Chapter 105: Chapter 0103: Immediate Results

Liang Fatty, Zhang Lin, and Little Five went out for a smoke.

Yang Ping summarised the work of the first day into a WeChat message and reported it to Director Tian.

He made a specific report about Teacher Yan’s case, but purposely didn’t mention local closure during the surgery in the surgery plan.]

Director Tian replied: I agree with your opinion. Implement the surgery as initially planned. Be sure to use Methylprednisolone for local closure during the surgery, focusing on the nerve compression segment of the ischium.

A good doctor is both brave and wise.

Without bravery, one would be too cautious and unlikely to succeed. Without wisdom, courage alone invites disaster.

To ensure the success of the surgery, Yang Ping entered the system space and dissected a few more specimens. Apart from routine full-body dissection, he paid special attention to the local dissection surrounding the pear-shaped muscle.

He slowly began to appreciate the power of the super cultivation method. Each dissecting training greatly contributes to the surgery, with improvements spiralling upward.

Just like basic science and applied technology, a strong foundation in basic science allows applied technology to thrive. Otherwise, applied technology would flounder and stagnate.

With the accumulation of dissection knowledge from several specimens and an orthopedics specialty, decompression of the sciatic nerve is a minor procedure.

The next day, after the morning shift and ward rounds, Yang Ping led everyone to examine the films and then proceeded to the operating room for surgery.

Director Zeng was very enthusiastic and genuinely wanted to learn something: “Let me assist you.”

Yang Ping said, “Director Zeng, I wouldn’t dare trouble you. Dr. Song can assist me. You might need to communicate with the patient’s family at any time.”

Yang Ping was the chief surgeon, assisted by Song Zimo. Director Zeng was free to observe and move around as he pleased.

Protecting the nerves during surgery is especially crucial. Carelessness can lead to nerve damage or excessive tension, which can have severe consequences after surgery.

This was the first time working with Director Zeng on a surgery, and they were unfamiliar with each other’s working styles. Yang Ping worried about accidental nerve damage, but it would be inappropriate to directly ask Director Zeng not to come up to the stage, so he arranged it this way.

They administered general anesthesia through endotracheal intubation. Little Five and Zhang Lin had prepared and positioned the patient in a prone position.

“Good morning, Director Yang!” Su Yixuan, accompanied by a nurse from Nanqiao Hospital, was arranging the tools. She greeted Yang Ping as he entered.

Yang Ping responded formally, “Nurse Su, I appreciate your help in preparing the operating table.”

“It’s only right to prepare for Director Yang’s surgery,” Su Yixuan replied with a sterilized mask, lips curled in a smile.

Once everything was prepared, they washed their hands, dressed, disinfected, spread the surgical drapes, and began.

An incision was made at the lower edge of the gluteal maxima, avoiding scar formation at the ischial tuberosity to prevent lasting pain when sitting.

Upon lifting the skin, they exposed the gluteal maxima, where local fibrosis had occured. They cut open the tendinous fascia of the lower edge of the gluteal muscle without damaging the muscle fiber, and lifted the gluteal maxima upward, protecting the subgluteal and femoropopliteal nerves.

The pear-shaped muscle was revealed, and indeed, the bottom third of it had fibrosed, turning into fibrous scar tissue that had completely lost the qualities of muscle tissue.

The sciatic nerve wasn’t emerging from below the pear-shaped muscle. Rather, it was piercing through the fibrosed pear-shaped muscle in the form of a trunk, getting compressed by scar tissue at the exit.

No wonder the symptoms of the sciatic nerve were so severe, and even worse during walking, because when walking, the pear-shaped muscle contracts and compresses the sciatic nerve, worsening the symptoms.

They carefully separated the nerve from the scar tissue, removing surrounding scar tissue to fully expose the outer membrane of the nerve.

The nerve formed a depression at the compression spot, swollen on both ends of the depression.

