Surgery Godfather

The surgical position is crucial; one inaccurate positioning could render the operation impossible.

The films were hanging on the operation room’s lightbox. Director Tian read the films again. Although Dr. Tao had already marked the operation site, Director Tian decided to verify the left or right side of the operation site himself.

“Professor Tian, how many people do we need in the surgery?” asked Director Miao.

Director Tian replied, “Just the two of us, Director, and we need Dr. Yang onboard. Dr. Song can rest.”

Song Zimo was responsible for driving. He needed to rest to avoid fatigue in case he had to drive back at night, so he stayed on as backup.

Director Miao had to perform the surgery. He was the director, and the patient was an acquaintance of his. Even if he didn’t do anything, his presence in the surgery was mandatory. It was the most logical arrangement.

“Begin the blood and fluid transfusion!”

Director Tian gave the instructions to the anesthesiologist and circulating nurse, and then assisted in positioning the patient in the prone position.

They would go from the back road and then the front road. This complex type of fracture could not be solved by either front or back approach alone; both approaches had to be combined.

Director Tian had long been confident about the operation. Indeed, the surgery was complex. There aren’t many hospitals capable of handling this kind of complex pelvic and acetabular fracture. It represents the pinnacle level of trauma orthopedics.

For the doctors of the county hospital, going out for further study is a chance to learn. Also, having a professor from a higher-level hospital do the operation is another learning opportunity.

Any available orthopedics’ doctors were now in the operating room to watch the operation.

Everyone had already been impressed by Director Tian’s professionalism back in the ward, and now they all wanted to see his remarkable surgical skills.

There were already three people on stage, and Dr. Tao didn’t know whether he should join in. It’s common to have four people for pelvic fracture surgery. He was torn.

“Xiao Tao, you can help out with the C-arm machine at the side.” Director Miao made the decision for him.

The positioning was completed, Director Miao, Director Tian, and Yang Ping went to scrub up.

Anyone who could do things was always energetic. Despite being fifty, Director Miao was still full of vitality, sturdy and forceful in action.

“How much blood is prepared?” Director Tian asked.

“Twelve units of suspended red cells and 1200 milliliters of plasma!” Dr. Tao replied.

That was enough. They started to scrub up and dress.

This kind of operation was beyond Dr. Tao’s reach. He usually only performed simple surgeries, leaving complex fractures for Director Miao.

Even Director Miao was not confident he could handle this patient’s surgery. It was not because of the patient’s special identity, but it was actually technically challenging.

Surgery was not child’s play. For an operation like this, if it cannot be handled, insisting would risk a patient’s life.

Doctors can brag in their day-to-day, but no one would be foolish enough to undertake a surgery they can’t handle. That’s purely self-destructive. One operation could ruin a lifetime.

As a department director, aside from holding up the department with skills, you need to have some backup. Like Director Miao, when the operation was too difficult to handle, he could make a call, and Director Han would dispatch an A-team to provide strong support from the province. Someone else may not be able to do this.

The sterilization and sheet set up were routine procedures and were the same in all hospitals. Yang Ping was the first assistant, and Director Miao was the second.

They started with the back road, aiming to reduce and fix the posterior column and posterior wall fracture of the acetabulum.

Director Tian was extremely proficient, making standard incisions, steadily advancing layer by layer.

Director Tian made the operation look light and effortless. His movements were unhurried but without any superfluous or ineffective ones, and the transitions were tight, so the operation was swift.

Usually, when Director Miao performed a pelvic surgery, gauze pads were used one after another. The clean gauze pads would be soaked with blood when they came out.

Now only one gauze pad has been passed over, and there was only a faint red hue on it. This led to doubts about whether this was a pelvic surgery, or if the surgery had even started.

A few doctors were moving around, trying to find the best observation spot, but they couldn’t get a good view and did not dare to come closer.

Unlike in Sanbo Hospital, where high-definition cameras provided a video feed, Shipo People’s Hospital’s operating room did not have this equipment.

“Prepare the plate, get ready for the electric drill!”

It was only about ten minutes, and the posterior column and posterior wall of the acetabulum had already been reduced. It’s time to apply the plate.

How come he was so fast without hurried movements?

When the several doctors were discussing in private, the plate had already been pre-bent and they had started to put in the screws.

Director Miao was impressive for being able to invite such a skilled professor from the provincial city.

Dr. Tao felt a bit discouraged. At the same age, the professor could handle such a major surgery with ease, while he was still struggling with secondary surgeries.

In about half an hour, the posterior column and posterior wall fractures had already been reduced. After syringing, they placed the drainage and started suturing.

X-ray!

The screen shows the rear wall of the acetabular posterior column has been fully repositioned, and the position of the steel plate and screws is good.

“Flip them over and prepare for anterior surgery!” This seemingly casual remark has already attracted countless admiring gazes.

To the observing doctors, the technological gap seems insurmountable at this moment.

Disinfect again, lay out the drapes, wash hands, and put on gowns.

The anterior surgery begins.

“There will a lot of blood loss in anterior surgery! Therefore, you must replenish fluids and blood in advance to dilute the blood,” explains Director Tian.

