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

Chapter 170 Tong the Fatty with Autism!

October 10th, Saturday, light rain.

In the operating room, Tong Yuan'an, while putting on his sterile surgical gown, asked, "Xiao Lu, are you on the night shift in the clinic tonight?"

Lu Cheng nodded: "Yes, Teacher Tong, I am now on duty according to the regular schedule."

"Today's surgery team is Tian Zhuang. This is a limb replantation, so Han Xiaoping can only call you."

After Lu Cheng and the circulating nurse finished laying down the last drape, he smiled and said, "If you say you're busy, Professor Tong, then the patient will have to be transferred to another hospital."

"Fortunately, Professor Tong, you are also willing to work overtime."

Ever since Lu Cheng worked a full 96 hours in the department during the National Day holiday, he has dared not disobey the normal work schedule and respect the fate of others.

Lu Cheng was even more afraid of ruining himself.

"Okay, I'll try to get it done quickly later, before you go to take over your shift."

Tong Yuan'an nodded: "Fortunately, it was only a forearm amputation, not a finger amputation, so the workload wasn't that heavy."

A severed finger can result in multiple finger severances, while a severed forearm has a wider cross-sectional diameter, but only one fracture point, making it relatively less complicated to treat.

"Okay, Teacher Tong."

Lu Cheng sat down in the assistant's seat directly opposite Tong Yuan'an, having already made the necessary preparations and waiting for Tong Yuan'an to take the lead in the surgery.

After taking the stage, Tong Yuan'an and Lu Cheng worked together to carefully examine the patient's broken ends: "It's alright. Although it's not the simplest knife wound, it's not a crushing injury either, so it's relatively easy to treat."

"The patient was injured recently, so the surgery can be performed normally."

"First we clean the wound, then we set the bone. When cleaning the wound, you and I will each take charge of one side."

"I'll take charge of the detachment side," Tong Yuan'an said, taking the initiative to take over the more difficult part of the operation.

"Okay, Tian Zhuang, you'll work with Professor Tong on the distal debridement. I'll handle the proximal end by myself for now." Lu Cheng arranged for Tian Zhuang to assist Tong Yuan'an.

Debridement is a basic skill, but distal limbs lack blood supply, so a more detailed assessment of tissue necrosis is required, necessitating more delicate procedures.

The blood supply to the proximal end remains intact, and necrosis can be assessed by looking at the bleeding points during the debridement process.

Lu Cheng upgraded his Debridement Skill to [Debridement Skill (Specialization 5/20)] during the National Day holiday.

If Lu Cheng hadn't failed to level up his basic debridement skills, which would have prevented him from further improving his limb replantation skills, he probably wouldn't have wasted his skill points.

While basic skills are fundamental, the overall concept of limb replantation is still incorporated into the topic of limb replantation.

Lu Cheng's [Limb Replantation Technique] is already at (Specialization 20/20), so he can handle the severed ends with ease.

When he focused on the task at hand, his operating speed was even faster than that of Tong Yuan'an, who had an assistant.

Lu Cheng had performed limb replantation surgery during the National Day holiday, so scrub nurse Xue Xue was not surprised by it.

However, when Tong Yuan'an saw Lu Cheng's thorough debridement, his chubby face twitched slightly. He wanted to remind Lu Cheng that there was no need to rush, as his teacher, Tong, would definitely finish the surgery before he went to his night shift.

After looking at it from side to side several times, Tong Yuan'an finally saw Lu Cheng's 'chicken feet'!
If we draw an analogy to tendon suturing, Tang technique is the method, and suturing is the basic skill, then debridement and suturing, nerve suturing, and vascular suturing are all basic skills, and the overall surgical procedure of limb replantation is the "method".

Basic skills determine the lower limit of surgical quality, while 'technique' indicates the upper limit of surgical quality.

While he was just cleaning the wound, Tong Yuan'an couldn't immediately tell Lu Cheng's skill level. But after a few glances, he finally noticed something was off.

Lu Cheng's movements were incredibly smooth; it was more than just memorizing them perfectly.

With these doubts in mind, Tong Yuan'an simply put down the equipment in his hand and patiently continued to watch for another half minute.