Yang Ping gently pointed out the nerve, “Director Zeng, look!”

Indeed it was Piriformis syndrome. Director Zeng felt relieved, knowing that his preoperative judgment was correct.

“Little Five, take a photo!”

Everyone moved aside as Little Five carefully aimed his phone camera to take a photo, taking precautions to avoid polluting the surgical field.

A rubber strip gently held the nerve open. At this time, it was crucial not to interfere with the sciatic nerve. Excessive tension could cause nerve damage; although it usually recovers eventually, it could take anywhere from a few days to several months. Lower limb numbness or weakness could lead the patient to misunderstand the surgery as a failure and an exacerbation of symptoms.

A doctor must always tread carefully.

“Dr. Song, make sure to protect the nerve!” Yang Ping reminded.

He was not really worried about Song Zimo, but feared Director Zeng would not pay proper attention to protecting the nerve. Any unintentional movement such as slipping with the retractor could damage the sciatic nerve. In an operating environment, it’s always better to be cautious and meticulous.

Understanding the instruction, Song Zimo placed one hand between Director Zeng’s hook and the nerve, providing stringent protection to the nerve.

With the nerve held open, Yang Ping bluntly separated the pear-shaped muscle from the surrounding healthy muscle fibers. Entering through a gap, his fingers divided a seam, then cut the fibrosed part of the pear-shaped muscle at the attachment points of both ends of the muscle. With a bit of healthy muscle fiber left, the fibrosed tissue was completely resected.

This way, the nerve was able to pass through the remaining normal pear-shaped muscle beneath the exit of the great ischial foramen without experiencing compression. As the separation was done along the natural gap among muscle fibers without damaging normal muscles, future formation of scar adhesion was unlikely, and future issues were prevented.

It was crucial not to allow any scar formation around the decompressed nerve; otherwise the surgery would fail, and the nerve would be compressed again.

Blunt dissection and sharp dissection: blunt dissection is used when there is a natural gap, while sharp dissection is used when there isn’t. The former follows an existing path, while the latter makes a new one.

They then thoroughly cleansed the surgical field and stopped bleeding again.

“80mg Methylprednisolone, mixed with 20ml of saline, get me a syringe!”

Methylprednisolone is a glucocorticoid that has anti-inflammatory and edema-reducing effects.

The injector quietly stabs into the nerve sheath diagonally, injecting the Methylprednisolone, and then sprinkles some on the outer membrane of the nerve to locally insulate the nerve. It waits for about five minutes.

Then, use 20mg of Ropivacaine, diluted with saline on a one-to-one ratio, to infiltrate the area where the muscle scar was cut. Then, infiltrate the cut edges layer by layer. This can reduce postoperative pain.

Upon re-inspection, the loosening was thorough, the blood clotting was perfect, and the entire surgery was pleasing with almost no bleeding. The gauze was even untouched.

The few Orthopedics doctors who were observing the operation discussed among themselves that the operations in big hospitals are really different.

The rubber band was pulled out, and the nerve was returned to its original place.

Insert the drain, sew the layers together, and the surgery is over.

As soon as the surgery was finished and the sterile single sheet was lifted, the patient woke up. Liang Fatty used a suction tube to clean the secretions in the patient’s trachea and successfully extubated the tube. The cooperation was very good.

The patient was recovering from anesthesia and was being taken out of the operating room. A nurse called a relative, and his son immediately came up.

Yang Ping took out his cell phone and showed him the pictures he took during the surgery: “Mr. Yan, look, this is your sciatic nerve, compressed like this, thinning in the middle and swollen at both ends. If you don’t undergo surgery, you will become paralyzed. You would have lost the use of one leg.”

Arriving in the ward, the patient had fully regained consciousness and could have normal conversations.

Those who have undergone general anesthesia can move all their limbs once they regain consciousness.

The patient moved his right lower limb a bit, and surprisingly, it didn’t hurt. Maybe the anesthetic was still working, but regardless, the pain was gone for now.

