From small clinic to medical empire

Chapter 75 Skin Flap Transplantation
Naturally, Zhang Zifan will not rigidly apply certain formulas and theorems when resecting cancer foci. For example, Heidelberg’s guidelines recommend that the distance from the lesion margin is 0.7 cm. This is just a guiding opinion based on a large sample review.

Specific to a certain patient, a certain cancer focus, there is no real standard.

Even if you follow the guidelines, the possibility of losing cancer cells is very high.

This is also why, in many cases, although the "radical surgery" of the cancer has been carried out, and there is no evidence that the cancer has metastasized, radiotherapy and chemotherapy are still needed.

It is to kill the possible remaining cancer cells through radiation and chemical agents.

Now Zhang Zifan's maxillofacial surgery technology has reached A-level, and he is also among the top [-] in the world.

To use an analogy, it is equivalent to the three or four hundred best basketball players in the world forming an NBA league.

Zhang Zifan is already at the NBA level in the field of maxillofacial surgery.

If you break up NBA players and throw them around the world to play, they will all be local tyrants.

With such skills, it will naturally show up in every dribble and every slash.

So Trudeau can see that Dr. Zhang's surgical foundation is quite solid, definitely at an excellent level.

But what he couldn't understand was why Dr. Zhang would cut out such a strange shape.

I saw that under Zhang Zifan's scalpel, the cancerous focus and its surrounding skin were cut into an irregular six-pointed star shape.

"Submit for inspection!" Zhang Zifan ordered with the final cut.

An itinerant nurse at Kuta Hospital did not dare to neglect, immediately carefully put the excised tissue into a container, labeled it, and rushed it to the pathology laboratory.

……

The so-called frozen section is a kind of pathological section.

Through the method of rapid freezing, the suspicious tissue excised during the operation can be analyzed immediately, and a conclusion can usually be drawn within 15 minutes.

Pathological slides are the gold standard for all examinations.

Whether a lesion is cancerous or whether a tumor is malignant or benign, all biochemical tests and doctor’s judgments can only be used as a reference. Only pathological sections and the detection of cancerous cells through a microscope can definitively explain the problem.

At this time, the tissue cut out by Zhang Zifan was frozen and sectioned to analyze whether there were still infiltrating cancer cells at its edges.

If the edge is a complete circle of normal cells without any cancer cells, it means that the resection is successful and no cancer cells have slipped through the net.

On the other hand, if there are still cancer cells in the outermost layer of the cut tissue, it means that other cancer cells must have been missed.

Time passed by minute by minute.

The atmosphere in the operating room became very dignified.

Dr. Russell kept staring at the computer screen and refreshing the pathology department feedback page.

Finally, at No. 15 minutes, the news came back!

"No sign of infiltration!"

Russell was stunned when he saw a line of big characters on the feedback report.

"What's the result, let me see!"

Just as Trudeau was about to push away Dr. Russell to check the report, the emergency phone in the operating room rang.

Russell subconsciously picked up the phone, and a woman's voice came from inside, and the words seemed to have a little accent unique to the black community.

"Russell, how did you do it? I don't think I should refuse your invitation yesterday..."

Because the hospital system was to be used, the doctor's name on the specimen note was Russell's.

The black female researcher in the laboratory felt that she might have rejected a date invitation from a money printing machine, regardless of the hospital's regulations to call to save the relationship.

Russell quickly hung up the phone. At this moment, his confusion has far exceeded the physical desire to have sex with the big black girl.

Russell quickly clicked on the details of the checklist and retrieved the image of the slice.

At this time, Trudeau also quickly took a camera to take a close-up shot.

In the cell field of view, the removed healthy tissue interface almost perfectly surrounds the cancer cells. Some of the spiky cancer cell extensions are also tightly wrapped by the specially cut starburst-shaped structures!
"This... Dr. Zhang, how did you do it!"

Professor Trudeau asked incredulously, although many surgeons have special surgical skills that can improve the quality of surgery, none of them can do what Zhang Zifan did.

"Surgical Intuition!"

Zhang Zifan had already thought up his rhetoric, from the indication of the geometric location of the cancer focus to the magical surgical intuition, Zhang Zifan talked nonsense, and Trudeau was confused.

Trudeau would like to say, why can't I see any geometric relationship at all, it's just a random pattern!

But the fact is before our eyes, this young man has indeed perfectly removed the cancer focus!
At this time, Dr. Russell certainly didn't dare to mention anything about taking over the operation.

It turned out that the other party was not too stupid, but that his vision was not wide enough!
After changing his attitude, Russell began to watch Zhang Zifan's operation carefully, planning to steal the teacher from close range with one hand or two. By then, wouldn't Dabo Heimei be able to catch it?
……

According to Russell's original operation plan, at this stage of the operation, the red lips and skin on both sides of the patient will be directly pulled together and sutured, and it will be considered a success.

But of course Zhang Zifan would not do this kind of treatment.

Lip repair surgery is Zhang Zifan's housekeeping skill, but this time, the previous surgery methods are useless.

Because no matter how the cleft lip repair surgery is designed, the method used is to cut and splice the remaining skin of the lip to restore the appearance.

But now the patient's original tumor was 4X3 in size, and the tissue that infiltrated the cancer cells was removed, and the remaining skin and red lips were not enough to make up a lower lip.

Therefore, flap transplantation must be done.

There are many parts of the human body that can be used as donor sites for flap transplantation.

Zhang Zifan chose the skin on the patient's inner thigh.

Because the skin in this area is softer, lighter in color, and less hairy.

Through the [Eye of Preset], Zhang Zifan decided the style of flap cutting almost without spending much time.

To transplant a piece of skin from the thigh to the lip, the most critical part is to establish good blood circulation.

Human cells have a strong ability to survive, but there is a prerequisite for this, that is, there must be blood to provide nutrients and oxygen, and to take away metabolic waste in time.

Generally speaking, in order to ensure the survival of the flap, the surgeon will preserve the deep fascia to protect the vascular network in the subcutaneous fat.

Doing so, however, can result in "overfullness" of the flap used, impairing function.

Therefore, Zhang Zifan directly degreases the skin flap, and perfectly separates the main blood vessels, and then docks them with the remaining skin blood vessels on the patient's lip under a microscope, and attaches a vascular stapler.

After that, Zhang Zifan punctured the fixed skin flap with a thin needle, and then blood oozed from the eye of the needle, which showed that the vascular access had basically been established.

"One hour and eight minutes!"

Dr. Russell looked at the time on the computer and expressed emotion, "My mentor, Professor Pandit, once completed a similar operation, and with the assistance of two microsurgeons, it took nearly two hours to complete it!
At that time, I thought that the hands of microsurgeons were so dexterous, but today I realized that compared to the dexterity of hands, no one can compare with the Chinese! "

Professor Trudeau is also very excited, although the survival of the flap will take some time to verify.

But judging from the surgical procedures and acupuncture tests, the survival rate of this flap used for lip reconstruction is definitely higher than 90.00%!

This is an amazing probability!

Just as Trudeau was about to turn off the camera and congratulate Zhang Zifan, the young man in front of him didn't stop.

"Neck lymph node dissection must be done!" Zhang Zifan said firmly.

(End of this chapter)