The playful, scrutinizing gaze slowly shifted into solemnity and astonishment.

If he didn't misread or misjudge.

Probably, perhaps, possibly, Lu Cheng's current overall level of limb replantation surgery is...

Tong Yuan'an's surgical skills are considered quite high at Xiangya Hospital. Even another associate professor, Han Yunshen, has a wider range of surgical procedures than him.

However, in terms of surgical skill, he is still superior.

Limb replantation is a standard procedure in hand surgery. For a mature hand surgeon to call themselves a hand surgeon, this is an essential introductory procedure that they must master, and it is a hallmark of a hand surgeon.

However, not every hand surgeon possesses exceptional skill in limb replantation.

Being proficient in one technology, being extremely skilled in another, or even being an absolute expert in one technology are all concepts.

According to Tong Yuan'an's understanding, to be able to perform limb replantation surgery normally, one first needs to accumulate a certain amount of basic skills, and then a lot of clinical practice.

As for him, his current skills were honed through hundreds of severed limbs and fingers, which is why he is able to surpass "surgical geniuses" like Han Yunshen in terms of specialization.

So, what Tong Yuan'an couldn't understand at this moment was that Lu Cheng had just started to learn about limb replantation, so where did he get so many hands to suture and practice on?
How did Lu Cheng's skill level reach such a high level in just one week?

Tong Yuan'an was a seasoned surgeon, not so inexperienced as to stop Lu Cheng from questioning him.

But it was precisely because of this level of professionalism that Tong Yuan'an felt particularly distressed.

Having certain guesses, but being unable to confirm their veracity, is truly frustrating...

Tong Yuan'an watched for about three minutes before suppressing his temper and continuing the wound cleaning procedure.

After the surgery distracted him, Tong Yuan'an was able to calm down and focus his attention.

As time slowly moved forward, about fifteen minutes later, Tong Yuan'an's thoughts became chaotic again.

No other reason than that Lu Cheng was looking at him right now!
The reason is simple: Lu Cheng's proximal debridement has been completed, and now he is just waiting for the bone setting, which is internal fixation.

However, the wounds on the distal limbs had not yet been completely cleaned, so Lu Cheng could only wait.

While waiting, Lu Cheng could only "watch" as he had done before...

Tong Yuan'an noticed Lu Cheng's gaze, but after his Adam's apple bobbed a few times, he glanced at Lu Cheng's cleaned and severed wound.

If you don't nitpick, you definitely won't find anything wrong that would make Lu Cheng stop 'looking' at it.

This puts more pressure on Tong Yuan'an.

I rely on.

What the hell am I? A rural doctor, here to provide targeted assistance.

In other words, I'm here to teach.

The reality is that my students are now more skilled than I am. What kind of teaching have I done?

What should I do after this extended period of working in the countryside?
Is it that Lu Cheng only has better basic skills in debridement than me, but actually has better skills in limb replantation?

The thought crossed Tong Yuan'an's mind, but he quickly dismissed it, because it was even more impossible.

Tong Yuan'an was well aware of his own debridement skills, which Lu Cheng could not possibly surpass. If Lu Cheng could surpass him, even if Tong Yuan'an were to nitpick and look for flaws, he might not be able to find any.

It's impossible for Lu Cheng to find fault with the details himself.

Another seven or eight minutes passed before Tong Yuan'an finally finished cleaning the wound.

Tong Yuan'an had other ideas in mind, so he said in a very cold voice, "You're young and quick, so you can finish the rest."

Upon hearing this, Lu Cheng glanced at Tong Yuan'an, but failed to notice the 'teasing' and 'doubt' in Tong Yuan'an's eyes, and nodded in agreement.

“Okay, Teacher Tong.” Lu Cheng agreed and began rinsing the cut ends with heparinized saline solution.

Immediately afterwards, Lu Cheng quickly swung the broken limb bones back into place.

Since the hand was completely severed, there can't be any deviation in direction during replantation; this step is crucial...

Otherwise, no matter how well the suturing is done, if the bone repositioning is not done properly, the postoperative hand position will be completely different from that of a normal hand, which would be a huge joke.

Generally speaking, this process is not difficult, but it does take some time to prepare for various anatomical structures.

