125: Chapter 125 Your suturing skills are among the top three in the entire province.
Director Xu Minhua was silent for a long time.
She reached out and gently touched the skin at the edge of the wound.
There were no subcutaneous indurations.
There was no suture knot reaction.
The tension of the suture was just right, neither too tight nor too loose.
She checked the finishing at both ends of the wound again.
The starting and ending points were handled cleanly, without any excess thread ends.
Director Xu Minhua withdrew her hand.
There was no expression on her face, but Director Li Sen could clearly see the slight constriction of her pupils.
"The surgical record states that the lead surgeon for the Suturing was Lu Chen?" Director Xu Minhua's voice was flat.
"Correct."
"He was the only one who did the Suturing? No one else took over midway?"
"Zhao Yaqin was the First assistant the entire time, but she didn't step in; Lu Chen did the Suturing alone from start to finish."
Director Xu Minhua looked at the wound once more.
Silence lasted for about five seconds.
"I want to see him in person."
Director Li Sen nodded.
"I'll call him over."
...
Ten minutes later.
Lu Chen walked into the ICU.
Today, he was wearing a clean white coat with his ID badge pinned to his chest, his expression as calm as ever.
Director Xu Minhua looked at the young man walking in, and her first thought was:
He really is quite handsome.
But she wasn't here to look at faces.
"You're Lu Chen?"
"Yes. Hello, Director Xu."
"How many years have you been performing surgeries?"
"I've been formally participating in surgeries for less than two months."
Director Xu Minhua's lips twitched slightly, but she didn't speak.
She gestured for Lu Chen to come to the bedside.
"Explain the logic behind this surgery to me, from the beginning, and don't skip any details."
Lu Chen nodded and began to explain.
"The patient arrived in Class III hemorrhagic shock. Blood pressure continued to drop during transport, and Ventricular fibrillation-induced cardiac arrest occurred within three minutes of entering the Red Zone."
"I immediately performed standard Cardiopulmonary resuscitation, combining chest compressions with one biphasic 200-joule defibrillation, restoring Sinus rhythm within four minutes."
"After the rhythm was restored, I quickly administered fluids to stabilize the blood pressure and moved the patient to the Operating Room."
"After releasing the tourniquet during surgery, I confirmed a complete rupture of the distal brachial artery and a lateral wall tear in the proximal radial artery."
"I handled the brachial artery first."
"I trimmed the bruised tissue from both severed ends, removing about two millimeters of devitalized segments from each, and then performed an end-to-end anastomosis under tension-free conditions."
"For the posterior wall, I used 7-0 Prolene suture for a Continuous interlocking suture with eight stitches. For the anterior wall, I used Interrupted suture with six stitches. The needle depth was full-thickness, with a margin of 0.5 mm and a spacing of 1 mm."
Director Xu Minhua interrupted him.
"Why didn't you use continuous Suturing for everything?"
"The posterior wall is deep with limited space, so continuous interlocking is more efficient and ensures a good seal. The anterior wall has plenty of space, and using Interrupted suture allows for stitch-by-stitch tension adjustment, making it easier to ensure precise intimal alignment. It also facilitates post-operative observation; if there's an issue with one stitch, it can be handled individually without affecting the whole."
Director Xu Minhua looked at him.
"How did you control the 0.5 mm margin?"
"Through a combination of feel and vision; it's achievable under a microscope."
"What magnification did you use?"
"Six times."
"Six times?"
"It was enough."
Director Xu Minhua's brow twitched.
Six-fold magnification for a brachial artery anastomosis isn't high; most vascular surgeons use at least eight to ten times for similar procedures.
Achieving a precision of 0.5 mm margin and 1 mm spacing under six-fold magnification requires an absurdly high level of hand stability.
"What about the radial artery?"
"The lateral wall tear of the radial artery was repaired using the same 7-0 Prolene suture with Interrupted suture, totaling four stitches. After the repair, I released the clamps to confirm there was no leakage."
"Did you use Heparinized saline to flush when you released the clamps?"
