Chapter 718 - 357: Fate Has Run Its Course

"In private, Professor Zhong Junyun has named this condition as non-anatomical compression-type dysfunction, or rather, functional dysfunction."

"Human motor functions are quite complex, indeed."

"When we explain to the patients, we often say that specific muscles and movements are like light bulbs, while nerves are like wires."

"A faulty bulb or wiring can both lead to dysfunction."

"But in reality, the actual human function is far more complex than circuitry."

"And during our surgeries, we discovered that the innervation functions of nerves can vary significantly based on differences in nerve branches or sub-branches..."

"Thus, when performing genuine functional reconstruction, in addition to focusing on the continuity of the main nerve branch, we must also consider whether the position of nerve branches is appropriate."

"Certainly, the rationalization of this is yet another complex problem."

"Currently, the best postoperative recovery of functional reconstruction only reaches around sixty to eighty percent functionality."

"It's difficult to break through that eighty percent barrier..."

After hearing You Junze's words, Xie Ziyuan's gaze flickered: "At our hospital, Director Tan currently uses measures that involve correcting the origin and insertion points of tendons, either shortening or extending the muscle tendon structure, to expand or reduce the functions of existing tendons."

"This approach differs from the one taken by the teachers at Union Hospital."

In summary, You Junze expressed an approach involving precise restructuring of nerve main branches and branches.

Meanwhile, Xiangya Hospital's functional reconstruction skill doesn't pursue extreme nerve precision restructuring; instead, it complements existing functions through improved effectors.

This can be seen as different paths leading to the same destination.

These two approaches are both popular major avenues in the field of functional reconstruction skills.

Currently, no one believes one surgery is better than the other.

Reassembling nerves seems to be a major path.

However, correcting the tendon structure to allow patients to quickly regain function and solve issues earlier is also a short-term, directly effective route.

After all, nerve suturing is already very challenging.

Nerve branch structure reconstruction is even harder to perform.

Tendon suturing, tendon twisting, and other operations are techniques that many hand surgeons can easily master.

First pursue quantity and surface; on this foundation, if quality can also be improved, it's a correct route.

We can't expect to have fish and meat every day when we're already not getting enough to eat, can we?

We have to take this path step by step.

Lu Cheng was aware that the team had professional hand surgeons who would introduce many ideas.

"Professor Xie, could you be more specific?"

"What techniques does Director Tan use for functional reconstruction skill?" Lu Cheng asked while operating.

Xie Ziyuan, on-site watching the muscle anatomy of the patient, elaborated by sourcing locally: "Take, for instance, the thumb extensor; we all know the primary function of the thumb extensor is to extend the thumb's interphalangeal joint and metacarpophalangeal joint!"

"Among them, the extensor pollicis longus acts on the thumb interphalangeal joint and metacarpophalangeal joint, causing the thumb to extend dorsally."

"The extensor pollicis brevis mainly acts on the proximal phalanx of the thumb, assisting the extensor pollicis longus in completing the extension motion, allowing the thumb to move away from the palm plane and expand the web space!"

"For the patient, what's more important is the gripping function."

"It's not just about gripping objects; it's also about being able to release them."

"Thus, if we're unable to pursue all the functions of the thumb extensor, we'll fixate the two types of tendons together to strengthen the function of the extensor pollicis longus..."

"If extending the thumb is compared to a signal transmission, more muscles can be activated simultaneously when the same signal reaches locally."

"Professor You, if Professor Zhong were to perform this type of functional reconstruction, he wouldn't operate this way, right?" Xie Ziyuan asked You Junze.

You Junze shook his head: "Professor Zhong definitely wouldn't operate this way!"

"However, I also feel, given the current treatment bottleneck, both treatment effects are equivalent."

"Or perhaps, from a certain perspective, sacrificing other functions for some important ones might yield better postoperative outcomes than equal consideration for all."

"This is also a point of confusion within several teams at our hospital."

This is specialized hand surgery discussion.

This is a very realistic issue.

Suppose this was a drought year.

Everyone knows drought means no crops will grow, no crops mean starvation for everyone.

Under these circumstances, would you choose to eat less refined rice and starve daily, or would you plant sweet potatoes, potatoes, and corn — rough grains?

