Nineteenth Century Medical Guide

Chapter 99. 96. Syphilitic Nose + Impacted Teeth

If we say that the few surgeries in the middle section are limited to the shining points in the display process, we don't deliberately pursue success or failure.Starting from Ignatz's groin, the level of reporting has risen to a new level.

Surgery is only a means to cure the disease and save the patient. The ultimate goal is to keep the patient alive, so the subsequent surgery must be successful.The sign of success, in addition to getting rid of the pain, must also ensure that the patient lives well.

There will be no more failures in the following operations, and each of them is more dangerous and more complicated than the other.

But while Ignatz was talking about everything he encountered during the operation, Kavey was talking about something else with Damirgon.

Damirgang did have ambitions, but his ambitions were tied to that small clinic.

He knows very well that even running a small clinic requires a lot of money, and surgery is even more costly.It costs money to maintain technically required corpses, equipment updates, cleaning, maintenance, bandages, gauze, and sutures.

But he still feels that as long as he is good enough, money will be invested in this clinic, and the future is bright.

Damirgang is obviously a young man who has not experienced the baptism of capital, and Kawei must be more sober in this regard.

Capital has a purpose, and investing in hospitals and clinics generally has two purposes.

One is to make money. With the quality of disease sources in the clinic in Damirgang's hands, not to mention making money, it is already very good if it does not lose money.If the fee is forcibly increased, the clinic will lose its advantage of being cheap, and patients might as well turn to the cheaper Municipal General Hospital or St. Mary's Hospital for treatment.

The second is charity, but charity needs to be seen by others, and it needs exposure.There are many people in large hospitals, and there are newspapers to publicize, so there will naturally be traffic. Naturally, investing in large hospitals can better reflect charity.

So the result is very clear, if it is not an acquaintance, and there is no such experience as Laszlo, who would invest money in a small clinic for no reason.

Besides, the chief surgeon of this surgery clinic is still a half-assed master.

Damirgang couldn't say no to Kawei, and there was really no reason to refute.In fact, when Carvey finished talking about those things, he had already doubted his ability, and he was half-hearted
Soon Ignatz finished his speech, and the host immediately invited Dean Watman, who had just arrived at the venue not long ago.

The dean took the manuscript, stood on the podium, and put on his monocle.He didn't talk about his operation straight to the topic like other doctors, but started with a rare international surgical society the year before:
"At the French Surgery Conference the year before last, I had the honor to meet Dr. Eriksson. He is a surgeon at the Affiliated Hospital of King's College London and enjoys a high international reputation.【1】

Dr. Eriksson began to try rhinoplasty more than ten years ago, probably in 1850, a little later than me, and the success rate was not high.But after his unremitting efforts, rhinoplasty, cleft lip plastic surgery and bladder fistula repair have gradually become his signature surgery. "

After introducing the other party, he began to cut in from the data samples again, and began to discuss the cause of nasal loss in Britain and Austria, as if he had the appearance of modern medicine.

"We exchanged a lot of things. For some reason, the number of rhinoplasty patients in the UK has been decreasing [2]. Most of his patients lost their noses due to lupus or various traumatic accidents. .They no longer see, or at least rarely see, patients disfigured by syphilis."

After talking about Britain, he had to mention Austria: "But our country is still dominated by syphilis. As we all know, when there are very serious cases of syphilis in public institutions, it is usually related to people who are stingy or poor in constitution. They often have .”

puff.
cough cough~~~
A strange sound interrupted Watman's speech, and at the same time attracted everyone's attention.Following the voice, they all looked at the young man holding the water glass: "Doctor Carvey, what's the matter?"

"Ah, it's okay, cough, cough, cough, cough, I choked on some water." Carvey quickly took out a handkerchief and wiped his mouth, "I chatted with Dr. Damirgang before, my mouth was a bit dry, drink water I'm in a hurry. Teacher, please continue, don't worry about me."

"In addition to miserliness and physical fitness, I also consider that the dose of mercury used for treatment may be insufficient [3]. The UK's application of mercury doses is indeed bolder, and I think the country can follow suit."

