This doctor is already middle-aged, and he's only just started practicing medicine.

Chapter 11 Tendon Repair!
"Thank you for your hard work, Professor Chen." Lu Cheng, who had benefited from Chen Song's fame, spoke respectfully after leaving the operating room.

"What's so hard about a 'vacation'?" Chen Song smoked in the 'fire escape' leading from the doctor's office in the emergency observation ward to the corner outside the hospital. The few smoke rings blocked Lu Cheng's view, making Chen Song look even more unfathomable.

Compared to the emergency department of Xiangya No. 2 Hospital, the pace of life in the emergency department of Longxian People's Hospital is like a "vacation"!
"Professor Chen, I don't know anything about what you just instructed me on the operating table. I was a resident orthopedic surgeon before."

"I will go back and find it to read," Lu Cheng replied honestly and specifically.

Chen Song wasn't surprised: "So, it would be strange if you knew how to do it."

"Take your time reading. Your previous major was orthopedics, so you can only start by learning about orthopedic diseases..."

"Want one?" Chen Song took out his "Harmony Brings Wealth" cigarette.

Lu Cheng hesitated for a moment, then calmly lit a cigarette. But after just one puff, he choked and started coughing, his eyes watering.

"Forget it, you'd better not waste my food."

"Smoking is bad; it can easily affect the nerves in your hands. I can't quit." Chen Song put away his cigarette pack, took another deep drag, stubbed out the cigarette while exhaling smoke rings, and put his mask back on.

"Emergency surgery, in essence, boils down to two points: the control of vital signs."

"That is, circulating blood volume and blood pressure. What we surgeons need to intervene in is bleeding. If we do this well, the patient's life is likely to be saved."

"The severity of emergency cases lies in their rapid arrival and rapid death; their nature is also that they can leave quickly and live quickly, with immediate results."

"Therefore, among the basic surgical skills, hemostasis is the most fundamental content of our emergency medicine."

"Once you've mastered hemostasis, you can gradually practice other surgeries. For example, the first time I performed this surgery, it took me a full eleven hours to get off the operating room. My teacher stayed with me outside the operating room all day."

"That's how you learn surgical techniques, little by little," Chen Song explained in great detail.

"Then came the diagnosis."

Chen Song's guidance did not advance the panel regulations this time, but Lu Cheng still found it extremely helpful: "Thank you for your guidance, Professor Chen. For now, I can only focus on suturing the tendon."

"Hmm..." Chen Song was very satisfied that Lu Cheng had self-awareness. He put his hands behind his back and walked into the observation ward with an air of mystery, like a detached and leisurely person.

Lu Cheng was going to complete the emergency room medical records, surgical procedure records, initial progress notes, and postoperative ward round records for the patient who had just been treated.

In life-threatening emergency surgeries, every minute can mean the difference between life and death.

According to the law, in emergency situations, signatures are not required. The hospital's on-call supervisor can authorize the procedure to proceed legally, with signatures and medical records to be submitted later.

Even if a patient dies on the operating table, it is still an emergency measure to avoid danger.

……

At noon, the aroma of Lu Cheng's lunch filled the doctors' lounge. Lu Cheng was organizing disposable masks as he entered the emergency surgery clinic.

In front of the patient, Du Daihua was very polite: "Dr. Lu, this patient has a wrist tendon injury... Director Lin said he wanted you to take a look!"

The patient was a young man, around thirty years old. His wrist had been temporarily bandaged to stop the bleeding. He looked at Lu Cheng thoughtfully and said, "Dr. Du, is this Dr. Lu? He looks rather young."

Du Daihua said, "Yes, Dr. Lu is a top student at Han City University!"

"He looks very handsome, and his surgical skills are just as impressive."

Du Daihua, a graduate of a second-tier university and a resident physician, dared not even consider comparing her 'basic skills' to Lu Cheng's after witnessing his procedures. Furthermore, knowing that even Director Peng of the orthopedics department had made a mistake with tendon suturing, she avoided him like the plague.

Medical studies are extremely lengthy, and becoming a doctor is a profession that requires a very long time to master. The surgeries that Lu Cheng couldn't get, Du Daihua also couldn't get, but he was willing to wait…

While Du Daihua was communicating with the patient, Lu Cheng had already removed the patient's outer gauze. After glancing at the depth of the wound, he expressed himself quite professionally: "Brother, this is a flexor tendon injury in the carpal tunnel. In the professional field, this is a flexor tendon injury in zone IV."

"The stitches will definitely need to be put in. The on-call orthopedic doctor called today and said he can't handle this situation. Do you want to go to the state hospital or..."

"Let me handle it for you?"

The patient's right to informed consent is not just about whether or not they agree to Lu Cheng's procedure; Lu Cheng must also provide suitable alternatives.

Let Lu Cheng handle it; go to Xiangzhou People's Hospital, choose one of the two.

Chen Song doesn't treat tendon injuries; the cases are too minor, and he's too lazy to make a move.

Zone IV flexor tendon injuries are relatively easy to treat. Textbooks recommend the modified Kessler method, which is also one of the simplest tendon suture techniques.

Lu Cheng's cautious attitude and tone made him sound reliable, and he was also quite pleasing to the eye: "Dr. Lu, do you mean that even orthopedic surgeons can't handle this tendon, but you can?"

