Nineteenth Century Medical Guide

Chapter 396 392. Bottleneck

In the eyes of others, this penis reconstruction machine may be a surgical performance, a new development of plastic surgery techniques, and another innovative operation that demonstrates Kawei's comprehensive capabilities. But for Berget, the nominal third assistant, this is a big test of his hard work during this period.

Returning to Vienna again and returning to the operating table where Kawei was operating, Elena grabbed three theater tickets and dragged her niece and reluctant husband to watch his performance.

Before the operation, they did not have high expectations

Taking into account the middle-aged couple sitting in the stands, Kawi also gave Begut a chance to perform. There must be some contribution from his parents, but more of it is the result of the hard work of this outstanding graduate of the medical school for so long.

He does deserve these opportunities.

From the initial skin incision and separation, to the removal of free vascular pedicles and skin flaps, to urethroplasty and vaginal stem anastomosis, Kawei's requirements are like the task chain of an RPG game, with increasing difficulty. Only by doing it well Only one will lead to the next one, and if something goes wrong in the middle, it will be interrupted.

Fortunately, Berget's skills improved rapidly and he practiced repeatedly before the operation. Several important tissue separations and sutures were left in his hands. The operation was generally quite satisfactory, and only a small error occurred in the final anastomosis stage.

His growth was obvious to all, won applause, and awakened Herman's competitive spirit.

Originally, there was a competitive relationship between the three of them, and the gap was not small. But once the speed of progress changes, the gap will be quickly narrowed, and the competition between the three assistant positions will become increasingly fierce.

Hermann, who has experienced hundreds of surgeries, has become quite skilled in his technique. Even he himself feels that his skills are definitely among the best among the younger generation, which he would never have dared to think about before.

Kawei returned to the left abdominal wound, while Hermann went to the right thigh: "The skin flap includes the dermis layer, and the abdominal defect area needs another skin graft to heal. Hermann will cut a medium-thick skin graft on the outer side of Alphonse's right thigh. Covering, the leg wound will slowly begin to recover due to the preserved dermal layer.”

Heman was doing the operation in his hands, but what he was thinking about was his future.

中厚皮片包括表皮和部分真皮，相当于全层皮肤厚度的1/3-3/4。按其厚度又再次分为薄、厚两种。薄中厚皮片的厚度在成人为0.15-0.25mm，厚中厚皮片的厚度为0.625～0.75mm。

There is no skin remover, and Kawei’s requirements are not high, as long as the thickness does not exceed 1mm. The previous fire in Paris gave Herman a lot of experience in skin removal. After determining the size and shape of the skin slices, his operation was once again separated from his attention.

It is necessary to suture the distal wound edge of the urethral flap and the distal wound edge of the vaginal stem body flap relative to each other, and then form a new external urethral orifice and vaginal stem opening. During the whole process, the position of the support needs to be stabilized, and a part needs to be left outside to prepare for the final fixation.

Of course, he also knew that once he was raised to a level compared with all other doctors, he would be in the middle of the pack. Ignatz, Sedieu, Mosier, and Massimov are all much more technically advanced than him, not to mention that Kavi is still around. It's too early to be proud.

The operation is about to be completed. How to get rid of the pursuit of others and how to determine his own future are the major issues that he is more concerned about.

What we need to do now is to break through the bottleneck. How did Hills, who also realized that he was in the bottleneck area, do it?

He was confused. His goal was still out of reach, but behind him were more and more pursuers pressing closer and closer. Just as Morasso understood Ignatz's marriage, he also understood Hills' original state of mind.

Change hospital? Accepting a higher position and more control at another hospital?

Damirgaon and Herman dealt with the external urethral opening.

"Oh"

"Next, you two will be responsible for suturing the rest of the penis, Herman."

Skin grafts are different from skin flaps in that there is no need to select the supplying vascular pedicle, and the difficulty of cutting is much lower.

It is not uncommon for assistants to become distracted during surgical operations, especially when the operation is simple, and this will happen if their thoughts cannot keep up with the surgeon's. But Herman, as a first aid, should not be distracted and is not allowed to be distracted. Closing the penis is related to the appearance and urethra. Herman was distracted this time and asked Kawei to give the needle to Damirgang, without giving him a chance to continue the operation.

Just when he was distracted for a moment, Kawei's needle holder knocked over. Damirgang quickly reminded in a low voice: "It's time to close the penis."