Lu Cheng also matched them one by one, and it can be seen that Lu Cheng's matching speed was very quick.

Ulna, radius, nerves, blood vessels, tendons...

Lu Cheng spent less than two minutes aligning them and finding the right direction for them to match.

After comparing them, Lu Cheng had Tian Zhuang start using Kirschner wires for temporary fixation to completely fix the position.

After inserting the two Kirschner wires, Lu Cheng and Tian Zhuang began to insert the steel plate...

The procedure of plate and screw fixation for limb replantation is far less difficult than that for non-disarranged fractures.

Because there is no soft tissue tension, the distal hand can rotate 360 ​​degrees, and the 360 ​​degrees of the surrounding bone are disconnected, providing a wide field of vision.

Applying steel plates under such circumstances is simply following procedure.

Locate the fracture line and peel off the periosteum.

After the steel plate is inserted into the bone end, holes are drilled using the screw formula, the depth is measured to determine the length of the screw, and then an electric screwdriver is used to screw it in.

In just half an hour, Lu Cheng and Tian Zhuang completed the plate and screw internal fixation of the radius and ulna.

This speed isn't exactly lightning fast, but it's still quite fast. Even if Tong Yuan'an himself tested his own speed, it would probably take him more than forty minutes.

Based on this, Tong Yuan'an became even more convinced that Lu Cheng's proficiency in limb replantation surgery was likely higher than his own.

This guy's talent is simply beyond the reach of ordinary people.

Talent is something you can't learn without practice. For example, I've never performed a full-process fracture reduction, open reduction and internal fixation surgery before, yet I can perform this kind of surgery.

But once he's done it a few times, his one time is equivalent to ten or fifty times for others.

You don't need to perform too many surgeries to reach the highest level of surgical proficiency.

For someone like this, the most important thing is the surgeon performing the first few surgeries...

Surgery isn't something you learn by watching; you learn by doing.

"Continue," Tong Yuan'an said, not waiting for Lu Cheng's glance for permission.

Lu Cheng immediately began suturing the muscles and tendons.

This is one of Lu Cheng's strengths...

In terms of speed, quality, and technique selection, Tong Yuan'an could only look on with envy.

How many types of tendon suturing techniques does Lu Chenghui possess? How proficient is he in these techniques? He has the most experience in this regard.

For example, his newly created Tajima suture technique is even more advanced than that of Professor Tajima's team.

His team's original "tong method" is even more advanced than his own, not to mention Lu Cheng also has his own newly developed "suturing technique"!
In other words, these techniques cannot be used casually. Lu Cheng is not yet an associate professor, and he cannot create original techniques for fear of being reported. Otherwise, it is unknown whether the quality of the vascular beds Lu Cheng creates can be matched by those old professors in Xiangya Hospital.

……

Lu Cheng completed the tendon and muscle sutures quickly and with better quality, which was Tong Yuan'an's natural assessment.

Of course, Tong Yuan'an had also seen Lu Cheng's 'cooking' before, so he didn't think there was anything hypocritical about Lu Cheng doing so well.

Having seen Lu Cheng's past, one can better understand the astonishing speed of his growth.

After the muscle and soft tissue are sutured, the remaining crucial step is vascular suturing.

The severed arteries and veins in the forearm are very thick, much larger than the diameter of the severed finger.

In hand surgery, some highly skilled professors even joke that, apart from the arteriovenous anastomosis of severed fingers which requires microsurgical instruments, the replantation of severed limbs in the forearm and above can be completed without microsurgical instruments.

This is where a person's true skill level is tested.

That was obviously a joke.

The essence of human civilization lies in the ability of humans to flexibly utilize various tools, rather than discarding better tools and unconditionally limiting their own potential.

……

In terms of vascular suturing, Lu Cheng's operation was standard and not something that Tong Yuan'an found incomprehensible. On the contrary, Tong Yuan'an would find that there were still many areas where Lu Cheng's vascular suturing could be improved.

This was, after all, Tong Yuan'an's culmination of his skills, and the source of his confidence in surpassing his peers; it was not something Lu Cheng could easily surpass.

However, when it came to nerve suturing, Tong Yuan'an could only smile and remain silent.

