Nineteenth Century Medical Guide

Chapter 451 447. Conservative Treatment
According to the open fracture classification, Devinke's fracture is classified as III-b, while Shelly's is only III-a. From a medical point of view, Devinke's calf injury is indeed more serious than Shelly's upper arm injury.

In terms of healing, Devinke's healing was more difficult than Shelly's because of the length of the wound and the exposed fracture ends. It is still difficult to completely heal the tibial shaft by relying solely on a four-pin unilateral fixation bracket. The follow-up measures must be continuously revised based on the patient's cooperation and recovery status.

Cavi considered several options before the operation. Once the two fractures had healing problems after internal and external fixation, such as infection, gangrene, soft tissue necrosis, thrombosis, etc., new treatment methods would be needed to provide a safety net.

But Devin Ke still exceeded his expectations.

Not only did he drink and smoke after the operation, he also tried to move his right leg in front of his friends to demonstrate the perfection of Kavi's operation and to show off how well he spent his 100,000 francs.

If it were modern times, this wouldn't cause any major problems, as internal and external fixation requires rehabilitation in advance. But this was the 19th century, and it was an open fracture with external fixation. Methylene blue couldn't compare to real antibiotics, and the chance of nail tract infection would only be higher.

Kawi listened to the screams, looked closely at Devinke's swollen calf, and asked, "Does it hurt?"

Devinke: ???

His sweat from the pain had already soaked through his hospital gown, and his wet long hair and thick beard were stuck together, emitting a strange smell.

Devinke no longer cared about the smell. He had lived here for more than a week and was used to everything. He wanted to grab his calf with both hands, but he didn't dare to touch the external fixator directly. He could only use his palm to hold it tightly above his knee, hoping to relieve the severe pain from his calf by compressing the pain.

The idea is good and makes sense, but it has almost no effect and will further block venous return: "Ah! Dr. Kavi!!! It hurts so much!!!"

"Do you really feel pain?"

"Ah? I was screaming so loudly! What are you doing?"

Although Kawi was teasing him, his hands were not idle at all. After carefully checking the swollen skin around the suture line of the wound, he also touched the pulse of the dorsalis pedis artery and then moved his toes vigorously. Moving the toes would definitely pull the tight calf skin above, which would naturally hurt.

"You ask me what I'm doing? What else can I do? I'm helping you clean up your mess after you got infected like this." After saying that, he turned around and found Peon, "Go get a cut package from the theater's disinfection cabinet."

"Open it now? Do you want to tell the operating theater where to send it?"

"No need to go through so much trouble, just cut it here."

"What about ether?"

"Ether is so expensive, let's leave it to those who need it."

Peon took a breath of cold air, feeling that Kavi was very different today than usual. At the same time, he did not understand the meaning of Kavi cutting open the bag, but as a junior doctor, he had to obey orders.

Because of the eye removal that night, he missed Devinke's external fixation surgery. Now is a good opportunity to take a good look at how the fixation is done inside.

Devinke on the bed didn't hear what Kavey and Peon said because his screams were too miserable. He just kept asking him, "Doctor Kavey, what should we do now? Ah! It hurts so much. You, you asked me to move my toes. I can't move them at all now. I really want to cut them off with a knife!"

"Cut it off? That's right, cutting it off is a solution, once and for all!" Kavi followed his train of thought and asked, "So? Have you decided to amputate?"

"what???"

Devinke shook his head repeatedly, but the pain was too severe, and even drinking a whole bottle of YP tincture didn't help. What he said just now was not random, but his true feelings: "If, hiss. I mean if. Ah. If I really had an amputation, then the hundred thousand.?"

Kavi didn't respond at all: "Hasn't the 100,000 already been paid? Amputation doesn't cost that much."

Devinke was fully aware of why some wounded soldiers would say amputation was a relief. At this stage, cutting it off might be the right treatment. "No, that's not what I meant. Ah!!! Be gentle!!!"

Kavi seemed calm and his tone was no different from usual: "How is it? Do you want to amputate?"

