139. Waterman’s series

In modern maxillomandibular resection, due to the loss of large areas of maxillofacial bone, autologous bone grafting is often chosen according to the patient's requirements. That is, a section of bone (mostly the hip bone or fibula) is cut off along with the surrounding muscle flaps and blood vessels.

, and transplanted into the patient's mouth together.

The success of autologous transplantation is related to smooth blood supply.

Limited by the fineness of suture needles, it is definitely not possible to anastomose such small blood vessels with a diameter of less than 5mm now. It is most convenient to simply fill it directly with ivory.

However, for bone shaping, modern people choose to use computer-aided design, cut the long bones into small segments, and then use titanium plates to make connecting arcs. In the 19th century, they relied on some artistic personal techniques, from casting to subsequent cutting and polishing.

, leaving full power to the most famous sculptor in Vienna.

There was no lively scene like Kawei's just now in the surgery area, but Kawei's views shocked everyone's brains.

The operation of inserting the maxillary bone made of ivory into the face is already avant-garde. It doesn't matter whether the connection is firm or not. As long as it can be done, it will be a monument in maxillofacial surgery. Now metal plates and

Fixing with rivets, treating human bones as iron warships is outrageous when you think about it.

But it seems feasible.

A good idea always arouses a lot of responses, and soon several doctors who are good at plastic surgery in the audience took out their notebooks. Without asking, they were able to come up with many solutions to artificial maxillary bones from this idea.

.

But after all, the job of surgery is not to repair industrial machines. No matter how novel the idea is, it still comes down to the same problem in the end, that is, how to disinfect metal plates and rivets, and what to do if infection occurs?

Objects stuffed into the skin and flesh are not like surgical incisions, which can be opened and disinfected twice. If there is inflammation and swelling in the body, incision and drainage will be a small matter, but permanent removal of the bone will be a big deal.

It's the same as Charles' concerns before.

After all, doctors are solving patients' pains, not creating troubles. If the expensive ivory can't solve the problem once and for all, or at least it can't solve most of the troubles with a high probability, then what's the point of using it to make it?

?

Kawei also knows this. What he wants most when he travels here is antibiotics.

Unfortunately, the threshold for drug production is very high, and the production of antibiotics is also really troublesome. The labor force of Savarin and Mattick is severely insufficient in the laboratory. Now, the ability to verify the existence of puerperal microorganisms is already the limit.

“I don’t know if it’s feasible to soak ivory in carbolic acid for a long time.”

Waterman nodded, very satisfied with this method, but it was not enough: "The ivory is actually not bad, the trouble is the incision in the mouth. After the last mandibular removal, even if it ulcerated, it was easy to deal with, but now it is in the mouth

.How to ensure the disinfection of the oral cavity? Should I give him carbolic acid every day?"

"That's definitely not possible. I think you can use gauze soaked in carbolic acid for packing."

"It's a bit toxic." Waterman shook his head. "Ever since the voles raised by Kawei died due to long-term stimulation by carbolic acid, I have always been skeptical about this thing."

"I'm afraid high-concentration alcohol won't do either."

"Since these two are not good, then bleach is even less good."

"Try using carbolic acid first. The concentration itself is not high, and then try to make it as dry as possible." Kawei said at this time, "In addition to packing gauze, you also need to do more washing. In addition to washing with physiological saline, there is also disinfection.

Liquid flushing.”

"For what?"

"None of those three can be used in the mouth."

"Recently, after studying the paper of French chemist Tanner, I found that a strong oxidizing compound he invented can effectively inhibit the growth of microorganisms [1]." Kawei said, "After testing, it was found that at 3%

It is harmless to humans and animals at certain concentrations, and can even be used on wounds. I think it can be given a try."

"You invented a new disinfectant?"

"It can't be regarded as an invention, it can only be regarded as a discovery." Kawei explained, "This oxidant is safer than carbolic acid, but it is easier to decompose."

Waterman listened to Carvey's suggestion. The new disinfectant sounded good, but it still could not completely solve his doubts. The large defects and wounds left after maxillary resection could not be solved by flushing.

He suddenly looked at Charles beside him: "By the way, can the palatal guard you just mentioned be made larger?"

"What do you mean?" Charles stopped what he was doing.

"Can you put carbolic gauze on the removable palatal guard and dental tray to protect the upper wounds?"

"It's okay, but it's a bit heavy."

Waterman sighed: "The patient is already lucky. If the tumor grows a little higher and the infraorbital wall is removed together, I don't know what to do with his left eyeball. According to the anatomical structure, there is no

The infraorbital wall will cause the orbital contents, including the eyeball, to lose support.”[2]

"It's going to fall."

"Definitely."

"If this is the case, a palatal guard + gauze packing should also work."

"Are you waiting for the soft tissue to grow back?"

"Maybe. This maxillary resection was done only after I made up my mind. I have never seen the scope of resection expanded."

