Practicing Medical Skills in a Small Clinic-Chapter 42: "Cold Weapons" and Tactile Sensation

Chapter 42: Chapter 42: "Cold Weapons" and Tactile Sensation

From the perspective of instruments, there are usually three commonly used separation instruments.

The first type is various traditional scalpels.

They are considered ’cold weapons’, but they have unparalleled advantages over other tools when separating extremely difficult tissues or organs, blood vessels, and nerves.

Many surgical experts refer to it as a double-edged sword.

If mastered well, it can provide various bonuses. If not, medical accidents are waving at you.

Practicing with traditional scalpels offers a benefit that drives all surgeons crazy, which is the feel.

Nowadays, there’s a plethora of electrosurgical knives and laser knives, very convenient to use.

But their technological feel is too strong.

If you want to develop keen tactile feedback, only traditional scalpels can achieve it.

The skilled surgical experts can make a cut, and just by the tissue the blade touches, they can accurately identify it with their eyes closed. Some even press the knife against the incision and know whether there are large blood vessels or nerves underneath.

This skill allows them to dance on the blade and perform various high-precision major surgeries with ease.

However, it’s extremely difficult to develop a keen sense of tactile feedback.

Li Jingsheng, due to conditions, couldn’t afford an electrosurgical knife for the time being, not even the simplest and most commonly used monopolar electrosurgical knife. So surgeries could only be done with traditional scalpels.

Right now is an excellent opportunity to practice separating pathological tissues with a traditional scalpel.

With proficient skills in skin incision and superficial debridement as a foundation, as long as he’s careful, he shouldn’t make a misstep.

Quickly contemplating the pros and cons, and risks in his mind.

Then taking a deep breath again, making a decision.

Attempting to separate this fistula from the patient with the Entry Level Sharp Separation Method.

Whether successful or not, his separation skills will improve significantly.

Practical experience is the fastest way to enhance skills.

He never fights a battle unprepared.

Beginning to meticulously recall the various key points of the Sharp Separation Method with traditional scalpels.

"Before cutting, close the blood vessels as much as possible!"

"The removed tissue should be fully exposed and identified, ensuring that the tissue to be cut is always under direct vision during the procedure, to avoid cutting the wrong part or overcutting."

"When using ligatures or hemostatic clips, enough residual ends should be reserved to prevent slipping."

...

Tang Ping did not rush him, patiently waiting beside for Li Jingsheng to proceed to the next step of the surgery.

"Sister Tang, can you help me pull the wound open on both sides?"

"No problem. Should I use a retractor or just my hands?"

"Use a flat hook! But be careful with the force, ensuring my surgical field and enough tension while separating the fistula."

Li Jingsheng had no choice, lacking manpower, he had to let her multitask.

Using a retractor is a physical task, rarely asked of nurses.

It’s usually free interns or training residents called in to help with retraction.

Only if the attending is retracting for a chief surgeon’s procedure, they would be eager to do it. For secondary surgeries of attending physicians, they are mostly unwilling.

Some residents with a bit more skill even aren’t interested in opportunities for suturing.

Because they have already mastered suturing skills.

Under Li Jingsheng’s guidance, Tang Ping opened the incision on the patient’s back, and fresh blood emerged again.

However, Li Jingsheng remained calm, clamping a piece of hemostat gauze to absorb it, and immediately devoted himself fully to the separation of the fistula.

He has multiple reasons to be so bold.

First, the fistula is not deep, so the risk factor is low.

Second, the fistula is very thin, so the area needing removal is not large.

Third, he has a certain confidence in himself and a strong desire to master a separation technique.

...

Carefully, he slices bit by bit, separating the left side of the fistula from the healthy tissue, and then proceeds to handle the right side.

Before separating each side, he repeatedly ensures no larger blood vessels are present.

If accidentally broken, as long as it’s not a larger artery, it can still be salvaged.

But that would cause trouble, ruining his reputation.

So a lot of risks need to be taken this time.

To be exact, any surgeon operates with many unknown risks, even if it’s just the simplest first-level operation.

If one is timid in this profession, it’s better to go home early and take care of children.

As the teaching mentor says, surgery requires courage, attention to detail, hard work, and practice.

A minute on stage, ten years of work off stage.

With his efforts, the fistula gradually separates from the surrounding tissues.

Though the separated incision is jagged, overall, this first-time separation of a high-difficulty fistula on a patient is truly a remarkable feat.

Of course, this must not be known by the old man.

Otherwise, he would be angry enough to tear down his little clinic directly.

After twenty-one full minutes, he successfully separated and excised the entire fistula. Throwing it into the tray, the old man craned his neck to take a glance.

"Dr. Li, is that the thing causing the boils on my back?"

"That’s right, it’s the culprit for the unhealed boils. Now it has been successfully excised. Please don’t move, I’ll clean the wound and then suture to stop the bleeding."

Li Jingsheng said to him.

Successfully separating the fistula, he felt he had gained immensely.

Both mentally and technically, there was an exceptional improvement.