First, make a circular incision in the skin and subcutaneous tissue 0.5cm away from the original external orifice of the urethra, make a slight subcutaneous separation to create a proximal wound edge, and then join the new vaginal stem body with another combined force.

He slowly took a few deep breaths, loosened the tight muscles on his back, blinked and saw clearly the operation before him, and then devoted his attention to it again: "I'm sorry."

Since the blood supply of the reconstructed vaginal stem is supported by the inferior epigastric artery, the most critical things during jointing are the urethra and the support. Kavi himself performed the anastomosis of the reconstructed urethra, and then Damirgan performed the support sutures. The proximal end of the support needs to be sutured to the stump of the corpus cavernosum and the prepubic fascia.

Herman nodded.

This is probably the so-called bottleneck.

Kavi and Berget were responsible for handling the stumps of the vaginal stems.

Is it really the opportunity to be the surgeon that I lack?

Herman is far less impulsive than Hills, and Kawi is not as domineering as Ignatz. Since the Austro-Prussian War, Carvey had been giving him opportunities to be the surgeon, and this opportunity reached its peak during the trip to Paris.

Especially in the second half of the month, many repeated surgeries were basically performed by their three assistants. Hermann has more clinical and surgical experience, so he has been the surgeon several times even for major surgeries such as appendicitis and cesarean section.

But the chief surgeon didn't bring much to him.

After this period of time, I slowly summarized it. It only made the originally vague anatomical layered structure clearer, and I became more familiar with the surgical steps and rhythm. The improvement was not huge.

What is it that I lack?

Herman couldn't help but re-examine himself.

It's not easy to keep up with Carvey's surgeries, but he's really devoted to them. He compiled the diagnostic methods of all diseases so far and also knew the surgical procedures corresponding to these diseases. But just as others think, he mostly just followed Kavi's instructions, lifeless like an old man born in the 18th century.

He also wanted to have a mind like Kawei's, he also wanted to have the ability to make decisions independently, and he also wanted to turn the new spells that had appeared in his mind into reality.

Do you really need enough innovation ability to break through bottlenecks?

How can we have the ability to innovate? Do you need to have enough dominance like Hills to succeed?

No. Not necessarily

As Carvey has always emphasized, surgical operating principles and technical level are the key. At least there must be strong enough surgical capabilities to be able to carry various innovative techniques and the uncertainties they bring.

What is strong?

Herman didn't know the answer, but he knew that his level was definitely not strong. And the so-called strength must not only include technology, but also something else.

Suddenly his head tightened, and the muscles in his right hand contracted violently. The scalpel stopped exactly on the skin graft design line. If he continued to exert downward pressure, it would exceed the established area. Damirgaon and Berget are still suturing the skin of the penis body, and every step must be extremely careful to avoid any skin tension. Otherwise, it would be a small matter if the reconstructed penis is crooked, but it would be a big deal if the internal urethra is torsion, leading to further stenosis.

And Kawei also introduced the difficulties that need to be paid attention to during the operation in front of the audience, and may have to answer many questions afterwards.

Herman let out a long sigh and turned his attention to actual operations again.

He successfully cut off the skin and transferred it to the abdominal wound: "Shanwang, Jack, bring over oil-soaked gauze and cotton pads."

"coming!"

The donor site wound on the thigh does not require suturing, and there is no way to suture it. Just cover it with a layer of oil-soaked gauze, then cover it with ordinary sterilized gauze and cotton pads, and secure it with a pressure bandage with gauze rope. As long as the wound surface is kept clean enough, the remaining dermal layer will soon grow new skin.

The addition of Shan Wang and Jack just allowed Herman to give up the operating position of suturing abdominal wounds with skin grafts.

After Heman trimmed the skin, he gave the two simple suture instructions: "Fix the edges with interrupted sutures, and remember to use a needle holder to tie the knot, as Kawei said before. After tying the knot, don't cut the thread and give it to me. Do it for fixation, so that you can see whether the stitching is correct, and then cut it after all the stitching is completed.”

"it is good."

Herman was afraid that he would have random thoughts while he was sewing, so he chose to work as a temporary supervisor. Who would have thought that it would be easier to get distracted with empty hands. Seeing that the two of them had a good start, they thought of Hills again.

Hills' departure was a complete accident, or a coincidence.