The operation didn't take long. It only took less than an hour to cut off the maxillary bone. The result of the operation was pretty good, but the process was just like Orji's. It was too rough. The bleeding was not stopped where it should be.

The delicate separation was swept through in one stroke.

Although surgery has many branches and there are not many connections between the various disciplines, the basic techniques of surgery are still the same.

The blood supply of the maxilla is richer than that of the mandible, and the amount of bleeding during the operation, especially during the cutting process, is greater. If it is performed by Kawei, he will definitely try to stop the bleeding, and if possible, he can also ligate the external carotid artery first.

, can greatly reduce the amount of bleeding.【3】

As for the opened muscles and skin, Waterman did not protect the blood vessels, and there were several unnecessary bleedings.

There were no accidents during the operation, and it was considered a success in everyone's eyes, but the real results cannot be judged until the patient recovers.

Waterman was not interested in suturing the second half of the muscle and skin after resection, so he left them all to his assistants. As the chief surgeon, he only took a brief look at them.

Compared with the drastic surgery, the post-operative discussion and interaction with the audience took up a lot of time. If the host had not come in and said that the next patient had arrived in the lounge, I am afraid Waterman could have continued chatting leisurely.

"Since I was inspired by Dr. Carvey last time."

Waterman was still watching Charles soaking the bones with carbolic acid. As soon as he said the first sentence, he felt something was wrong. He raised his head and looked at Kawei in the audience: "How come I am always inspired by you? Maxillary resection is the same."

, eyelid repair too.”

"The dean was so complimentary."

"Don't praise or disapprove, the idea was indeed the one you thought of first." Waterman didn't mean to win anyone's love, "But just having the idea is not enough, you must put it into practice as soon as possible, check for omissions and fill in the gaps in practice, and form a system as soon as possible."

A completely new surgical technique."

Kawei also wanted to try it, but unfortunately the Municipal General Hospital didn't accept many plastic surgery patients.

And his famous young surgical genius not only had to cope with medical school studies, but also had to deal with experiments. After returning to the hospital, he had to be devastated by appendicitis and cesarean section. Especially cesarean section, counting the last month, eight months

Taiwan, if you continue, you will really become a master of obstetrics.

"Then there's no way." Waterman said with some pride, "Ever since the surgical meeting, I've been looking for a way to repair simple blepharoptosis. After several attempts on cadavers, I'm now certain that the flap transposition method is completely feasible.

"

At the regular surgical meeting, what was discussed was a patient with simultaneous drooping of the upper and lower eyelids.

While others were still wondering which of the upper and lower eyelids should be done first and which one was more difficult to deal with, Kawei had already thought of the complementary repair method of the upper and lower eyelids, which greatly stimulated Waterman's slightly slow old-fashioned surgical thinking.

He soon thought of how to apply this flap transposition method to the faces of other patients with ptosis.

"Since it's a series, let's save the host's introduction. Everyone, hurry up." Waterman invited the patient in first, "The next patient is the assistant I just hired for the School of Surgery. He works very well.

He works hard and is a good person.”

A young man walked in from the gate, wearing a simple gray cloth short coat, a white shirt underneath, and an ordinary peaked cap on his head. He looked to be in his early twenties.

Compared with the two patients who were just pushed into the field, he is much healthier. He breathes steadily and walks vigorously. He looks just like the audience present. The only flaw is that the lower eyelid of his right eye is droopy, that is, the outer lower eyelid.

Turn over to reveal a piece of red conjunctiva, which looks like heavy makeup, very weird.

"Hello everyone." The young man smiled and waved to the stage, looking very relaxed. "It turns out that this is the operating theater. I am really excited."

"First time here?"

"Yeah, I always wanted to make money and come here to see how exciting it would be, but I didn't expect that my wish had already come true before I made much money." The young man didn't have much scruples about the blood-stained operating chair.

When he found that the blood stains had dried, he sat directly on it and said, "Is this where the surgery will take place later?"

"Yes, you will inhale ether and sleep for a while. When you wake up, the operation will be completed."

"It's amazing." The young man asked curiously, "Do you want to start now?"

"It's still early. The previous surgery has just ended, and the assistants need to do necessary cleaning work." Waterman glanced at the clock, "And the scheduled time is 9 o'clock. We still need to wait for about 15 minutes for the audience to arrive.

Let’s start again after everything is straight. First, tell me about your experience of lower eyelids going from slight drooping to severe ectropion. What made it become so loose?”

"Childhood burns."

After years of precipitation, the melanin in the burn area has become very light, but if you look closer, you can still see some traces remaining on his right cheek: "After the burn healed, I felt that the lower eyelid of my right eye would move forward.

It fell, and I couldn't control it. This appearance made me feel inferior for many years, and I still can't find a girl willing to marry me."

"Permanent damage caused by burns." Waterman patted his shoulder and comforted him, "I will help you repair it."

"Thank you, Dean."
To be continued...