131: Chapter 131 High ligation and stripping of the great saphenous vein?
2:00 PM.
The surgery was all set.
Zhao Ming was momentarily stunned when he received the notification.
"High Ligation and Stripping of the Great Saphenous Vein?"
"Correct."
"This surgery... I've almost forgotten when I last performed it. It's been at least three years."
"You haven't forgotten your epidurals, have you?"
"Rest assured, that's etched into my bones."
Lu Chen briefed Zhao Ming on the patient's condition.
Zhao Ming fell silent for a moment after hearing it.
"A surgery that only costs six hundred yuan... If you hadn't brought it up, this family might have just gone home to wait for death."
"So it must be done."
"Alright, no problem. I'll assist you."
Operating Room.
The patient was wheeled in.
The Middle-aged man lay on the operating table, his eyes filled with tension and unease.
Lu Chen walked over and patted his arm.
"Uncle, don't be nervous. It's just a minor surgery. We'll give you an Anesthetic injection in your lower back in a moment, and you won't feel anything in your lower body. You'll be awake during the procedure, but it won't hurt."
"Doctor, I've only had one injection in my entire life, and that was when I was a child..."
"Don't worry, it's much easier than an injection."
Zhao Ming began the Epidural Anesthesia.
The Puncture went smoothly. After the medication was administered and a few minutes had passed, Zhao Ming began testing the Anesthetic level.
He took a testing needle and lightly scratched the sole of the patient's foot.
"Uncle, can you move your feet?"
The Middle-aged man blinked.
He didn't understand.
Or rather, he understood it, but interpreted it as something else.
In his dialect, the pronunciation for "move" and "cold" was almost identical.
The Middle-aged man shook his head hurriedly.
"Not cold! Not cold! My feet are quite warm!"
Zhao Ming was stunned for a moment.
"No, Uncle, I'm asking if you can move your feet. Give them a move."
The Middle-aged man grew more anxious.
"They're really not cold, Doctor. Feel them, my feet aren't cold at all!"
He tried his best to stretch his feet toward Zhao Ming.
Zhao Ming looked at Lu Chen with a bewildered expression.
The corner of Lu Chen's mouth twitched slightly.
The Nurse nearby was the first to react; it was Shen Xiaoning.
She walked to the head of the patient, leaned down, and slowed her speech.
"Uncle, the doctor isn't asking if your feet are cold. He's asking if you can move them. Try moving your toes."
The Middle-aged man finally understood.
He tried to move his toes.
He couldn't move them.
"Oh my! My feet... my feet won't listen to me!"
"Yes, that's right. It means the Anesthetic is working."
The Middle-aged man sighed in relief.
"You gave me a fright. I thought you were asking if I was cold."
The whole Operating Room erupted in laughter.
Zhao Ming rubbed his forehead.
"Uncle, your comprehension skills are truly something."
Shen Xiaoning was laughing too, but fearing the patient might be embarrassed, she quickly offered comfort.
"It's okay, it's okay. Many people get nervous during their first surgery. Just relax, Uncle."
The Middle-aged man smiled sheepishly, the wrinkles on his face bunching together.
After washing his hands and donning his surgical gown, Lu Chen walked to the operating table.
His expression changed the moment he put on his mask.
"Ready to begin."
Zhao Ming confirmed that the Anesthetic level met the requirements and nodded.
"Anesthesia ready. You may begin."
Lu Chen picked up the scalpel.
High ligation and segmental stripping of the great saphenous vein.
The steps of this surgery were not complicated.
First, a small incision is made in the Inguinal Region to find the junction of the great saphenous vein and the Femoral Vein, which is the Fossa Ovalis. Here, the great saphenous vein is ligated and severed.
Then, small incisions are made on the medial side of the knee joint and the medial side of the ankle joint. A Stripper is used to pull the main trunk of the great saphenous vein out from under the skin.
Finally, the two incompetent Perforating Veins are addressed, ligated, and severed.
It sounded very simple.
And it really wasn't that difficult to perform, at least not for Lu Chen.
