Surgery Godfather

Dean Pan, the health bureau officials, the township government, and Village Chief Fang all came to visit Yang Ping, expressing their thanks, condolences, and apologies.

Tian Yuan reported Yang Ping’s injury to Director Han. Upon hearing this, Director Han expressed great concern and ordered Tian Yuan to shorten the outpost assignment and retreat early, specifying that he would inform her of the specific withdrawal time.

He then immediately called Yang Ping, expressing his concern and urging him to rest well.

Soon after, Director Tian and Song Zimo both received phone calls from Director Han, who stressed the importance of taking good care of Yang Ping and cautioned them to prevent any potential infections.

About ten minutes later, Director Han made another phone call, this time to Tian Yuan’s cell phone.

After the call ended, Director Tian said, “We’ll head back early the day after tomorrow. The hospital will arrange a car to pick us up. The car will arrive tomorrow, and we, the orthopedics team, will all leave ahead of schedule.”

“I’ve told Director Han that Xiao Su will also be going back with us,” Director Tian added.

Tian Yuan was kept busy, and her phone rang again. It was Dean Pan who had received notice from his superiors. He informed her that due to an emergency at Sanbo Hospital, a few members of the medical team needed to return earlier than planned.

“Return earlier? What about the patient with chronic osteomyelitis of the femur, Xiao Xu? His surgery hasn’t been performed yet.” Yang Ping was still worried about this patient.

Xiao Xu’s bacterial culture results showed that he had coagulase-negative Staphylococcus on the exposed bone, but no other bacteria was detected, which was in line with the preliminary judgment. The surgery could be scheduled now.

Director Tian said, “The surgery can be entrusted to Director Zeng. Just make sure he understands the key points of the surgery.”

Yang Ping was not reassured: “No, that won’t work. In this surgery, the removal of infected bone tissue needs to be very thorough. If even a tiny bit is not completely removed, the surgery will fail.”

“In that case, we can suggest that he come to Sanbo for the surgery in the future.” Director Tian was in a dilemma as the return time had already been set, and knowing Director Han’s temperament, it would be quite difficult to make a change.

“His financial condition is not good. He cannot afford to go to the city at this point.” Yang Ping had deep sympathy for Xiao Xu.

“Let’s schedule the surgery for tomorrow then, and have Song Zimo as the chief surgeon,” Yang Ping suggested.

He asked Little Five to call Director Zeng. He instructed him to sterilize the external fixation frame and its supporting equipment in advance, informed the patient to start fasting, and arranged for him to undergo a full-length femoral CT scan tomorrow morning. He also called for a bedside vascular ultrasound to locate the recipient artery of the skin defect area and the donor artery of the latissimus dorsi area; furthermore, he sought consultation from the Department of Internal Medicine for perioperative thyroid function management.

“For this patient, each imaging examination showed an increased range of bone tissue infection. I’m afraid if we don’t operate now, the whole femur might get infected and then there will be no chance.” Yang Ping explained.

“I have seen this patient’s films. I heard you surmised that the local bone tissue infection of the femur is due to hyperthyroid bone mineral disease?” Director Tian asked.

“Yes, so it’s best to remove the infected bone tissue as soon as possible,” Yang Ping replied.

“I’ll be in the operating room tomorrow to assist Song Zimo,” Director Tian said enthusiastically. After arranging the surgery, Yang Ping finally felt relieved.

That night, Yang Ping rested early.

Upon entering the system, he dissected a few more subjects, and a preliminary anatomical image of the human body was established in his mind.

For doctors, especially surgeons, the ability to visualize is very important.

Yang Ping originally had strong visualization skills, and through intensive training in the system, the human anatomical diagram in his brain gradually became clearer. When he closed his eyes, the major organs, nerves, and blood vessels appeared incredibly clear, but some details still needed further refinement.

Although there’s no physiological energy consumption in the system, mental fatigue still existed, so he didn’t stay for long and exited the space to get some sleep.

The next morning, Xiao Su sent him a WeChat message. She was waiting outside the dormitory, inviting him to have breakfast with her.

Watching from a corner, Xiao Su was gently feeding Yang Ping breakfast bit by bit.

Liang Fatty said, “From the very first time I saw them, I sensed that there’s a story between them.”

“What story?” Zhang Lin was curious. Was there a story he didn’t know about?

With confidence, Fatty said, “That night of the emergency finger amputation, it was Yang’s first surgery, and Xiao Su was the scrub nurse. There was something off about the way they looked at each other.”

“Really? No wonder they knew each other before. Could it be that our senior brother transferred from the People’s Hospital to Sanbo just for Xiao Su?” Zhang Lin stroked his chin, speculating boldly. He had a talent for unearthing stories.

Fatty nodded affirmatively: “That’s eighty percent accurate. Before this, both of them were quite secretive. If not for Yang’s hand injury this time, their secret would still be hidden; they’ve kept this concealed quite well.”

Zhang Lin said, “Yes, for a while, we suspected that they were going to get married. Even though our senior brother denied it, it seems our guess was right.”

Little Five remained silent off to the side.

“Why are you so quiet today?” Zhang Lin asked him.

Now, Little Five was also confused and couldn’t sort things out.

After handover, Yang Ping was unable to do rounds due to his condition, so Song Zimo led the team on ward rounds.

