Practicing Medical Skills in a Small Clinic novel Chapter 42

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.

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