Having said all that, Waterman still hopes to find a connection between nasal ulcers and syphilis treatment: "Okay, let's get down to business, let's talk about surgery."

Austria's plastic surgery leads the whole of Europe. As the founder of plastic surgery, Wattman has been able to skillfully compensate for the soft tissue defects in the nasal framework.He has collected many cases over the years, learned lessons from them, and finally achieved this almost perfect plastic surgery.

This report is tantamount to a summary of his rhinoplasty over the years, and the purpose is far more than simply reporting the operation process.

"Today I would like to introduce a rhinoplasty I performed in mid-February. The patient is a 20-year-old girl with severe miserliness. She lost her nose completely last year because of syphilis.

She arrived with an artificial nose, which was completely missing, and the center of the face showed a large I-shaped hole with a small amount of scar tissue at the edge. 【4】

I examined the patient's nose further and found that the alae and lower part of the septum were destroyed, but the nasal bone and upper part of the septum were preserved.As they have good support for the plastic surgery, I resolved to use the old Indian method of taking a flap from the forehead and swiveling it over the defect. 【5】

When I checked, I also found that she still had severe pain in her jaw and her temperature was high. I suspected that she had osteomyelitis. "

Carvey originally thought that all the operations that could be done in the 19th century were minor operations. Even if the amputation seemed drastic, the process was actually not complicated.After sawing the bones and cutting the meat, the muscle flaps are made and the blood vessels are sewed up.

But just today, at this regular operation meeting, he felt for the first time how the nearly 60-year-old surgeon can solve difficult problems in the absence of medical treatment.

Of course, his patients are equally powerful.

"What I need to do is to reshape the patient's nose first, and then cut off her festering mandible. As for the extent of resection, it depends entirely on the degree of bone invasion."

Watman began to describe the operation process: "On February 2, the patient was sent to the theater for surgery, and with the help of ether, I performed this rhinoplasty + mandibular resection + chin plastic surgery.

First, some remnants of the alae need to be removed to expose the septal cartilage and the lower end of the nasal bone.These parts are very rich in blood vessels, and the operation needs to be careful enough to reduce bleeding as much as possible.Next, make a clover-shaped flap for the forehead by cutting along the drawing lines previously ink-traces. 【6】

Lift the flap from the forehead to stop the bleeding as much as possible and wait until the bleeding has stopped before twisting the flap into place.The left and right sides are secured with three sutures each, and the flap is gently supported with strips of cotton wool coated with essential oils.The middle tip is sutured over the upper lip to form the columella. "

The operation is considered to be over here, and the next step is the highlight that endangers the patient's life.It wasn't just the troublesome mandible that Watman had to contend with, but also the anesthesia time.

"I consulted the dentist at the Municipal General Hospital. According to the medical history provided by the patient and the abnormal position of her teeth, the condition of the mandible should have started in the early permanent teeth and had lasted for quite a while.

We estimate that the mandible healed naturally for a period of time because some new bone formation was visible, but the repair process was terminated by the newly developed purulent cavity.

Surgery was not hesitated, I made a long curved incision under the mandible, and found that the mandible had developed a large number of purulent lesions.The bone has been completely destroyed, and the scope is beyond the preoperative expectation, extending to two segments.As a last resort, I had to use a bone saw to cut the mandible into three pieces and remove them one by one. "【7】

Removing the mandible wasn't simple, and Wattman managed to do it as finely as possible while building up speed.

During the operation, the girl's tongue was preserved and wrapped with the original skin.He also kept the tooth, which was carefully placed on the gum, hoping to gain enough firmness during the healing process to keep it usable in the future.

Even Waterman once imagined that the mandible can regenerate, but unfortunately this is very unrealistic.

"The operation went well, and the postoperative recovery is also very smooth." He drank saliva, moistened his throat, and continued, "The wound on the nose healed beautifully, and the sutures were removed on the fourth day after the operation. Yes, although the dressing has some adhesion, but it is not serious.

