Nineteenth Century Medical Guide

第95章 92.1+1+1＜1
In the eyes of others, there is no loophole in the operation process, the only flaw is that the patient recovers slowly after the operation.He stayed in Graze Hospital for more than half a month, and some wounds festered during the period, and it took a long time for him to basically heal.

Hills knew that Carvey had relatively high requirements for postoperative care, and thought that he would deal with him the same way he dealt with Dr. Hodge, making a fuss about the patient's recovery.

In Carvey's eyes, however, nineteenth-century surgery was full of loopholes.Excluding the improper operation during the operation, the quality of the postoperative wound is as unpredictable as a lottery.It is too harsh to blame contemporary surgeons for postoperative infection, and it is difficult to show their true strength.

No one thought that Carvey would question the surgical incision.

Incision is the first step in surgery. For doctors, it is actually to find an entrance into the patient's body.

But cutting the skin is a kind of injury, so the choice of incision is very particular.It needs to provide enough vision and heal as quickly as possible after surgery.In plastic surgery, the incision itself deviates from the purpose of plastic surgery, so we must be more cautious in operation.

The horizontal incision on the lower eyelid can indeed be hidden by the pouch fold, which plays a role in lightening it.

However, it is a bit strange to still perform a transverse incision when we know in advance that we will need a second reduction surgery.

It shows that Colrigo's eyelid surgery is said to be "complicated", but in fact it is just a simple stack of small operations, and there is no reasonable integration on the original basis.

Since one longitudinal incision can solve all problems, why make two incisions?
The answer is simple, just didn't expect it.

It wasn't just Corrigo who didn't expect it, nor did so many surgeons around him, and neither did Ignatz.They followed Colrigo's 1+1+1 linear surgery idea, and even thought it was very good. They didn't think about how to change the edema of the postoperative incision at all.

"Because the scar tissue from the transverse incision continues to pull down on the eyelid, Professor Colrigo did the eyelid shortening."

Carvey said: "What if the vertical incision is used directly? The scar of the longitudinal incision itself greatly reduces the risk of lowering the eyelids, and also reduces the number of incisions, and even shortens the distance of the eyelids. Except for a little aesthetic flaw , everything else is an advantage.”

卡维给这台手术做了精简，把原本“1+1+1”模式的复杂手术改成了“1+1”。

The operation incision is reduced, the operation difficulty is reduced, and the operation time and incision exposure time are also reduced.These advantages greatly relieve the wound edema after the operation, the edema is relieved, the chance of postoperative infection will be further reduced, and the survival rate of the patient and the probability of achieving the expected effect of the operation will also increase.

Hills swallowed, really not knowing how to refute.

Because when Carvey just raised this question, he had already realized the shortcomings of the operation. It was indeed that the single longitudinal incision that Carvey said was more in line with the patient's interests, and there was no point of defense.

"With my somewhat meager experience in plastic surgery, I really can't give an answer." Hills shook his head helplessly, "But I will bring your question to Professor Colrigo, if there is a definite answer will tell you."

"Well, Mr. Hills is worrying."

Carvey decided to let it go and let the regular meeting continue, but the surrounding surgical colleagues didn't think so.

His speech just now has changed many people's views on him, and at the same time changed their understanding of eyelid surgery: "Just now Mr. Carvey only said that it was the first question. The question itself is very sharp and deep. It is worthy of our attention. Good understanding. So what's the second question?"

"The second?" Carvey shook his head, "I guess I made a mistake, there is no second question."

"No? How did I hear that?"

"I heard it too."

"Mr. Carvey did use the wording 'first question' when replying to Dr. Hills just now."

Carvey's goal has never been Sears, and now that Sears' confidence has been shattered, it's meaningless to continue asking.But if they calmly give up this opportunity, it will accelerate and aggravate their emotions, so what should be said must be said.

"The second one is not actually a question, it's more like a random guess of mine. It would be very rude to put such unverified things on the table at such an important meeting. When I have time later, I will Will pay a private visit to Graze Hospital and have a chat with Professor Colrigo."