Lu Cheng shook his head slightly and replied cautiously, "That's not what I said. It was the orthopedic doctor on duty today who said he couldn't handle it."

"Director Peng from the orthopedics department has gone to the countryside again. Your surgery is scheduled for a specific time, so we can't delay it too long." "If you want better treatment results, you can go to the State People's Hospital in Jilin City immediately. The on-duty doctors there can find someone who can treat you."

Dr. Peng, the head of orthopedics, is capable of treating this tendon injury, but his previous experience with tendon sutures has left him with a psychological aversion, so he simply avoids this type of case.

When Director Peng is not on duty, the on-duty doctor will naturally not be in trouble.

Even if it's a "misunderstanding" raised by the patient, Lu Cheng has to explain it clearly.

It's unethical to climb to the top by stepping on your peers or to elevate yourself by stepping on them. Even if someone can't suture a tendon, they can still perform fracture surgery or arthroscopic surgery.
Tendon repair is just one of the more specialized procedures in the subspecialty of hand surgery, and it has only gained increasing attention in recent years.

If we go back twenty years, we could just sew it up and avoid infection; whether it would become stiff was not within the scope of discussion in the medical field.

As long as there is no bleeding or infection, it is considered a treatment.

“Then go ahead and do it… I think you’re pretty honest…” the young man agreed.

"Tendon suturing is a standard surgical procedure that requires going into the operating room, and it's not cheap. Whether it's my surgery or someone else's, it costs more than two thousand yuan."

"You'll need to be hospitalized for rehabilitation after the surgery!"

"I also need to make this clear to you," Lu Cheng explained.

"We still have to do it. I can't go back with this torn tendon, can I? I can't even bend my fingers." The young man looked quite helpless.

Even though it's expensive, it still needs to be treated; it's gotten to this state.

A ruptured tendon is no joke. He had just read some informational materials, which indicated that it could leave behind postoperative stiffness, potentially resulting in a condition where the hand is crippled.

……

Tendon repair surgery is not a simple debridement and suturing procedure; ordinary local anesthesia is not sufficient, and nerve block anesthesia must be performed in the emergency operating room.

The anesthetic drugs and tendon sutures used in the county hospital are all domestically produced. The sutures used are Ticron (3-0), which costs 195 yuan per suture. Lu Cheng is unsure how much can be reimbursed. However, it is much cheaper than Johnson & Johnson Ethibon 2 (2-0) sutures which cost 239 yuan per suture at Xiangya No. 2 Hospital.

After the conversation and signing were completed, the patient went to the emergency operating room first. Lu Cheng then said to Zhang Tiesheng, who was on standby, "Brother Zhang, this tendon suture is a level two surgery. Should we write that you were the chief surgeon or that I was the chief surgeon?"

Zhang Tiesheng is a senior attending physician, with more seniority than Lu Cheng.

Chen Song was too lazy to perform the surgery himself, let alone be his assistant. However, Professor Chen Song promised to come and take a look after the surgery.

Tendon suturing is not something one person can handle, so Zhang Tiesheng was on standby for the surgery.

Zhang Tiesheng, of medium height, wore black-rimmed glasses and looked rather refined. He chuckled and said, "Since it was you who handled it, Xiao Lu, of course it's listed as the lead surgeon. I'm the assistant!"

How could Zhang Tiesheng possibly take the blame for Lu Cheng? The emergency department may need 'business,' but they can't just throw people away, okay?

“Okay, Brother Zhang.” Lu Cheng understood.

Once inside the operating room, the routine disinfection and draping procedures were performed.

Then Lu Cheng sat in the main seat and began cleaning and suturing the wound, while Zhang Tiesheng watched attentively from the assistant's seat.

Although he had only heard that Lu Cheng could suture tendons, based on his interactions with Lu Cheng, Zhang Tiesheng was certain that Lu Cheng was not just talking big.

If Lu Cheng says it's possible, then it's highly likely to be possible.

He can avoid taking the blame to play it safe, but he can't afford to lose his learning mindset when observing surgeries.

There must be a reason why Professor Chen Song wanted to mentor Lu Cheng but was unwilling to mentor him.

"What kind of suturing technique is this?" Zhang Tiesheng asked with slight doubt after looking at it.

The orthopedic surgeons he knew at the hospital who sutured tendons didn't seem to use this technique; mattress sutures and braided sutures were their most common methods.

"The modified Kessler tendon suture technique is currently the most recommended suturing technique for IV flexor tendon injuries." Lu Cheng's suturing was meticulous, and his answer was equally meticulous.

Zhang Tiesheng's expression stiffened slightly, and he remained silent.

This kind of understanding is a theoretical dimensionality reduction attack. Zhang Tiesheng only knows that the entry requirements for tendon suturing are very high, but he doesn't know how to divide the flexor tendons. The wrist joint flexor tendons are in zone IV, and the modified Kessler is the most recommended treatment for zone IV flexor tendons...

The academic approach must have been taught by Professor Chen Song!
I never expected that Lu Cheng would actually be able to learn it!
Zhang Tiesheng was neither jealous nor envious of the tendon suture technique Lu Cheng had performed.

Lu Cheng really went all out for the surgery.

Zhang Tiesheng's gaze lingered on Lu Cheng...

(End of this chapter)