Although eating is not as good, there will be fewer days of hunger?

The ultimate path is undoubtedly to develop rice and wheat seeds suitable for drought years.

But before the seeds are developed, faced with a prolonged drought season, what should be done?

Filling the stomach is definitely the priority.

"Director Lu, what would you choose?" You Junze handed over the question to Lu Cheng.

Lu Cheng is still a beginner in functional reconstruction skill.

Though he possesses expert-level proficiency, this level is not uncommon at Xiangya and Union Hospitals.

Both hospitals require the operating professors to have this standard to represent the core battle power of the hospital.

If you don't possess such skill, even if you lead a team in the hospital, you won't be allowed to go out and shame yourself.

Lu Cheng smiled and said: "I don't know either, so I asked the two teachers."

"I feel, use wherever it's applicable; at least temporarily if it works, if you can perform the surgery, the effect is there, that's enough."

Surgery is quite difficult, functional reconstruction even more so.

Each step's decision can make a significant difference in patient prognosis.

It's like the saying, "A tiny error can lead to a huge deviation."

Since one can't find one's own path, it's better to adopt the predecessors' and educators' ideas, and refrain from recklessly trying original thoughts.

Only when highly mastering the surgical effects of these two choices can one further refine or summarize, even creating original methods to overwhelmingly defeat the two ways!

In truth, it's a rare situation clinically where one can convince others.

...

The surgery duration was shortened, but not significantly short.

A limb preservation surgery combined with functional reconstruction skill still consumed nearly six hours of Lu Cheng's time.

By the time they exited, the sun was already setting.

The evening glow was distant, and the mountain clouds were red, looking far away, still quite appealing.

It seemed as though the red mountains were lifting the red glow.

You Junze, while putting on his shoes, remarked: "Director Lu, your surgical speed is truly remarkable."

"For this kind of surgery, Director Zhong typically wouldn't go on stage; I would be called over by our hospital's trauma surgery, and completing the entire process would require at least around ten hours."

"With you here, it's directly cut by two-fifths."

"This efficiency is truly convincing!"

Meanwhile, Xie Ziyuan and Leng Hua'an and others abandoned social niceties and mutual praises.

Speculating: "Director Lu, what do you think caused the time savings? Is it primarily due to wound cleaning skill or those suturing techniques being better?"

"Both, I believe the main reason is faster wound cleaning."

After careful consideration, Lu Cheng shook his head lightly: "From my operational experience, I don't feel these suturing techniques saved much time."

"Yes... it didn't really save any time."

Xie Ziyuan nodded slowly: "Therefore, the core of limb preservation surgery combined with functional reconstruction skill still lies in limb preservation, not the subsequent functional reconstruction."

"After all, it's because there's limb preservation that functional reconstruction exists."

"If the limb couldn't be preserved, direct amputation wouldn't even have a limb preservation surgery to speak of."

After a moment of silence, You Junze suddenly asked: "Professor Xie, did you notice? Director Lu, when performing functional reconstruction, almost also dealt with nerve terminal branches."

"This meticulous technique?"

As You Junze was speaking, someone greeted them with a smile from the opposite direction, interrupting him: "Director Lu, good afternoon."

Being interrupted didn't upset You Junze; at this moment his mind was filled with professional knowledge.

Lu Cheng was also focused on discussions with You Junze and others, so after glancing at Xiang Dahong, he only replied: "Director Xiang, good afternoon."

Then Lu Cheng and You Junze, among others, bypassed Xiang Dahong.

Lu Cheng continued speaking: "Actually, I want to try combining Director Tan's and Director Zhong's functional reconstruction approaches..."

"Professor Xie, Professor You, this is what I'm thinking, since the core of functional reconstruction..."

Leng Hua'an wasn't among the discussion objects for Lu Cheng, so he had the chance to notice Xiang Dahong's awkward stance.

Xiang Dahong turned around and returned his gaze; his eyes focused in Lu Cheng's direction.

But Lu Cheng seemed uninterested in continuing the conversation with Xiang Dahong.

However, Leng Hua'an didn't recognize Xiang Dahong, so after a couple of glances, he caught up with the group again...