Speaking of this, it can be regarded as a ladder for Hills, so that he can go down the steps as soon as possible.

It's a pity that some people seem to disagree with this approach: "Mr. Carvey proposed such a good improvement plan, which made Professor Corrigo's operation overturned again. I think you can express your idea and let everyone chat together. "

Very simple arch fire, but effective enough.

Soon the venue was filled with various voices: "It is still recommended to speak out, let us open our eyes."

"Yeah, tell me, what are you afraid of?"

"Isn't it because of Dr. Hills' identity that he kept it secret?"

Carvey was speechless, and when he realized that his previous words were not rigorous enough, he had no choice but to bite the bullet and say all his "ideas".This is definitely a new experience for the surgeons around, and it also opens a whole new world for them.

"I think Professor Colrigo's eyelid surgery is too complicated, and the complexity is unreasonable." Carvey's frankness came suddenly, "I chose longitudinal section before because it was a kind of simplification, but now I think it is still not enough. It can be further streamlined, in a complementary way.”

"How to go further?"

"This time, we can make a transverse incision on the lower eyelid to remove the tumor like Professor Corrigo. In order to prevent the recurrence of lower eyelid eversion, we can use the patient's own skin as a filling to prop up the lower eyelid that keeps falling down. skin."

"Fill your own skin?"

"What does it mean?"

"How does it sound like you want to cut off the skin of other parts and transfer it to the lower eyelid."

"It's very difficult to achieve. The transferred skin is very prone to wound ulceration, and the loss outweighs the gain."

Filling with skin is also called skin grafting in the modern sense. To these gentleman surgeons in woolen coats and top hats, it is simply poison: "The idea is bold, but it is not feasible in practice."

"Mr. Carvey does lack experience in plastic surgery."

"Yes, the failure rate of skin grafting is too high, but any doctor who has experience in plastic surgery should not propose this idea."

Opposition was endless, and even Ignatz felt that Carvey's thoughts had some personal emotions, and he was a bit suspected of revenge: "The skin grafting is really not good, let's let this matter go."

"What are you thinking, how could I take the risk of doing skin grafting, which is not friendly to doctors and patients." Carvey explained with a smile, "All I have to do is to pack Dr. Colrigo's three minor operations into one An operation. What I envisage is a kind of proximal skin flap transposition, which can solve three problems of the patient at one time."

As the name suggests, the operation is to transpose the adjacent skin flap to the defect without cutting the skin, just suturing both sides.

Carvey put it simply, and many people, including Sears, couldn't imagine the subtleties of this improvement at first glance.That is to say, director-level surgeons like Ignatz and Edinson have done a lot of plastic surgery all year round, and often deal with skin splicing, so they can understand the meaning of Carvey in the first place.

Ignatz seemed a little numb, and quickly drew a sketch on paper in surprise, and handed it to Carvey.After getting an affirmative answer, Ignatz quickly regained his composure.

It is not incomprehensible for a doctor who can think of a reasonable method of suturing the uterus and can control the hemorrhage of complex trauma in the first place.In the eyes of outsiders, Carvey seems to have no intersection with plastic surgery, but Ignatz is very clear that he also has his own understanding of plastic surgery.

After all, the new cleft lip surgery was given by Kavey, and that treatment method solved many troubles of the existing surgery.

But Eddinson, another deputy dean, was different. He had just met Carvey.

He was already in an unstable state of surprise after listening to the first question. Now that he heard the basic tenet of the new improved surgery, his surprise turned into fright, and he was not feeling well.

Where is the improvement plan? This is obviously another brand new operation, which has nothing to do with Colrigo's operation.

This kind of idea should have been born in a senior and experienced surgeon like Ignatz, myself or Corrigo, why shouldn't it come out of the mind of a 17-year-old kid?

