getting married. He had to discuss everything, compromise everywhere, and he couldn't get his own way. He felt a little bit about the failure of Ignatz's marriage, but he and Mariana were far from that point, and he had no interest in other women.

Think about it after you calm down. These daily conflicts are harmless and let her handle them.

The chat among the aristocrats and wealthy businessmen on the stage was still going on, and after nearly 40 minutes of discussions, questions, and presentations about Kavi's surgery, Alphonse was put to sleep under anesthesia.

After more than 10 minutes, Kawei and his assistants stood on the operating table.

The hanging board hanging in the center of the field has been replaced with a flap selection chart, and Kawei used ink to draw the flap incision design line on Alphonse's belly on the operating table. 【1】

This flap is a paraumbilical flap with the inferior epigastric artery as the axis artery. It was first reported and studied by Taylor in 1974. The first person to apply it to vaginal stem reconstruction was Professor Lin Zihao from the Plastic Surgery Department of Shanghai Changzheng Hospital, who completed and reported it in 1989.

The main advantages, and the reasons why Kavi chose this place, are three.

First, the anatomy of the blood vessels supplying the flap is constant, which is very important for early surgery without other auxiliary equipment. At the same time, the blood supply range is also wide, the vascular pedicle is longer than other flaps, and the reconstruction efficiency is generally higher than other surgical methods.

Second, the flap area is large enough, the selection is flexible, and it is not restricted by the skin conditions of the vagina and lower abdomen, especially for patients like Alphonse who have suffered trauma to the vagina and have skin scars.

Third, the donor site is stable and close enough to the costal cartilage, so a large wound can solve all problems.

"We will make a midline incision on the edge of the skin flap and below the umbilicus along the designed line." Kawei took the scalpel and performed the incision smoothly. "This position is about 3cm below the umbilicus, and 2cm away from the midline is the paraumbilical flap. Starting point: Angle obliquely to the lower corner of the shoulder blade.

Among them, flap A, 11*3.5cm, is mainly used for urethral reconstruction. Flap B, 10*10cm, is mainly used to reconstruct the vaginal stem. This triangular flap C is used to connect the pedicle flap. The distance between the vertex of the triangle and flap B is 4.5-5cm. "

Kawei's operation was very clean. After quickly incising the skin and subcutaneous tissue, he performed subcutaneous dissection on the superficial surface of the anterior rectus abdominis sheath to reveal the anterior sheath. Then make an incision at the midline of the anterior sheath, pull the lateral edge of the anterior sheath laterally, and then turn the rectus abdominis muscle toward the midline of the abdomen to see the subgastric arteriovenous and vascular bundles.

"Please be sure to stop bleeding when lifting the skin flap, and be careful when dissecting." Kawei continued to separate the subcutaneous tissue and said, "Our patient may only have this piece of skin flap. Once the blood vessel is damaged, although it can be regenerated Yes, but I don’t think anyone wants to spend more time on this.

Did you see it? "

Hermann, Damirgaon and Berget all nodded: "It's the perforator blood vessels that enter the skin flap."

"how to choose?"

"Choose the two largest perforators as the flap supplying vessels, such as this one"

Kawei looked along Hermann's hemostat: "This is the paraumbilical cutaneous artery that I have always emphasized during the preoperative preparation meeting and anatomy training. It is the largest blood vessel among these perforators and must be included in the supply of the skin flap. "In blood vessels."[2]

The three of them nodded again, basically understanding the operating procedures of this step.

"Leave two of them and ligate the other blood vessels."

Kawei handed over the blood vessel treatment to Herman, and he continued to incise the anterior sheath along the perforator vessels in a fusiform manner, continued to extend the incision downward, and then connected it to the midline incision below the umbilicus, and then dissected the blood vessels at the rectus abdominis by himself: " When dealing with intramuscular blood vessels, some muscle cuffs can be retained in order to ensure separation without damaging the blood vessels.

We need to continue to separate downward until the skin flap can be transferred to the original base of the vaginal stem without tension, forming a paraumbilical island-shaped skin flap with the inferior epigastric blood vessels as the pedicle and a small anterior sheath and muscle cuff. "【3】

After the skin flap was removed, a second round of applause erupted in the venue.

Strictly speaking, I don’t know which round this is, but reporters like Varela are willing to count it to express their somewhat restrained appreciation. At the same time, he also wrote down his doubts in his casual notes, how to process a skin flap to become a tubular penis.

However, unlike the previous unfounded doubts, this time he was really confused and firmly believed that Kawei would be able to find a solution to this problem that convinced everyone.

Kawei divided the four people into two groups. In one group, he and Beget dealt with the urethra formation together. In the other group, Herman and Damirgang worked together to incise the skin along the upper edge of the flap and remove the costal cartilage.

It is not difficult to remove the costal cartilage. The two practiced quite a lot on cadavers and were very skilled in the operation from positioning to incision to removal. During the urethroplasty, Kawei only supervised and did not start: "Put the long skin flap A just now with the skin facing inward. Everyone must pay attention to the fact that the skin is facing inward and the wound surface is facing outward, close to the catheter roll. into a tube shape."[4]

"Everyone, let's treat the abdominal skin as the lining of the urethra and do the suturing after urethroplasty first." Seeing that Berget's alignment was pretty good, Kawei made some adjustments and then took the silk thread. "Wait for the skin flap. After A is sutured and the costal cartilage is almost harvested, we will process flap B.”

After removing the costal cartilage from the side waist, there is no need to suture now. The wound is opened and flap B is processed directly by Hermann and Damirgaon.

Flap B is different from A. The skin surface faces outward and the wound surface faces inward to fit with the wound surface of flap A, surrounding the newly processed formed urethra to form a vaginal stem. 【5】

"So that's it!"

"The level of thinking is not on the same level as ours."

"It can still be like this. Hey, can my previous surgery also work?"

Every time the picture on the hanging board changes, it can trigger an exclamation in the audience. Many doctors feel that their minds are going through a brainstorm, and new inspirations will flash through them from time to time. Then I started chatting with my colleagues about the subtleties of surgical design, as well as the difficulties and difficulties that may arise.

Obviously, they found that the entire operation, from the removal of the skin flap to the final roll up to form the vaginal stem, was very difficult. It can be seen from the precise numerical calculation that Kawei made sufficient preparations for this operation, taking into account the positions that need to be extended or cut when the reorganized tissue is sutured.

Roll out two layers of skin flaps on the urinary catheter, and then put in the costal cartilage for support, and then we have the prototype of reconstructing the vaginal stem: "With a little trimming and suturing, the completed vaginal stem can be perfectly grafted to On the stump where Alphonse used to be."

(End of this chapter)