Chapter 222: Weaving the Net

Suturing the blood vessels was a very familiar job for Ling Ran.

When he first arrived at Yun Hua, the Medical Affairs Department tried to display their might and power by suturing rats’ tails.

When he thought about it now, that was the equivalent of having new recruits compete against members of the special task force in a shooting game. The difficulty level of suturing rats’ tails was practically at the top of the medical field.

However, suturing the vascular network was still a difficult challenge that far surpassed the average level.

The blood vessels in the feet were thicker than the blood vessels in the hands, but those blood vessels were the main arteriovenous fistula. The perforating arteries that divided the posterior tibial artery or the peroneal artery were not so thick. Many of them were thinner than the arteries of the fingers.

And when it came to finger replantations, he did not need to just suture two to four blood vessels.

Of course, if he were to compare the level of difficulty between Achilles tendon repairs and finger replantations, the difficulty in finger replantations was higher, because the replantation of severed fingers had a high requirement for the quality when it came to suturing blood vessels, and its tolerance for low-quality sutures was very low. One bad suture could lead to thrombosis, which will then lead to necrosis.

Such high requirements were not required for the vascular network around the Achilles tendon. Academician Zhu Tongyi’s Plan A was just the reconstruction of the vascular network. There were three or four perforating arteries on the medial side of the Achilles tendon and three or four perforating arteries on the lateral side of the Achilles tendon. Academician Zhu Tongyi hoped to reconstruct two perforating arteries on each side, and at the very least, one perforating artery. Then, he wanted to ensure that a certain number of small blood vessels were reconstructed. That was the basic requirement for Plan A.

Most importantly, even if Ling Ran failed in reconstructing one or two blood vessels, the effect would not be too severe, at least it would not lead to the failure of the Achilles tendon repair.

And if the plan they chose failed? While there were plenty of things to say if an experimental surgery like this worked, if it failed, they would have no way of explaining themselves.

Zhu Tongyi stared at Ling Ran’s movements quietly, and he seemed to be more nervous than Ling Ran.

Ling Ran was, in fact, getting more and more relaxed as he operated.

His wrist moved gently. His fingers slid up and down the microscope nimbly. With a few movements, he was done suturing a blood vessel. He then pulled out another blood vessel, and with a few moves, he stitched it up again.

Ji Tianlu was busy cooperating with Ling Ran. Even Lu Wenbin, the second assistant, was also busy moving about the operating table. He would pour the saline solution to moisturize the blood vessels at one moment, then after a while, he would dab the surgical area using gauze. After some time, he would drain the area of excess fluid, and he would also use a retractor sometimes. The level of work was comparable to someone in charge of roasting his own food in a barbeque buffet.

Everyone had a frown on their face. They had the look of agony of someone who fought in a bloody battlefield or stayed up late the previous night to do their homework.

Only Ling Ran’s expression did not change. In fact, he was so happy in his heart that he could fly.

He was actually suturing a real living adult’s blood vessels, and he even had to suture the entire vascular network. How delightful was that?

If this was a finger replantation, Ling Ran had to carefully debride, fix the bones in place, and perform tendon suture before he had the opportunity to play with two or three blood vessels, which was the most critical part of the surgery. Once he was done, he had to suture the nerves, and he had to then toss the task of suturing the skin to the other people.

To Ling Ran, debridement was no longer as interesting. Internal fixation was much more similar to the work of a carpenter. As for tendon sutures? The flexor tendon was still rather fun, but normal tendons were just not exciting. The blood vessels and nerves, which were what remained after everything else was done, were considered to be the most interesting part in a finger replantation surgery.

But what kind of situation did Ling Ran encounter today?

He encountered a difficult situation where he had to suture the blood vessels in a huge vascular network filled with fine and small blood vessels.

It was the equivalent of Zhu Tongyi giving the most essential part in a finger replantation surgery to Ling Ran to play with.

Ling Ran was on cloud nine.

This was not the rat tail in the simulation training space. Perhaps a rookie doctor would be very happy to be able to suture a rat’s tail once, but Ling Ran had long since passed the stage of a rookie doctor.

There was a living human who he could suture, and even had two assistants working with him. He had a scrub nurse handing him the equipment he needed, had a circulating nurse to help him as he performed the suture. This was more comfortable than practicing alone in the training space.

“Change to a finer thread.” Ling Ran was on a high. He sutured three perforating arteries in one go, and when he encountered a fourth perforating artery that was thinner than the rest. He simply changed decided to change the thread again.

Academician Zhu Tongyi had to remind him. “Your main focus should be ensuring homeostasis is achieved.”

The implication was that it was impossible for him to re-suture the entire vascular network. He could only choose the important blood vessels to form a barely functioning vascular network.

This was just like how originally exquisite and orderly supply routes would mostly be destroyed after a war. The general responsible for the reconstruction was not to restore every single one of the supply routes bit by bit, but to restore a supply chain to ensure that the most important supplies were delivered. The rest of the supply chain could be restored by the others, and they could do so over a long period of time.

Ling Ran understood Zhu Tongyi’s order. He nodded and explained. “I want to make an extra channel to serve as an alternate channel.”

Unlike ordinary “generals”, Ling Ran, who was in a good condition right now, not only wanted to restore the supply chain, he wanted to make one more.

“Do we still have time for that?” Zhu Tongyi looked at his watch, and his expression eased up a little.

