In the observation room, Director Duan had already printed out the patient's case file and distributed it to the junior doctors.
"Everyone, pay close attention to the surgical plan of Dr. Qin and Dr. Wu, and learn from it. This case is the most representative one in this batch of patients."
The junior doctors began reading. "A Zone II flexor pollicis longus tendon injury? That's incredibly difficult."
"Yeah, I wonder what kind of surgical plan Dr. Qin will use."
"The thumb is one of the most important fingers, accounting for 50% of hand function. The thumb's flexor function, in turn, makes up 20% of the thumb's total function. A healthy flexor function is fundamental for performing fine motor movements. Therefore, an injury to the flexor pollicis longus tendon causes significant thumb dysfunction, making its effective repair critically important."
The doctors all murmured in agreement. If a patient like this were on their operating table, they wouldn't dare to proceed so readily.
"Zone II tendon injuries involve a complex tendon sheath system, making them prone to postoperative adhesions. That's why repairing them has always been a clinical challenge. It's the main difficulty and the key focus of this particular operation."
"An ideal flexor tendon repair requires enough tension to withstand early rehabilitation exercises. It also requires a complete tendon sheath to prevent bowstringing deformity from occurring. Given this patient's condition, they'll definitely need a custom-designed surgical plan."
Director Duan also started recording the surgery in advance, so it could be used as a training video for the junior doctors to study later.
In the operating room, Qin Donglai and Wu Ting began the surgery.
As before, Wu Ting was the lead surgeon, with Qin Donglai supervising.
The patient was under a standard brachial plexus nerve block, placed in the supine position with a pneumatic tourniquet on their upper arm.
After immediately completing the routine disinfection and debridement, Wu Ting flexed the patient's interphalangeal joint.
Watching Wu Ting's debridement technique, the doctors in the observation room couldn't help but comment, "This young doctor's fundamentals are incredibly solid. He's a doctor from City First Hospital, all right."
Director Duan also emphasized:
"All of you, pay close attention to Dr. Wu's medical practices. While debridement is a basic surgical procedure, the quality of the initial wound management is a deciding factor in healing and the functional and morphological recovery of the injured tissues. You all must take this very seriously."
As the director of the county hospital, Duan Qiang had a discerning eye:
"Look at Dr. Wu's technique; there's a lot we can learn from it. First, take his muscle debridement. His assessment of muscle devitalization is incredibly precise."
"When we perform debridement, we must completely remove all devitalized muscle. The criteria for this are color, tension, contractility, and bleeding. As you can see, Dr. Wu's judgment is decisive, and his movements are crisp and efficient."
The junior doctors had only a hazy understanding at first, but with Director Duan's explanation, they could finally appreciate the true proficiency behind Wu Ting's actions.
"Now watch how Dr. Wu handles the tendon. Wherever its continuity is intact, he chooses to preserve as much as possible to prevent rupture, covering it with subcutaneous tissue to prevent exposure. It's these small details that increase the surgery's success rate and ensure a better postoperative prognosis."
While Director Duan was still marveling, Wu Ting finished the debridement flawlessly and began to probe the distal end of the tendon.
"Scrub nurse… a 15cm section of an IV tube… surgical scissors…"
Hearing Wu Ting's command, the scrub nurse was somewhat confused.
The junior doctors in the observation room were equally baffled.
"What is Dr. Wu doing?"
"Could it be some kind of brand-new tendon repair technique?"
"I'm learning so much today. I have to write this down, write this down."
Seeing Wu Ting's novel approach, the doctors were all buzzing with excitement. Even Director Duan was filled with admiration.
'I have to invite Dr. Qin and Dr. Wu for more surgical exchanges in the future,' he resolved. After a moment's thought, Director Duan decided that when it came to payment for the operation, he would prepare a separate fee specifically for Wu Ting.
'This Dr. Wu is so young,' he thought. 'He's bound to have a limitless future. I absolutely must build a good relationship with him.'
'Dr. Qin's career will probably top out at associate chief physician. But with the potential Wu Ting is showing, he could go much further—maybe even beyond City First Hospital. For someone at a county hospital, the only chance to befriend a talent like that from a major city hospital is before he truly rises to prominence.'
Back in the operating room, Wu Ting soon began performing his modified Surgical Technique.
The proximal end of the patient's tendon had retracted to the transverse carpal ligament. To address this, he made a 15 mm longitudinal incision proximal to the wrist crease, between the flexor carpi radialis and palmaris longus tendons, to dissect and expose the proximal stump of the flexor pollicis longus tendon.
Then came an ingenious move. He took the 15 cm section of IV tube, trimmed one end into a bevel, and passed it retrograde through the oblique and A1 pulleys. He guided it along the tendon tunnel, out through the original wound, and up to the wrist crease. Next, he sutured the proximal tendon stump into the tube. Finally, by flexing the patient's wrist, he used the tube to pull the proximal stump down to the Zone II injury site.
"Scrub nurse… two needles… 6-0 Proline suture… needle holder…"
Listening to Wu Ting's calm commands, the scrub nurse, though tense, kept up perfectly.
'This was an experience she could never have on a normal day,' the nurse thought. 'So intense and exciting. He really is an expert from City First Hospital.'
In the observation room, it was only at this moment that it dawned on everyone. A wave of acclaim immediately erupted.
"So that's it! That's brilliant! The IV tube serves as both a protective guide and a fixation device. Now he's using a modified Kessler method for the repair, with a 6-0 Proline running-locking suture around the circumference to keep the coaptation site smooth."
"What an ingenious modification!"
The doctors were completely and utterly impressed.
"A simple, ordinary IV tube! It effectively preserves the entire pulley system, minimizes damage to the tendon and pulleys, and prevents postoperative adhesions. It solves the single greatest challenge in repairing the flexor pollicis longus tendon!"
"And the running-locking suture technique minimizes the gap between the tendon stumps, resulting in a much smoother repair site."
"Best of all, the circumferential suture also significantly increases the repair's tensile strength, which is crucial for facilitating early functional rehabilitation."
"I never imagined we'd get to witness a surgery of this caliber right here in our own county hospital."
As Wu Ting and Qin Donglai perfectly concluded the surgery, everyone in the observation room rose to their feet and applauded.
Inside the operating room, Qin Donglai was overjoyed. The surgical plan was one he and Wu Ting had developed and refined together. It had been an undeniably difficult procedure, but thankfully, Wu Ting's execution was flawless.
'This kid… I'll have to give him more opportunities to operate in the future.'
This freelance surgery had given Qin Donglai a much fuller appreciation of Wu Ting's potential and innate surgical talent.
[Ding! You have co-designed and flawlessly performed a flexor pollicis longus repair surgery with Dr. Qin. You have obtained a keyword from Dr. Qin: Tracheotomy (Yellow).]
[A technique mastered by Dr. Qin over many years of emergency care, used to relieve respiratory distress caused by laryngeal obstruction, respiratory dysfunction, or retained lower respiratory tract secretions in emergency situations.]