But this surgery had a key point that was easily overlooked.
During high ligation, several Tributaries join near the junction of the great saphenous vein and the Femoral Vein. If the ligation isn't clean and a tributary is missed, recurrence is likely after surgery.
On the scan image provided by the system, there were four Tributaries entering the junction in this patient.
Lu Chen wouldn't miss a single one.
The surgery officially began.
He made a three-centimeter incision in the Inguinal Region, cutting through the skin and subcutaneous tissue layer by layer to expose the Fossa Ovalis.
The main trunk of the great saphenous vein was clearly visible, significantly dilated with thickened walls.
Lu Chen carefully separated the tissues along both sides of the main trunk, identifying the Tributaries one by one.
While passing the instruments, the Nurse nearby couldn't help but take a look.
Lu Chen's hands were incredibly steady.
In this kind of fine dissection, his fingers made no redundant movements; the direction and depth of every cut were exactly right.
All four Tributaries were found, ligated, and severed one by one.
Then, the main trunk of the great saphenous vein was double-ligated and cut where it joined the Femoral Vein.
High ligation complete.
Next was the stripping.
Lu Chen made small incisions of about two centimeters on the medial side of the knee joint and the medial side of the ankle joint, exposing the main trunk of the great saphenous vein at both locations.
He then inserted the Stripper through the ankle incision and pushed it along the lumen of the great saphenous vein all the way to the knee.
"Prepare for traction."
While stabilizing the knee incision, he slowly and evenly pulled the Stripper out from the ankle.
The entire main trunk of the great saphenous vein was stripped out.
The operation was clean and efficient.
No bleeding, no breakage, and no residue.
Watching from the opposite side, Zhao Ming nodded silently.
Although the surgery itself wasn't hard, the quality of Lu Chen's technique still felt satisfying to watch.
That sense of rhythm—knowing when to be fast and when to be slow—wasn't something an ordinary Resident Physician possessed.
Next was addressing the Perforating Veins.
Based on the locations marked by preoperative ultrasound, Lu Chen made two small incisions of about one centimeter on the medial side of the lower leg, precisely finding two incompetent Perforating Veins to ligate and sever.
Finally, it was time for Suturing the incisions.
None of the incisions were large; even the biggest one in the Inguinal Region was only three centimeters.
But Lu Chen's standards for Suturing didn't drop just because the incisions were small.
He aligned the layers one by one, performed subcutaneous tension reduction, and used Absorbable Sutures for Subcuticular Continuous Suturing on the skin.
When the last incision was finished, the entire surgery concluded.
It took forty-one minutes.
Zhao Ming glanced at the timer.
"Forty-one minutes. That's the fastest great saphenous vein stripping I've ever seen."
Lu Chen took off his gloves.
"The surgery itself isn't complicated. Being fast is normal."
"If you said that and were overheard by those senior doctors in the General Surgery Department who've been doing this for twenty years, they'd probably want to tie you to the operating table."
"That they'd have to register for an appointment first."
Zhao Ming laughed.
After the surgery, Lu Chen went to brief the family members waiting outside the Operating Room.
The Middle-aged woman and The girl had been standing at the door for nearly an hour.
Seeing Lu Chen emerge, both of them straightened up simultaneously; The girl's hands were trembling.
"The surgery went very smoothly. The veins have been stripped, and all the issues have been addressed."
The girl suddenly squatted on the ground, covered her face, and burst into tears.
The Middle-aged woman was also wiping away tears, her mouth never stopping.
"Thank you, Doctor. Thank you, Doctor..."
"Don't cry. Pressure bandaging is still needed after surgery. The dressing will be changed in three days. The ulcerated area will need regular dressing changes for about two to three weeks to heal. Once you're home, make sure he doesn't stand for long periods."
The girl stood up from the ground, wiping her tears.
"Doctor, the surgery fee... when should we pay it?"
"Just go to the cashier on the first floor. The Nurse will give you the billing slip."
The girl nodded vigorously.