Pain greatly negatively impacts a patient and seriously affects their life, like a relentless nightmare. Some patients who are tortured by pain even become suicidal.

Having had this burden lifted, even if only temporarily, made the patient feel extremely relieved, like they had been reborn.

“It doesn’t hurt anymore!” This is the first thing Teacher Yan said upon returning to the ward.

“Go and say thank you to the doctor!” Teacher Yan instructed his son.

The son said, “Don’t worry, I know.”

In cases of nerve relaxation, some may experience a rebound where the symptoms become worse than before. To avoid this, Yang Ping used Methylprednisolone to locally insulate the nerve, eliminate inflammation, alleviate nerve edema, and prevent possible postoperative rebound. This would enhance the patient’s postoperative experience, which is crucial. The patient wouldn’t know whether the surgery was performed well. What they would know is whether the problem was resolved and to what extent.

For Teacher Yan, relief from pain means success. A million words wouldn’t be as persuasive as his own experience.

After more than ten years, he finally had a day without pain.

Teacher Yan was so excited that his hands were shaking. He gripped his son’s hand: “Remember, say thank you to Director Yang.”

Even though the entire process went smoothly, Yang Ping didn’t let down his guard for the time being. He couldn’t jump to any conclusions yet. After all, he had used local insulation during the procedure. He still needed to see if any rebound symptoms would appear in the next few days, even though the probability was low.

Yang Ping instructed the bedside doctor to pay attention to stomach protection and use some nerve nourishing medications. He stressed to Little Five that he should personally handle the dressing changes and to call him over while doing so. He wanted to see it for himself.

After the surgery, Yang Ping and Director Zeng rested in the office.

Teacher Yan’s son came over. His facial expression was normal this time; he wasn’t scowling anymore.

“Thank you, Director Yang!” He took the initiative to shake hands with Yang Ping.

Yang Ping said, “You’re welcome. Doctors and patients are comrades, and our common enemy is sickness.”

“Director Zeng, thank you too.” Seeing Director Zeng beside him, the old man’s son expressed his gratitude.

Just after the surgery, it was clear that there was an immediate effect, but it was unknown whether it could be maintained. So, the old man’s son didn’t say much. He decided to observe a bit more for now.

Dean Pan and Director Tian had just arrived at the department, and from a distance, they heard Dean Pan’s voice. Because he was missing a tooth, his speech had a unique character.

“Director Yang, you’ve worked hard! I heard you just finished a surgery.” Dean Pan shook hands with Yang Ping.

Director Zeng said, “The patient we just did surgery on was Teacher Yan, who has been pestering us for a year. The pain has eased after the surgery, and the patient’s family just came to thank us.”

Director Tian had already reported this matter to Dean Pan last night. Such a patient was a special case, and the surgery could not be done discreetly.

Dean Pan said, “Oh dear, as soon as I landed, you had me clean up the mess. This is so embarrassing, airing our dirty laundry like this.”

Yang Ping said, “Dean Pan, your words are too harsh. Director Zeng was the one who figured out the medical condition. I was only asked to mediate due to the deep misunderstanding between both parties. It’s not a big deal.”

Dean Pan turned to look at Director Zeng: “Director Zeng, learn from the professors in the provincial city, and dig deeper.”

Director Zeng felt extremely pleased though he knew Yang Ping was being polite. Therefore, he said, “That’s why I am always there to pestle Director Yang, trying to squeeze out some real knowledge. Director Yang was instrumental in helping me understand this medical condition.”

After a bit of small talk, they inquired about any work difficulties, living conditions and habits, and also recommended a few interesting places in Nan Bridge.

Dean Pan and Director Tian then left to go to other departments.

“What about that left femoral osteomyelitis?” Director Zeng took the initiative to bring it up.

He had sensed that Yang Ping had something to say when they made their rounds yesterday.