If Kawei had already shown all his strength at that time, Hills would put aside his pretentiousness of more than ten years of clinical experience and be willing to be a second assistant, and he would not be given such a comfortable position on the other end. If there were any one less step in the three steps, this situation would not be the case now.

Compared with the technical gap between Hills and Ignatz, the distance between himself and Kawei is much larger. Since your own level does not meet Kawei's standards, there is no need to learn from Hills.

Unlike him, I still have room for further improvement in my skills, and Kawei seems to have a lot to learn. For example, the decision-making ability in times of crisis, the rhythm of first aid, and the more complex anatomy knowledge of the trunk.

I'm far from the point where I can leave Kawi, and running away now is all over!

Herman mechanically took the sutures handed over by the two men. Suddenly there was a feeling of metal tapping on the back of his hand, and Kawei's voice was heard in his ears: "This knot is tied close, please keep it 3-5mm."

"Ok."

"Herman."

"Ah."

"Let me watch here." Kawei knew that he was thinking about something and took the thread from his hand, "Go and help them two. If the sutures continue like this, the trajectory of Mr. Alphonse's urine will definitely be distorted. ”

"it is good."

After spending this time together, Kawei understood Herman very well, and the only thing that could distract him was surgery. Considering Berget's outstanding performance, perhaps only ordinary civilians like Damirgaon would not have a sense of urgency.

There is no big problem with the suturing of Damirgang and Berget. Originally, the penis stem would deflect during its growth, which is a normal phenomenon. The sentence just now was completely to give Heman some confidence, and it was also a "warning".

Herman also understood Kawei’s intentions very well.

It is also the leader who does the fixing. In the case of Jack and Shanwang, it is a supervisor, but in the case of Damirgang and Berget, it is said to be "help", but it is actually the third assistant. This is another warning for him to be distracted. If he does it again, he will have to leave early.

Fortunately, Heman had figured it out and there was no confusion in his eyes.

At 11:23 pm, the operation was completed.

According to Kawei's post-operative evaluation: "Mr. Alphonse will be proud of having the world's first reconstructed penis for the rest of his life, and I sincerely hope that he will not destroy this dilapidated body again."

Due to Alphonse's strong physique, there was only partial redness and swelling in the suture area after the operation, and there was no ulceration. The nearly 50cm suture line showed no signs of collapse. He went to bed less than three days after the operation. Within two weeks, he tried to remove the urinary catheter and try to urinate on his own. One month later, all the wounds were completely healed.

Kawei's operation can only be considered a marginal success at the surgical level. Compared with breast reconstruction using large skin flaps, the penis is obviously more delicate and there are still many areas that need to be improved.

But at the level of public opinion, the call for this surgery to be "exclusively for men" is much louder than that of "exclusively for women."

Kavey's surgery was reported not just in Vienna and Paris, but also in Berlin, Budapest, London and even Moscow. Anyone who knows something about surgery will have a very high opinion of reconstruction. Many people even want to come to Vienna in person to see what the world's first reconstructed penis looks like.

Kawei naturally had no reaction to public opinion.

In the following months, in addition to dealing with laboratory problems, he was more focused on the design of Jenny's electrified operating table.

Unfortunately, the "electric knife" suggested before was still far from the kind of electric knife he remembered. Although electrocoagulation can be achieved in the true sense, the switch can only be placed beside the bed instead of on the handle of the knife, which greatly reduces safety.

It is impossible for Kawei to increase the risk of the operation for the convenience of coagulation. In the end, it was not certain whether the patient could be saved, but he was killed by the uncontrollable electric current.

However, a lot of money has been invested in the design, so he chose to settle for the next best thing: "There is no need to be depressed, the money given by the bank will not be wasted. If you can't use the electric knife, you can use something else, such as installing an electric lamp for this bed, and a A super electric light made of more than a dozen light bulbs.”

"Lamp? That thing is expensive, right?"

Bamboo filament electric lamps that have not been improved by Edison are indeed very expensive. Not only are the materials expensive, but it also costs money to make a vacuum bulb. But Kawei is also fed up with the kerosene lamps in Vienna. In the future, the surgeries will only become more and more complicated, and the shadow will greatly interfere with his operation speed.

Of course, the most important thing is that he is not short of money: "You dare to do it. No matter how the finished product is, the Municipal General Hospital will definitely buy one. If the effect is good, it can be sent to the Paris World Expo for exhibition, and I will be your spokesperson. "

(End of this chapter)