Ordinary Achilles tendon surgeries, including its preoperative preparations, took about an hour or two. The longest duration of the patient on the operating table was two hours, and the shortest was thirty to forty minutes.

Zhu Tongyi’s Plan A was much more complicated. In his plan, the chief surgeon would take about four hours to complete the surgery. The allocated time was not simply decided, it was a ‘dynamic equilibrium’ he found according to the degree of exposure of the Achilles tendon and other factors.

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If the time was too short, the chief surgeon could not complete the surgery. If the time was too long, the outcome of the surgery might be compromised.

Now, once Zhu Tongyi saw that the surgery was going well, he hoped to finish the surgery within three hours, which would thereby ensure a more efficient recovery.

As he observed Ling Ran’s progress, Zhu Tongyi felt very hopeful. Even if Ling Ran made another alternate channel, if he could maintain his current speed, they might still make it to the time.

After he considered that ending the surgery way too early provided no additional benefits, Zhu Tongyi agreed to Ling Ran’s idea of suturing several more blood vessels.

Ling Ran was also very familiar with Zhu Tongyi’s plan. His eyes were fixed on the microscope. He was so happy he did not want to leave at all. He said, “We did not cut off many small blood vessels. We have hope to restore 30 to 40% of the vascular network. There are benefits to restore more of the vascular network, right?”

“Of course, but you must try to ensure quality as much as possible.” Zhu Tongyi reminded. “The danger of vascular spasm is still there, and the only useful blood vessel is an unclogged blood vessel.”

The more blood vessels that were recovered, the more nourishment the Achilles tendon would gain during its recovery.

The reason why patients who received minimally invasive Achilles tendon repair surgery could be discharged and go through rehabilitation so soon was due to the vascular network near the Achilles tendon still being around the tendon. As long as the Achilles tendon was sutured and the adhesion was handled well, it could recover to its previous state.

Open surgeries on the Achilles tendon performed in order to ensure the strength of the tendon did not have this benefit, especially if the surgery was performed using unique operative routes, such as an Achilles tendon repair surgery performed a pararectal incision to the tendon. The complications were obviously higher than surgeries performed with a midline incision to the Achilles tendon. The reason for this was that the latter had less blood supply, and hence, it had fewer blood vessels to destroy during the incision.

In Zhu Tongyi’s plan, the sutured blood vessels must be of a certain quality in order to function.

The quality did not have to be as high as the quality in the blood vessels of finger replantation, but it still needed to be of a certain quality.

In fact, Zhu Tongyi’s Plan A was basically making Liu Weichen’s Achilles tendon repair suture into an Achilles tendon repair suture combined with a blood vessel reattachment surgery, which was ten times more difficult. It was even harder to guarantee the quality and quantity of the surgery.

Zhu Tongyi looked at the young Ling Ran and feared that he lose his patience or his concentration.

This was the most common problem for young people.

Once the surgeon became careless and impulsive, problems would occur during the suturing of blood vessels.

Ling Ran did not pay any attention to Zhu Tongyi’s repeated urgings. He sutured the blood vessels with a steady hand and said, “I’ll guarantee the quality.”

Ji Tianlu could not help but look up and said, “Doctor Ling will be fine.”

Zhu Tongyi came back to his senses and quickly said, “I’m far too concerned about our plan, so much so that my judgment has been impaired.”

In the demonstration room.

All the doctors were in an uproar when they heard these words from Academician Zhu Tongyi, who was the leader of the research institute, and the absolute front of the medical center.

Doctor Qu could not hold back his feelings any longer and said angrily, “Truly, people would rather believe in outside help than believe in those beside them. The director is too easy-going.”

“That’s right. Even his tone of voice is no longer the same.”

“Hey hey hey, don’t magnify the problem. Our Academician Zhu did not say anything, didn’t he?”

“What do you want Academician Zhu to say? That’s enough? You have to understand that the plan is Academician Zhu’s. This is supposed to be a guided surgery. Ling Ran is just a chief surgeon.”

The 223-pound resident doctor cackled as he hugged his mineral water, “Ling Ran is just a chief surgeon? ‘Just’?”

The doctors who were very impassioned just now wisely shut their mouths.

It was very difficult to show off between peers, not to mention showing off in front of a professional doctor in a department.

If they were facing an outsider, they might still have something to say. When they faced their own people, everyone was relatively clear about their respective positions.

It could be said that the research institute gave Ling Ran the chance to be the chief surgeon for this surgery, but it could also be said that Ling Ran came over to help because the research institute could not find anyone qualified enough among them.

But no matter how they looked at this, Ling Ran currently occupied the strongest position in their institute.

The 223-pound resident doctor was unwilling to belittle his opponent.

He was also afraid of his opponent’s strength, but he was willing to admit to his difference in strength compared to Ling Ran. Ling Ran’s skills were strong, his talent was good, and he was perhaps a first-class surgeon in the country, but… doctors improved continuously!

The 223-pound resident doctor had set a detailed goal for himself. Once he was finished with his tasks at hand, he would enter isolated training and catch up to Ling Ran’s skills in the shortest possible time.

At that time, he would definitely find another opportunity to defeat Ling Ran. Then, he would bring a pair of purebred French lops and go to Xiao Yun.

As the resident doctor thought of this, he excitedly finished a bottle of mineral water from Nongfu Spring. He then let out a satisfied belch belonging to a 224-pound fatty.