Devinke had learned from Kawi's strength that he did not dare to hesitate. He endured the pain and expressed his question in the fastest and clearest words: "If I have my limb amputated now, can I get a refund for the 100,000 francs I paid after the operation?"

There was a clear time and surgical method, and he also added a status to the 100,000 francs to make it clear that it was he who paid the 100,000 francs. He also stated his own requirements, leaving no room for Kavi to avoid the topic.

But Kawi had no intention of avoiding him, he was just teasing him: "No."

"Ah? Can't retreat?" Devinke stared at the nails on his leg, feeling as if his identity had been swapped. "It's just four nails. You, how come you're darker than me?"

"Black? How black? I've always charged this price." Kavi listed the surgical expenses of several princes and nobles. "Except for the Vienna Theater, which charges admission and is almost free of charge, the fees for other surgeries are not low. Marshal Ludwig's surgery cost 10,000 kronor, which is about 50,000 francs. The surgery of former Police Chief Sebasto cost 30,000 francs, and there are..."

“Then why should I pay 100,000???”

"There are so many new instruments. This is made of the best steel in the world! It also has the finest threads to prevent it from slipping. It's the only one of its kind in the world!"

Devinke didn't expect that the things he boasted to his friends would disgust him: "But, but if I have my limbs amputated, won't these be useless?"

"It's your own business if your things are useless! What does it have to do with me?!"

Kavi's face suddenly turned cold: "I told you to have a good rest, quit smoking and drinking, elevate your whole leg, and immobilize for two weeks. Did you do it? You didn't! These few days, while I was away from the hospital, you invited a bunch of people to make this place a mess. You smoke and drink every day, and you even took down the leg-elevating frame, and you still wanted to get out of bed and dance with others."

At this time, Peon came in with the incision package. The door was already crowded with people, some from other wards, and some from the general's wife, Shelly, who was about to be discharged from the hospital two days after the operation. Shelly had internal fixation, and the postoperative infection was actually more serious than Devinke's.

She also thought about going home to rest because the ward was too noisy, but Kavi refused. In the era without qualified antibiotics, complications after fracture surgery would become very serious once they developed, and it was better to stay in the hospital than to go back.

Shelly knew the stakes and trusted Kawi's judgment, so she endured it and didn't go home. After seven or eight days, the incision on the right upper arm had survived the infection and healed almost completely. The only trouble was the weight of the steel plate and nails, and it might take some time to get used to it before removing the internal fixation.

She felt angry and amused at the miserable appearance of Devinke. She wanted to take a look and then leave, to get some fresh air outside the ward, to be quiet. However, gossip can go from boring to interesting only if you have a companion to chat with. If this companion is an old acquaintance, it will be more interesting.

Morisot, standing at the back of the crowd and silently waving his brush, is this companion.

"Ms. Morisot?" Shelley seemed to have seen a savior who could save this boring ward routine. "What a rare guest! Why are you in the hospital?"

Morisot was painting when he heard someone calling him. He glanced around and saw a familiar face coming towards him through the crowd: "Ah, Madame General."

After a moment's hesitation, Morisot realized that he seemed to have missed the opportunity to visit Cheryl here. They were both frequent visitors to the salon, and the other party was a potential sponsor of the painting. This was against the rules of the social circle. If she had never come, it would be fine. There were many reasons to come up with, but it was strange to suddenly appear in the ward.

"I"

"It's okay, it's okay. You painters are all very busy. I understand."

Xie Lisi might have cared about it before, but now that she was about to be discharged from the hospital, and there was a control group to set off her injured arm, she obviously didn't take it to heart: "You were sketching?"

"Um, I guess so." Morisot turned his gaze back to the ward and started to paint again. "I came here specifically to find inspiration for my paintings. I've already painted several. I'll just treat this as practice."

"Paintings. Oh!!!" Shelly suddenly remembered Kavi's surgery tour at the end of last year. "It was the oil painting that was painted in the operating theater! I couldn't get in that time because the number of people arranged was really limited. Didn't you show me the draft later? It was a really good painting! It felt like I was there!"

"Well, thanks for the compliment."