After making the rounds, everyone in the doctor’s office was preparing to discuss Xiao Xu’s condition. There was a ruckus outside that seemed like a patient causing trouble, so Director Zeng stood up: “I’ll go have a look.”

“Over here, over here!” Teacher Yan hobbled in on his crutch.

His son and daughter-in-law were carrying a large banner, on it were these golden characters: Cure at hand!

“Director Yang, what happened to your hand?” Teacher Yan gasped as he saw Yang Ping’s hand.

Yang Ping smiled: “I accidentally grazed it, it’s no bother.”

Teacher Yan nodded: “That’s good, your hands can’t get into trouble.”

The old man instructed his son and daughter-in-law to carry in the banner. This banner was big, at least three times larger than usual.

“Director Yang, there’s not much we can do to thank you, so we brought over this banner, just a token of our gratitude. I wanted to write a poem originally but after wracking my brain for two days, I couldn’t come up with one. So, these several characters will do.”

After the excitement died down, they continued to discuss Xiao Xu’s condition. Director Tian also came to the orthopedics department.

After Xiao Xu had his CT scan he returned to the ward. The attending physician brought up his CT images and Director Zeng put them up on the light box.

“This patient, the surgical procedure mainly consists of three steps. First, the removal of the intramedullary nails, replaced by external fixation. Second, the complete removal of the diseased bone tissue, and filling the bone defects with vancomycin-loaded calcium sulfate. Third, repair the defect using a free latissimus dorsi musculocutaneous flap. The hardest part is the removal of the infected bone tissue. It must be precise and thorough. Each of his radiographic examinations shows that the range of bone tissue infected is expanding. Therefore, we need to redo the CT scan before the operation to determine the extent of the infection.”

Yang Ping briefly outlined the procedure, looked closely at the images on the light box, and said, “The rectangle bone flap should be made 10 centimeters above the edge of the patella in the extended position. It should be 8 centimeters long and 3 centimeters wide. The centerline of the rectangle is the centerline of this section of the femur. This way, we can completely remove the infected bone tissue. Hand me a piece of paper.”

Someone pulled out a piece of A4 paper from the printer. Through his bandaged hand, Yang Ping barely grasped the pen with the webs of his fingers and started to draw on the paper: “This is the shape of the infected bone tissue, and this is the shape of the rectangular prism.”

A 3D shape was drawn on the paper, the irregular shape was surrounded by a regular rectangle.

“How did you work that out?” Song Zimo was looking at the drawing.

Yang Ping replied, “It’s based on the CT scan image, with an added safety margin of twenty percent of normal bone tissue.”

Song Zimo thought, this requires strong spatial visualization ability. If he were to draw it, he probably would need to measure and redraw multiple times. Yang Ping looked at the image and drew it just by estimation, demonstrating his impressive spatial visualization ability.

Director Tian adjusted his glasses: “What are your chances of success?”

“Theoretically, it shouldn’t fail,” Yang Ping was very certain, after all, the extent was calculated from the CT scan.

“Trim the skin and muscle defect into an oval shape, 12 centimeters long and 5 centimeters wide. The size of the latissimus dorsi musculocutaneous flap will be twenty percent larger than this. It can perfectly repair the defect in the lateral thigh muscle.”

An ultrasound technician arrived, the attending physician informed them.

Together with the ultrasound technician, Yang Ping searched for the arteries in the defect area and the latissimus dorsi area, marking all usable arteries one by one.

A skin flap is a piece of skin taken from one location to replace skin missing in another location. If it’s close, the skin can be transferred with the blood vessels still attached. If it’s further away, the blood vessels are cut and reconnected to the blood vessels at the defect site.

The musculocutaneous flap includes stealing along with the muscles and skin. It can be used to replace both skin and muscles.

It’s all just robbing Peter to pay Paul.

Yang Ping instructed Song Zimo to draw the shape of the defect to be repaired, as well as the shape of the latissimus dorsi musculocutaneous flap, all with a surgical marking pen.

“Doctor, once this is done, I can finally enlist,” Xiao Xu hadn’t forgotten his dream of becoming a soldier.

Yang Ping glanced at his glasses: “You’re nearsighted and still want to enlist?”

Xiao Xu took off his glasses: “These are just for show.”

Enlisting is out of the question, this young man will soon realize that sometimes dreams clash with reality, some conflicts are simply irreconcilable.

After the internal medicine doctor viewed the thyroid function data, he concluded that it wouldn’t interfere with the surgery. He suggested another thyroid function test after the surgery, control it with medication, and for him to personally assist the operation, on alert for thyroid crisis.

Song Zimo would take lead, assisted by Director Tian as the first assistant and Director Zeng as the second. This surgery wasn’t difficult for Song Zimo.

In the middle of the procedure, Yang Ping patiently guided Song Zimo on accurately locating the infected bone tissue. Song Zimo, with his reasonably strong spatial visualization ability, found it easy to understand.

Once the bone tissue was removed, Yang Ping confirmed repeatedly that the infected bone tissue had been completely excised, with a ring of normal bone tissue around it; this was the ideal situation.

Chronic osteomyelitis is most troublesome to orthopedics specialists; it’s what they dread most. Because bacteria hide inside bone tissue, where antibiotics can’t reach, they can’t effectually combat the bacteria. So once you get chronic osteomyelitis, it relapses time and again and often requires many years to heal.

If there are no unexpected complications, Xiao Xu should be able to recover this time.