This is the real "technique" that Lu Cheng learned from the advanced training course at Peking Union Medical College Hospital. The basic principle is the same, which is the combined suturing of the peritunic and the outer membrane, but the specific operation mode is different.

Because Tong Yuan'an hadn't asked Lu Cheng about the specific details, he didn't understand much of it.

Tong Yuan'an was certain of one thing: the hand surgery department of Huazhong Union Hospital was extremely skilled in nerve suturing.

The expertise and expertise in nerve suturing and the treatment of neurological problems at Huazhong Union Hospital are renowned throughout the country.

While the hand surgery department at Xiangya Hospital is undoubtedly formidable, it lacks such a distinctive "peak"!
After this calculation, Tong Yuan'an's scalp tingled with shock.

I glanced at the surgery timer panel.

【16:02:32:14】Two minutes past four in the afternoon.

【03:45:54:32】The operation lasted three hours and forty-five minutes.

The remaining subcutaneous tissue suturing and skin suturing can be completed in a maximum of half an hour, which means that Lu Cheng can finish the surgery around 4:30.

And the quality will be very good.

Tong Yuan'an's previous worries have finally come true without any surprise.

This teacher of his could teach a lonely subject in front of Lu Cheng.

Lu Chengfang handed over the remaining subcutaneous tissue suturing and skin suturing to Tian Zhuang.

Tian Zhuang had no other doubts and honestly began to operate the procedure step by step.

While cutting the sutures, Lu Cheng said to Tong Yuan'an, "Teacher Tong, can today's surgery be classified as a limb replantation?"

The overall cost of limb replantation surgery is higher than the cost of replanting the limb separately.

Lu Cheng is not a conceited person; he puts in the effort but doesn't take the reward he's entitled to.

If it can't be operated, there's nothing that can be done, but if there's someone on stage who can operate it, then the fees should still be collected.

Tong Yuan'an's chubby face twitched for a while, but because of the mask covering it, Lu Cheng wouldn't notice.

She nodded slightly: "Mm..."

Tong Yuan'an was a man of few words.

Lu Cheng then said, "Teacher Tong, I have to work in the emergency room tonight, so I don't have much time. Please arrange your own dinner later."

Chen Song was still in Long County, but no one else knew about it. Chen Song didn't want to be bothered by phone calls during his leave of absence, so he asked Lu Cheng and the others not to make a fuss about it.

He applied for leave to conduct scientific research while at Xiangya Hospital, which had nothing to do with going to the countryside.

Surgeries in Long County were not part of his duties.

"Hmm...okay." Tong Yuan'an replied with two words this time, which was rather extravagant.

Lu Cheng: "???"

What's wrong with Tong Yuan'an this time?
To be honest, Lu Cheng preferred the joking Tong Yuan'an to Chen Songhua's "cat-like" Tong Yuan'an.

Tong Yuan'an kept trying to end the conversation, and Lu Cheng tried to force a conversation for more than ten sentences but failed to get the topic going, so he stopped talking.

It's obvious that Tong Yuan'an doesn't want to chat right now.

The surgery was completed smoothly. The patient, who had received nerve block anesthesia, was transferred directly from the operating room to the observation ward.

Immediately after the surgery, Lu Cheng returned to the doctor's office in the emergency department's observation ward to write postoperative instructions and surgical records.

Lead Surgeon: Tong Yuan'an; First Assistant: Lu Cheng, Attending Physician; Second Assistant: Tian Zhuang, Attending Physician. Planned Surgery: Limb Replantation. Performed Surgery: Limb Replantation…

Longxian County, Chen Family Firewood Chicken.

Chen Song, who wasn't in a good mood, sat with his hands behind his back, his eyes vacant. After the fat man Tong Yuan'an came in, he glanced at him sideways but didn't say anything.

He slightly raised his chin, and the light reflecting off his bright forehead pierced Tong Yuan'an's pupils.

After Tong Yuan'an entered, he plopped down on Chen Song's left, clasped his hands together, and his muscular physique bulged like a hill.

After sitting for a while, Tong Yuan'an raised his large right hand, rubbing his long beard on his left cheek, without showing any interest in talking.