The CT angiography has indicated many vascular injuries in the pelvis. The patient’s blood pressure was stabilized through fluid and blood transfusion immediately after the injury. However, now that we are directly approaching the fracture point, the bleeding, which had previously ceased, will inevitably resume.

“The death artery has already ruptured and retracted. We need to move quickly. We should find the blood vessel within ten minutes,” Director Tian reminds Yang Ping that their cooperation is crucial in this key step.

The ‘death artery’, which is an anastomotic branch between the obturator artery and the external iliac artery, is also known as the death wreath. Once ruptured and bleeding, it will recoil, much like a snake retreating into a hole in a bush–it becomes very difficult to locate and stop the bleeding. Consequently, the patient will fall into a perilous situation, which is why it is given such a frightening name. This is a major hurdle that must be taken seriously in pelvic surgery.

Regularly replenishing fluids and blood, Director Tian’s techniques not only supplement and dilute the patient’s blood, but also minimize the patient’s own blood loss. This specific patient, being anemic, cannot endure significant blood loss, otherwise, their blood pressure is likely to plummet.

Experience is gained and risks are assessed through numerous surgeries. Like a captain navigating the ocean, experienced surgeons can avoid hidden rocks and wind waves.

The anterior operation needs to address the acetabulum and iliac wing, as well as the sacroiliac joint and sacrum. The difficulty is extremely high. Even within the entire province, only a few prominent figures who frequently appear in academic conferences can perform this surgery.

To address multiple fractures, Director Tian uses an incision that he personally designed.

Director Miao, standing off to the side, feels as though he’s sitting beside a race car driver with sweat in the palm of his hand.

There are many nerves and vessels here–be careful! But Director Tian skillfully avoids them. If an accidental vessel incision occurs there and the blood cannot be stopped in time, slow down! But again, Director Tian perfectly avoids this.

As soon as Director Tian contemplates elevated exposure, the hook’s position has already changed, assisting in the revelation. Blood has just begun to seep out, but the assistant has already clamped the vessel with a hemostat. A touch from Director Tian’s electric knife brings a perfect stop to the bleeding.

Just when you’re about to caution about nerves and vessels, the assistant’s hemostat has gently pushed it away, aiding in the separation of vessels and nerves.

With Director Tian’s high-level skills and Yang Ping’s excellent coordination, the surgery is practically a perfect performance.

Director Tian just realized that he didn’t pay enough attention to the assistant during the initial posterior surgery. Now it seems that this assistant is so perfect. No wonder Director Han asked himself to bring him along. Director Tian looked up at Yang Ping.

Director Miao has already been dazzled and cannot keep up with the pace. He can only stand to the side, idle.

The surgery has entered a critical phase, and we are about to encounter the death artery! Before coming to Shipo, Director Han repeatedly reminded Director Tian to be careful here!

“Controlled hypotension!” Director Tian ordered the anesthesiologist.

Intraoperative controlled hypotension, also known as low-pressure anesthesia, can control blood pressure within a lower yet safe range. Lower blood pressure naturally results in less bleeding, similar to how a pipe with lower pressure has a weaker water flow.

“The death artery is hemorrhaging and has recoiled already, we are unsure if it has occluded on its own,” Director Tian reminded Yang Ping.

Although it’s nerve-wracking, it is essential to face and resolve it. Otherwise, the surgery cannot proceed, let alone bone fixation.

The left and right hands cooperate dexterously, and the scissors skillfully perform sharp dissection.

Once the adhesions are separated, blood spurts out immediately, and the blood vessels are not visible.

As expected, the death artery has recoiled and ruptured the fragile self-clotted blood clumps. However, Director Tian remains calm. Anyone else would have completely collapsed by now or lost the courage to continue.

But he is Director Tian after all. He just needs to replenish blood to buy him ten minutes. Then he can find the death artery and stop the bleeding successfully.

Using the speed of blood transfusion to buy ten minutes is not a problem. He had considered this well before the surgery.

The suction device in Yang Ping’s hand quickly sucked up the blood to keep the operation area clean and create the best surgical vision for Director Tian.

“The blood pressure is dropping, they’re in shock!” The anesthesiologist cried out in a somewhat panicked voice.

Shock?

Need gauze quickly! Gauze!

Director Tian immediately stops the surgery, temporarily packing with gauze. His hands move swiftly to pack the bleeding area with gauze. Yang Ping has taken over, pressing down firmly to free Director Tian to handle other matters.

The monitor indicates that the blood pressure has dropped to 70/30. True shock has set in and it is still declining.

There wasn’t much blood loss just now, even with the bleeding from the death artery. It only just started bleeding. They had already started blood transfusions and fluid replacements just now, so why did the patient suddenly go into shock?

Could it be that the earlier posterior repositioning affected the major arteries or veins, such as the abdominal aorta or the internal or external iliac artery, causing a rupture?

No, the entire process just now was clear. There were no blind maneuvers, and he had completely understood the images before the surgery. None of the bone fragments were close to the major blood vessels.

Several possibilities quickly flashed through his mind.