He suppressed a large number of discordant voices in the venue, and helped the host stabilize the order: "Everyone, please be safe and don't be impatient. Some people just said that they can chat, why can't they talk now? Since it is a new The surgical method, then let Dr. Carvey come on stage and give a detailed introduction, there is no need to quarrel."

At Edinson's proposal, Carvey had to go to the podium again and replaced Sears, who was embarrassed all the way.

This may also be regarded as a strategy to save the country with a curve.

"I didn't expect that I would be on stage so early, I always thought it would be a while later."

Carvey joked about himself, and then roughly drew a rough sketch of the surgical procedure on the blackboard: "First of all, we need to be clear about the changes needed to restore the upper and lower eyelids. Expansion and filling is addition. Since one is doing subtraction and the other is doing addition, why not help them to be self-sufficient?"

After his instructions, several exclamations were heard in the venue, and it seemed that several doctors understood his operation method.

"What we have to do is to resect the subcutaneous tumor along the lower eyelid margin, and then remove a part of the epidermis to restore the lower eyelid to its normal position. Then the doctor needs to make a cutting design line on the upper eyelid according to the size and shape of the wound defect."

Carvey drew a skin defect below the eye, then outlined a dotted cut above it. 【1】

"After making the design line of the upper eyelid, quickly cut out the flap and fill in the defect of the lower eyelid with the transfer of the flap pedicle." Carvey said, "It's similar to playing a jigsaw puzzle, except that we dig it ourselves. pit, prepare the landfill materials by yourself, and then fill the pit yourself.”【2】

After the two sketches appeared, the rest of the doctors who had a little slower brains finally realized the greatness of this idea.

Carvey not only cut away the skin of the upper eyelid to lift the sagging upper eyelid, but also brought a very useful support flap for the lower eyelid.This flap still has a part connected to normal tissue, which can ensure the blood supply of the epidermis.

With blood supply, necrosis and shedding are not easy to occur after skin grafting.

Carvey really managed to compress the aggregate of three surgeries into one, and made the effect of his "1" far exceed the original "1+1+1".

"Whether the operation can be done and how the effect is, I don't care, everyone needs to verify it one by one." Carvey finally humbly said, "At the same time, I am still a little worried about the operation, such as the number of sutures on the edge of the skin, the skin The size mismatch of flap cutting and so on will affect the effect of surgery.”

Everyone looked down at the notebooks in their hands, and hadn't written anything for a long time.

In the end, the one with the most records is this "surgery" that does not exist in reality and was added temporarily.Look at the neat surgical steps on the paper, and the realistic surgical drawings one by one. What is surgical talent?This is talent, and everyone can listen to him casually.

However, in the plan, this new operation, which is like a major earthquake in eye plastic surgery, is not even a warm-up.

Because the next step is Carvey's real home field, the two failed cesarean section operations are preparing for his cesarean section report.

Why other people's operations failed, but his was successful, everyone present hoped to find the answer in the comparison.

"Next, we will ask Professor Ignatz from the Municipal General Hospital to bring us a cesarean section for refractory placenta previa." The host introduced, "The mother is a mother of three children. I was about to give birth to my fourth child a month ago, but found that I had symptoms of placenta previa.”

Ignatz took off his coat and hat, and quickly went to the stage to take over the conversation: "The operation uses a paramedian incision. From the very beginning, we rushed to cut in and get the fetus quickly. We hope to use speed to beat the bleeding. The uterus is sutured before the maternal blood dries.

My team has repeatedly practiced the process of skin cutting, uterus cutting, and fetal extraction, and can strictly control the speed of fetal extraction.This cesarean section took less than 200 seconds from the time the skin was cut to the time when the fetus was taken out.

In fact, there is still a chance at the beginning of the operation, but
Forget it, I won't make excuses anymore, let's just talk about the result, the operation failed completely under my leadership.

The reason is that unstoppable massive bleeding occurred at the incision of the uterus, and even if the fetus was taken out, the mother still did not survive beyond the closure of the abdomen.”

(End of this chapter)