Morisot knew that she had captured the picture well, but it lacked a little spirit. It was a rare opportunity to meet Kavi, and it was a temporary postoperative treatment. There was no better opportunity than now. She needed to concentrate very hard and try to draw everything in the ward on paper.

But in the face of such desire, she still behaved very decently in front of the people in the general's mansion. She did not only care about her own drawing paper and leave the general's wife aside.

Until Peon walked to the door and was about to close the door of the ward.

Whether it is a simple surgical treatment or a general physical examination, any operation in the ward needs to be kept private. Morisot had never been hospitalized before and was not aware of this, so she was caught off guard when she suddenly encountered it. In a panic, she could only shout Kavi's name: "Doctor! Doctor Kavi!!!"

Kavi was angry and had just scolded Devinke. When he saw her, he didn't immediately respond in a good tone: "Huh? I'll tell you later!"

"I want to come in and take a look!" Morisot really didn't want to give up this opportunity.

Postoperative complications, especially those caused by some trivial things that should have been avoided and that could destroy all previous surgical results, are the things that Kavi finds most unbearable.

If he had followed his temper before the time travel, he would never have given a painter like Morisot any chance. Treatment standards are absolute and cannot be violated by anyone. Art cannot save a patient's life.

But it is still the 19th century after all, and the identity, relationships, and environment are all different from those of modern times. Thinking back to the previous tour operation and looking at the general's wife standing next to her, Kavi finally compromised.

Temper is like air shot into a ball, once a hole is opened it will be drained out immediately. Kawi has recovered to his original state, and he began to review the omissions in the whole operation in his mind.

The occurrence of compartment syndrome so long after surgery must be due to the removal of the leg-elevating frame, which caused the obstruction of venous blood return, plus the double effect of nail tract infection. Bacteria and congestion are too compatible. But apart from these, is there something else I haven't done well?

Was the debridement during the operation thorough enough? Was there a misjudgment of the skin tension when suturing the incision?

Should we directly use small incisions to relieve tension after surgery to prevent postoperative infection, rather than trying more aggressive suturing? If we had opened the wound and used simple negative pressure closure drainage at the beginning, would it be better now? If we had made preparations in advance when the skin temperature rose the day before yesterday, maybe it wouldn't have turned out like this now that the skin temperature has dropped.
Kawi sorted out the situation layer by layer, and his tone was much softer, but he still didn't look at Devinke well: "Mr. Devinke, since you let me choose, I will temporarily choose to keep your calf and do conservative treatment first."

It turned out to be a conservative treatment, and Dr. Kavi finally didn't perform surgery!

"Okay, okay, okay!" Devinke was so happy that tears and snot flowed, and even the pain in his calf was relieved a little. "How should I treat it? Let's start quickly, I really can't stand it! It hurts too much!!!"

Peon covered Devinke's legs with a drape from the operating theater, and then placed the incision bag in the middle and opened it. After opening it, there was still a cloth bag inside, but there was an extra pair of pliers. Kavi put on gloves and picked up the pliers to open the cloth bag inside: "Be careful, the cloth bag inside is clean, and your clothes, skin, saliva, and hair cannot touch it!"

The interns and Peon standing beside him all nodded. Kavi had designed this kind of incision bag in the first place for simple surgery in the ward, and they all participated in it.

Kavi used forceps to replace his right hand, opened the small bag, and revealed the surgical instruments inside, including scalpels, hemostats, curved trays, and sutures. In fact, it was not much different from an operating theater: "Mr. Devinke, your calf is swollen due to infection, and the blood supply is weakened and close to necrosis. In order to relieve the symptoms, I am going to cut open your calf now."

"Cut it open???" Devin couldn't understand, let alone accept it. "Didn't you just say conservative treatment?"

Kavi lowered his head to prepare the necessary items, and asked Peon and the interns to come around. He explained, "It's just an incision, not a removal. Compared to the amputation mentioned earlier, it is certainly a conservative treatment."

Devin K:
"Hold him down, don't let him move."

Kavi winked at the two interns, then held Devin's taut calf skin with one hand and cut directly into it with a scalpel in the other.