The jaw also healed beautifully, the sutures were removed on postoperative day 7, and the suppurative osteomyelitis did not interfere with the healing of the wound.I want her to use her teeth for the bite, but it won't be easy.But we are still training the patient to master the ability to chew solid food, mainly between the tongue and the upper teeth.

The only fly in the ointment is that the new nose is a little sensitive, and some edema appeared on the surface, but it still greatly improved her appearance.Fortunately, the loss of the chin did not seriously change the facial shape, and the degree of change was less than expected before the operation. "

Regardless of the complexity of the operation or the postoperative recovery, this operation is enough to be placed on the table.

But in the eyes of others and even Watman himself, although the procedure of rhinoplasty is exquisite, it is not without precedent. It has long been a mature operation with a set procedure.If it is really complicated, there is also an arm flap transfer operation to protect the facial skin.

A skin flap of the upper arm was cut and sutured to the missing nose. In order to preserve the blood supply, the arm and the head must be fixed to prevent displacement.Maintain at least 1-2 weeks until the suture is healed, cut off the remaining connecting part of the arm, and then do the second suture of the columella. 【8】

This surgical method is much more difficult than that used by Watman. It needs to consider the position of the skin suture, and it also needs to face the wound healing in a semi-closed humid environment.

As for the mandibular resection, Wattman was really bold and saw the urgency of time at a glance to combine the two.

The final questioning session was even more lively than Ignatz's inguinal hernia. The questions focused on the number of stitches for the rhinoplasty and the placement of the teeth after the mandible was removed.

"Dean, how did you determine the number of stitches? How about doing four stitches with small needles for a tighter stitch?"

"It's a matter of balance. Four needles will damage the skin around the nose too much, which is not good for healing. Two needles are too few, and it is easy to fit and shift. Compared with three needles, it is just right."

"Now it is proved that occlusion has nothing to do with the lower row of teeth. If there is another mandibular resection, will the teacher give up placing the teeth?"

"I won't give up," Watman replied. "The teeth are not only for the bite, but also for supporting the skin of the lower lip, which can make the jaw fuller and reduce the missing feeling after the mandible removal."

"Is there a better way to deal with the bleeding when the forehead skin flap is cut? Sometimes the patient's bleeding is a bit heavy, and it is difficult to stop."

"There is really no good way to stop the bleeding. I usually do partial compression. Others can only rely on the patient's physique. Some people stop the bleeding quickly, while others are very slow. According to my personal perception, it is completely random."

The questions basically focus on these aspects, but what Carvey really cares about is wound healing.

Although Watman has been saying that the healing is good, and the most critical part of the operation has been skipped, Carvey still does not believe that in the 19th century, when there was no concept of disinfection and hand washing, large incisions could heal well.

The nose is okay, surrounded by scar tissue, the infection is better.But the mandible is a purulent inflammation, and it is a widespread infection. In this case, even modern surgery wants to avoid postoperative infection. It is not easy, and a lot of cleaning and disinfection are required during the operation.

Carvey looked at those colleagues who were only interested in suturing skills, and shook his head in his heart. Doesn't anyone care about wound healing?
Just when Carvey was about to wait for others to finish asking himself before speaking, Watman suddenly avoided other people's questions and directly clicked on him:

"My operation is very complicated at first glance, but if you disassemble it carefully, it is just satisfactory. Compared with the next cesarean section, it is still a lot worse. Personally, I still hope to hear the dissection He is the expert in visceral suturing and hemostasis.”

What he said was quite beautiful, but it was meaningless to Kavi, because he was tired of hearing it long before he came here.

On the contrary, the flattery from the dean of the School of Surgery soon won a lot of disgusted looks, and Carvey could clearly feel that the atmosphere in the entire conference venue was undergoing subtle changes.

He was getting more and more confused about what Watman was thinking, and was about to throw stones to ask for directions: "Then I will ask anyone."

"Just ask."

"What I want to ask is, is there any remedial measure after the mandible is removed? After all, the whole jaw is gone, and the appearance will definitely be greatly affected." Carvey said, "For example, re-sculpt it with ivory?"

"."

"Or just install a silver one?"

"."

(End of this chapter)