Tokyo, 1994, starting with medical training

Chapter 22 is quite confident.

"Click".

Imagawa Ori screwed in the last locking screw.

Under the fluoroscopy of the C-arm machine, the plate was perfectly positioned, the screws were the right length, and the fracture reduction was impeccable.

She checked it one last time with a depth gauge.

"Remove the Kirschner wires."

Imagawa Orihime let out a long breath.

The fit between the steel plate and the bone is perfect, and the fracture ends are as stable as a rock under the restraint of the steel plate. This highly complex surgery can now be considered complete.

The remaining work simply involves cleaning the incision, placing a drainage tube, and suturing the muscle and fascia layers one by one...

It's all the assistant's work now; as the chief surgeon, she can leave early.

Kiryu Kazusuke responded immediately and removed all eight Kirschner wires one by one.

Imagawa Ori took off her blood-stained gloves and threw them into the medical waste bin. She was already preparing to turn around and leave the stage.

"Can you do the stitching?"

But after glancing at Kiryu Kazusuke, she stopped in her tracks.

Kirschner wire technique and intraoperative decision-making ability are one thing, suturing is another.

Ultimately, Kiryu Kazusuke was just a newcomer who had only been training for half a year.

Unlike suturing and Kirschner wire manipulation, suturing requires a lot of practice to master the techniques, and there aren't many tricks to it.

Therefore, she naturally assumed that even if Kiryu Kazusuke could do it, he would probably only be able to do the most basic interrupted stitches from the textbook, crooked and twisted, like a centipede.

"Otherwise, let Takikawa wash his hands and go on stage again."

Imagawa Ori glanced at Takikawa Takuhei, who had been in a daze since earlier, and added another sentence.

He was, after all, still nominally the top assistant.

Although he was replaced midway through, letting him finish the final stitches was a way of saving face for him and preventing him from being too embarrassed in front of the nurses.

Not far away, Takikawa Takuhei also subconsciously wanted to raise his hand to indicate that he could.

Of course he wanted to.

Being forced to step down is certainly shameful, but after failing to pass the specialist medical qualification exam for several consecutive years, face has long since become unimportant.

If I could go on stage now, I might be able to take the opportunity to ask Kiryu Kazusuke for advice.

For someone who had struggled for years in the quagmire of specialized medical exams, the desire to improve was overwhelming.

but……

Kiryu Kazusuke shook his head: "I have no problem."

Having just received "surgical incision suturing," he couldn't resist the urge to suture.

Although this skill cannot directly change the course of the surgery, it is still very important.

Suturing is not as simple as closing the incision.

Perfect stitching requires clear layers, neat alignment, and moderate tension.

It can minimize scar hyperplasia, reduce the risk of infection, and promote wound healing, which is the key to the aesthetics and functional recovery of the "last mile" of surgery.

Poor suturing results in crooked stitches, uneven skin edges, and either the stitches are too tight, leading to local ischemia and necrosis, or too loose, causing the wound to reopen.

For construction workers like Shinya Suzuki, the aesthetics of scars on their wrists may not be that important.

However, if infection or limited mobility occurs due to suture problems, it will undoubtedly greatly diminish the overall effectiveness of the surgery.

Imagawa Ori glanced at him with some surprise, but did not insist.

Seeing this, Takikawa Takuhei stopped thinking about it.

However, he didn't leave. Instead, he walked to the other side of the operating table, found a spot where he could see clearly without affecting the operation, and prepared to observe.

He and Imagawa Ori had different ideas.

Kiryu Kazusuke's superb Kirschner wire technique had completely impressed him.

Now, he was eager to see if this resident doctor's suturing technique was as miraculous as his Kirschner wire technique.

On the operating table.

Rinse with saline solution.

Kiryu Kazusuke did not begin suturing immediately, but instead gave instructions to the circulating nurse first.

The nurse quickly brought over a flushing device filled with saline solution.

He took it and began to carefully rinse the surgical field, thoroughly removing bone fragments, blood clots, and necrotic tissue debris.

This is a standard procedure designed to reduce the risk of postoperative infection.

But Kiryu Kazusuke did it with exceptional care, leaving no gap between muscles or fascia untouched.

"Place a drainage tube."

After rinsing, he skillfully placed a thin silicone drainage tube below the incision.

This tube can drain any accumulated blood or fluid from deep within the wound after surgery, preventing hematoma formation and compression of nerves and blood vessels, while also further reducing the infection rate.

"4-0 absorbable sutures, needle holders, tissue forceps."

He raised his head again and reached out his hand.

The scrub nurse standing nearby seemed somewhat surprised and did not act immediately.

"Wasn't it 3-0?"

She hesitated for a second and then checked again.

The thickness of the stitching is somewhat counterintuitive in terms of the numbering; the larger the number, the thinner the thread.

Although 4-0 absorbable sutures cause less damage to tissues and leave less foreign body reaction after suturing, which is beneficial to wound healing and aesthetics.

However, its drawbacks are also obvious.

Thinner thread means lower tensile strength, and it is easy to break if too much force is applied when tying a knot.

Moreover, it also requires higher hand-eye coordination and operational precision from the operator.

If not handled carefully, the skin edges may not align properly.

Some medical trainees, let alone 3-0 sutures, might even choose 2-0 sutures, which are less likely to break, just to be on the safe side.

Takikawa Takuhei, who was standing to the side, also began to have doubts in his heart.

Is the 4-0 line real or fake?

When he stitches himself up, he usually uses a 3-0 stitch. Although the resulting scars are not very attractive, at least they don't cause any problems.

After all, doing nothing means not making mistakes.

However, Takikawa Takuhei chose to believe.

So he moved even closer, not wanting to miss a single detail.

"That's right, it's 4-0."

Kazusuke Kiryu nodded and repeated his request.

Imagawa Orihime stopped in his tracks once again.

4-0 line?

Choosing such a fine suture for a wrist incision with considerable tension requires extremely high skill from the operator.

They seem quite confident.

However, she did not stop them, but simply stood aside and decided to take another look.

After receiving a second confirmation, the scrub nurse took a pack of 4-0 absorbable sutures from the suture rack, unpacked it, skillfully clamped the needle onto the needle holder, and handed it over.

Kazusuke Kiryu began the operation.

Judging from the movements alone, there was no sense of unfamiliarity whatsoever.

He began by suturing the deep fascia layer.

The tissue forceps in the left hand gently lift the edge of the fascia, while the needle holder in the right hand drives the curved needle to insert it at a smooth angle and then precisely exit from the opposite side.

His wrist movements are small but highly efficient; he pulls the thread, tightens it, and ties it in one smooth motion.

The first knot is tied.

The stitches are neither too deep nor too shallow, and the knots are neither too loose nor too tight.

Imagawa Ori's expression didn't change much, but her heart was in turmoil.

This stitch was so precise, it was unlike anything a resident physician could have done.

The resident doctors she had seen trembled like Parkinson's patients when they stitched their first stitch, and when they tied knots, they either couldn't pull them tight enough or they would break the thread.

Kiryu Kazusuke's needle strike was steady and skillful.

Perhaps it was just good luck?

(End of this chapter)