It’s not yet time to count the harvest of medical skills; after the surgery, when there’s time, it won’t be too late to check the changes in the attribute panel.

He carefully debrided and trimmed the wound.

Then he debrided and organized the original abscess cavity on the back again.

This abscess cavity has been debrided many times, and it currently looks fine, without new obvious infections. So, a simple cleaning will do.

The part connected to the sinus tract has been completely removed.

After finishing this, Li Jingsheng hurriedly performed suturing for the wound caused by removing the sinus tract.

If it was before, he would definitely sew it like a dog’s bite.

And he could only use Entry Level continuous suturing or interrupted suturing.

Now, he has learned four suturing methods, all at proficient level.

Suturing this wound, he seemed calm and assured.

The newly learned horizontal mattress suture not only reduces wound tension but also tightens epidermal blood vessels to assist in stopping bleeding, making it the perfect choice.

Using proficient level horizontal mattress suture was quite good.

The suturing speed is at least twice as fast as Entry Level.

Moreover, his knot-tying skills have also improved, square knot, surgical knot, slip knot, all at proficient level.

He has it well in hand!

Just two words: truly satisfying.

After suturing the old man’s wound, disinfect the surface, and cover it with gauze to protect the wound.

"Alright, I’ll help you up. You can’t leave yet; we need to infuse fluids later. Also, after you return home, you must protect the wound well, keep it dry. If it gets infected and purulent, it can be troublesome, even life-threatening."

The surgery is now completed and has been done successfully.

Li Jingsheng also breathed a long sigh of relief.

With an effort, the bicycle turned into a motorcycle.

Successfully completing this challenging surgery today is of extraordinary significance to himself and the Sunshine Clinic.

At the same time, it also helped the patient solve a major problem.

While the surgery went well, postoperative care is equally important.

Without being hospitalized for management, there will be many unpredictable risks.

For instance, if the patient doesn’t listen, feels pleased at home, and takes a drink.

Or if it gets hot, wants to take a bath, etc., all of which could lead to failure and extremely serious consequences.

Li Jingsheng must emphasize the consequences to scare the patient enough not to act recklessly.

"No water, absolutely no water. Even if I smell bad and get lice, I won’t let water touch it. Washing my face should be okay, right?"

The old man was so frightened his face changed upon hearing that the wound might be fatal if it touches water.

He immediately promised never to let water touch it.

"Washing your face, washing your hands, isn’t much of an issue. But be very careful, never let water touch the wound. Also, if it gets hot, just stay home with the air conditioner on, preventing sweat on your back."

Li Jingsheng helped the old man down from the bed.

Didn’t dare let go of his hand.

The patient is in his sixties, just finished surgery, lying for a long time, standing up suddenly, is easy to fall.

Within the clinic, he must be responsible for the patient’s safety.

"Even sweating is not allowed?"

"Certainly not, sweat easily breeds various bacteria, and if they get onto the wound, eight to nine times out of ten, it will cause infection. Back when I worked in a big hospital, there was a patient who didn’t listen to advice, and we doctors and nurses tried saving him all night but couldn’t."

Tang Ping speaking so vividly.

Having worked with Li Jingsheng for a long time, the two complement each other, influencing patients or customers excellently.

"Oh wow, that serious! Thanks to your reminder, I will definitely be careful."

The old man seems quite fond of his little life.

And rightly so, getting a substantial retirement salary every month, life’s really comfortable.

Surely he doesn’t want to die.

"Going out for a while is not recommended. In case you get caught in the rain or someone pushes you, the risk is high. The sinus tract on your back has been removed, and if you cooperate well with treatment, pay attention to nutrition, you might recover in less than half a month."

Li Jingsheng also knows that keeping the old man cooped up at home for too long, he surely won’t be able to hold it.

Giving a half-month time frame, the old man thinks he can endure it.

"Alright, I’ll just stay at home recently, watch TV, play with my parrot."

The old man easily made the choice most beneficial to him.

Opening the treatment room door, the old lady outside had been anxiously pacing back and forth N times. Seeing the old man being helped out by Li Jingsheng, her eyes reddened for a moment. But seeing he’s alright, her face instantly showed an extremely happy smile.

"Dr. Li, is the operation completed?"

"You gave me a big red envelope; if it wasn’t successful, that would be too unfair to you! Now the surgery is done, returning what was given, I’ll refund you the exact amount you gave me."

Li Jingsheng, having successfully completed the surgery, was in a great mood.

Smiling, he returned the batch of cash the old lady had given him in its original state.

The old man seeing this situation, froze for a moment before understanding everything.

He didn’t say a word, just looked at the old lady like a young man experiencing his first love looking at the girl he loves.

As if glued together.

Men’s feelings are generally deep, not good at expressing, but they like to express through actions.

"No no no, this is willingly given to you. Now the surgery is successful, I think the money was especially well spent." The old lady somewhat nervously glanced at the old man.

Probably fearing the old man might scold her for secretly giving a red envelope to Dr. Li.

But upon seeing the old man’s infatuated gaze, her heart instantly gained confidence, sweeter than having eaten honey.