"I did. Before completing the anastomosis, I flushed the lumen three times with Heparinized saline to ensure there were no thrombus fragments."
Director Xu Minhua nodded.
This detail was handled correctly; many young doctors overlook the intraoperative flushing step during Vascular Anastomosis.
"Tell me about the Suturing."
"After Debridement, the deep muscles were closed with Interrupted suture using 3-0 absorbable thread to restore muscle fiber orientation and alignment. The fascia layer used 4-0 absorbable thread for continuous Suturing, the subcutaneous tissue used 4-0 absorbable thread with Interrupted suture to reduce dead space, and the outermost skin layer used 5-0 absorbable cosmetic thread for Subcuticular Continuous Suturing."
"Why did you use Subcuticular Continuous Suturing on this kind of crush-avulsion wound?"
"The wound is on the forearm, an exposed area, and the patient is only 35 years old. If conditions allow, post-operative scarring should be minimized. I assessed the wound conditions; although the tissue damage was extensive, the wound edges could achieve tension-free alignment after Debridement, meeting the indications for subcuticular Suturing."
"What if you found the tension at the wound edges was too high after Debridement?"
"Then I wouldn't have used subcuticular Suturing. I would have switched to Interrupted eversion sutures plus Tension-reduction sutures. Function comes first, aesthetics second."
Director Xu Minhua stared into his eyes for a few seconds.
When this young man answered, there was no hesitation or ambiguity; every answer followed clear clinical logic.
It wasn't memorized from a book; it was spoken from true understanding.
She asked a few more detailed questions.
About how to judge muscle fiber orientation when Suturing deep muscles, how to handle the transition zone between bruised and normal areas, and the basis for choosing the spacing for subcutaneous Tension-reduction sutures.
Lu Chen answered them one by one.
Every answer was precise, professional, and well-founded.
Director Xu Minhua fell silent.
To be honest, she had prepared many questions before coming, most of which she believed a Resident Physician wouldn't be able to answer.
Now, she had asked them all.
Not a single one had stumped him.
It wasn't just that he wasn't stumped.
The quality of his answers was higher than that of several young Attending Physicians in her Department of Hand Surgery.
Director Li Sen watched the scene from the side, his expression calm, but there was a tiny curl at the corner of his mouth.
Director Xu Minhua walked back to the bedside and lowered her head to carefully inspect the wound once more.
This time, she looked even more closely.
She even pulled a small ruler from her pocket and measured the spacing of the sutures.
Then, her movements stopped again.
The spacing error was within 0.2 mm.
For a fifteen-centimeter complex wound with multi-layered Suturing, the spacing error for every single layer was within 0.2 mm.
She had been in the Department of Hand Surgery for thirty years.
When she performed microsuturing herself, the spacing error was usually between 0.3 and 0.5 mm, which was already at the top level in the province.
The Suturing precision of the young man before her was even higher than hers.
Director Xu Minhua put the ruler back in her pocket.
She stood up straight.
And looked at Lu Chen.
"Who did you learn your Suturing technique from?"
"Self-study and clinical practice."
"Self-study?"
"Yes."
"You haven't followed any teachers from the Department of Hand Surgery or the Plastic Surgery Department?"
"No."
Director Xu Minhua's gaze was complicated.
Silence lasted for about ten seconds.
Then she said something Director Li Sen hadn't expected.
"In this surgery of yours, I can't find a single area that could be improved."
Director Li Sen's eyebrows twitched slightly.
Coming from Director Xu Minhua's mouth, these words carried immense weight.
In this Hospital, being told by Director Xu Minhua that something was 'decent' was already a very high evaluation.
'I can't find a single area that could be improved'—she probably hadn't said that to anyone in ten years.
"The choice of Vascular Anastomosis plan, the execution, and the post-operative results all met the standards, and even exceeded expectations."
"I don't want to use seniority as a reference for the quality of your Suturing, because it's meaningless."
"This level of Suturing, in the entire province, I believe ranks in the top three."
"I'm talking about across all departments, all levels of seniority, and all ranks."
"Top three."