Chen Song glanced at Tong Yuan'an and sarcastically remarked, "Did someone cut your vocal cords today?"

Can't you tell I'm in a bad mood?

Tong Yuan'an's eyes darted halfway toward Chen Song, he turned halfway around, and closed his eyes.

With each deep breath, his broad pectoral muscles heaved, his breathing was somewhat heavy, and he still did not answer...

No one knew the awkwardness Tong Yuan'an was in at that moment.

As an associate professor at Xiangya Hospital, I must have had a very happy time during my rural assignments. After all, I could show off my abilities and be flattered by the doctors there. Earning respect through my skills is a sure way to feel accomplished.

But damn it, Tong Yuan'an had only just extended his study period when Lu Cheng swung a stick and hit him.

The problem is that this club is still a spiked club, with an original tendon suturing technique on the left and a nerve suturing technique learned at Peking Union Medical College Hospital on the right, trapping it in the middle, making it impossible to break through from either side...

Despite being called a rural doctor, he was surpassed in technical skills.

Now things are really messed up. Not only can he not show off anymore, but he also has to be careful to serve him. Who knows, Lu Cheng might even find fault with him if he's not careful.

Surgery is ultimately a profession that values ​​ability and skill. If you have the ability, you can certainly do whatever you want.

But if an associate professor has to be so careful in Longxian County, what's the point of going to the countryside?

The problem is, Tong Yuan'an has already extended his study period. Once this procedure is completed, it's not something he can simply stop doing if he doesn't want to continue...

Chen Song is smart; he took a break from his job.

Tong Yuan'an, a big fat man, was taken away.

Tong Yuan'an remained silent, which alerted Chen Song to something was amiss: "Brother? What's wrong?"

Tong Yuan'an kept his eyes closed, took two deep breaths, and then sighed, "Sigh..."

“Say something,” Chen Song said.

"I'm so embarrassed." Tong Yuan'an opened his eyes, tilted his head, and the beard on his left cheek almost poked his cheekbone.

Chen Song leaned slightly to the side, afraid that others might misunderstand that Tong Yuan'an had returned from studying in Chengdu: "Explain yourself clearly."

“That kid Lu Cheng…” Tong Yuan’an then slowly recounted the whole story.

In conclusion: "Anyway, that's how things are. I can't take it easy anymore. I'll probably have to keep a low profile from now on."

In the past, when Tong Yuan'an went to the countryside, he only saw unprofessional places. He would casually say a few words that were beyond the understanding of others, and he was very relaxed and comfortable.

It's like a graduate student barging into an elementary school classroom, and they're completely at ease.

Chen Song, however, did not ridicule Tong Yuan'an. Instead, he frowned and said, "We two brothers are truly in the same boat. We fell into our tragedies at the same time."

"Stop being sarcastic." Tong Yuan'an raised an eyebrow, flexed his biceps, and looked ready to fight Chen Song one-on-one.

“Xiao Lu’s girlfriend held me back,” Chen Song said.

Tong Yuan'an raised his upper eyelids and looked at Chen Song with a sinister gaze, unaware of the mockery in Chen Song's expression.

"How so?" Tong Yuan'an asked.

"This is no ordinary young girl at all; she knows so much about scientific research."

"From basic scientific cell experiments to clinical trials, there are basically no blind spots in the entire process."

"The research we have in our hospital's emergency department is nowhere near enough to satisfy her. Compared to her, I realize I'm just a complete novice in research."

“Today I gave Mu Nanshu twenty suggestions, and she found twenty-eight areas that were not good enough.” Chen Song was scratching his hairline so hard that it went even higher as he spoke.

"Cough cough..." Tong Yuan'an coughed a few times.

"Twenty suggestions, twenty-eight shortcomings? Chen Song, you're a real talent!"

Chen Song said irritably, "Don't be so skeptical. You'll have to deal with this girl eventually, so you'd better pray that your research group can put in a good job."

"Otherwise, when it's your turn, you'll be given twenty suggestions and thirty faults to find fault with."

Tong Yuan'an reached out, grinning and making a pained expression: "Don't say anything yet. Didn't Lu Cheng say that his daughter has to extend her studies?"

(End of this chapter)