145: Chapter 145 Only this person could do such a stitch.
Debridement took about eight minutes.
After Lu Chen had cleaned away all foreign objects and necrotic tissue, he re-examined the entire wound.
The eight-centimeter wound appeared even clearer after the Debridement was completed.
At the deepest part of the wound, two sets of torn muscles were clearly visible.
The one on the upper, outer side was the torn end of the zygomaticus major muscle; the muscle fibers had retracted by about three to four millimeters, and the cross-section was jagged.
The one on the lower, inner side was the torn end of the levator anguli oris, which had also retracted by a few millimeters, with an even more irregular cross-section.
On both sides of the wound, the corresponding proximal and distal ends could be found.
However, because the wound edges were jagged, the muscle bundles on both sides did not align neatly; instead, they were displaced, requiring each bundle to be matched one by one.
This was the most difficult part of this kind of surgery.
Muscle fibers were not electrical wires; it wasn't a matter of connecting red to red and blue to blue.
They were thin, dense, and would tangle with each other after tearing and retracting.
If one couldn't accurately identify the direction and corresponding end of each bundle, the result of the Suturing would be a mess.
After healing, the muscle's direction of contraction would be wrong, and the smile would be crooked.
After examining it, Lu Chen already had a complete surgical plan in mind.
"Alright, let's start the Suturing."
He sat on the surgical stool beside the treatment bed and adjusted the angle of the shadowless lamp.
Shen Xiaoning stood on his left, responsible for passing instruments and retracting tissue.
Section Chief He Zhongfeng and the on-duty doctor stood a little further away, watching nervously.
Lu Chen picked up the microsurgical needle holder and clamped a 4-0 absorbable suture.
"First, we will repair the deep muscles, starting with the zygomaticus major."
His fingers reached into the wound, gently pushing aside the superficial tissue to expose the torn ends of the zygomaticus major.
His fingertips paused on the cross-section.
With his heightened tactile sensitivity, his fingers could perceive the minute differences in tension and the texture of the muscle fiber bundles.
He quickly established the correspondences in his mind.
The first bundle on the proximal end corresponded to the one on the outer side of the distal end; their texture patterns were consistent, and the fiber diameters matched.
After finding the corresponding end, he used micro-tweezers to gently clamp the tip of the proximal muscle bundle, while his other hand controlled the needle holder.
He inserted the needle.
The 4-0 absorbable suture passed through the muscle bundle, the entry and exit points precise to the millimeter.
He inserted the needle in the proximal end, then crossed the gap and exited through the corresponding bundle on the distal end.
He tightened the thread and tied the knot.
Completed in one go.
The apposition surface of the muscle bundles was seamless, and the two torn muscle fibers were perfectly repositioned under the tension of the suture.
The first stitch.
Section Chief He Zhongfeng's uncle didn't feel much due to the anesthesia, but Section Chief He Zhongfeng saw it clearly from the side.
That stitch was too clean.
Although he was not a surgeon, he had seen enough surgeries to know what Suturing should look like.
He had never seen anyone achieve this level of precision at the muscle layer.
The angle, depth, and spacing of the thread passing through the muscle bundle looked as if they had been precisely calculated.
No, it didn't just look like it; it really had been precisely calculated.
Lu Chen did not pause.
The second stitch.
The second muscle fiber bundle on the proximal end corresponded to the position on the inner side of the distal end.
His fingers gently touched the cross-section to confirm the texture direction.
Insert needle, pass thread, tighten, tie knot.
Another perfect muscle bundle alignment.
Shen Xiaoning watched his operation from the side, holding scissors in her hand, ready to cut the thread, but her attention was completely captured by his fingers.
Those hands were too steady.
Operating on muscle bundles only a few millimeters wide, his fingers had no tremors; not even the rhythm of his breathing affected the stability of his hands.
She swallowed hard and handed him the scissors promptly after he tightened the thread.
"Cut the thread."
"Alright."
Lu Chen continued to suture downwards.
The torn ends of the zygomaticus major were divided into four bundles due to the irregular wound edge.
Four muscle fiber bundles, eight torn ends; they needed to be matched one by one.
Lu Chen identified, aligned, and sutured them bundle by bundle.
His speed was not fast, at least much slower than his usual skin Suturing.
But this was not because he was rusty or hesitant.
It was because every stitch needed to be extremely precise, allowing for not a single deviation.
For the alignment angle of each muscle fiber bundle, even a deviation of half a millimeter would cause problems with the muscle's direction of contraction after healing.
He did not allow such a deviation to exist.
The four muscle fiber bundles of the zygomaticus major were all sutured.
It took six minutes.
"Zygomaticus major repair complete, alignment is good. Next, we will repair the levator anguli oris."
His voice was as calm as a weather report.
Section Chief He Zhongfeng stood by, his palms sweating.
His uncle sat on the treatment bed; because of the anesthesia, he couldn't feel anything on his face, but his eyes were fixed on Lu Chen's expression.
There were only two words he saw on Lu Chen's face: Certainty.
This young man showed no signs of nervousness or hesitation; every movement carried a sense of natural composure.
The situation with the levator anguli oris was more complex than the zygomaticus major.
This muscle was located deeper and had intertwined fiber bundles with the surrounding buccinator and orbicularis oris muscles, and the direction of retraction after tearing was also more complex.
Lu Chen's fingers slowly probed the depths of the wound.
He could feel the subtle differences in texture between the muscle fibers.
The fibers of the levator anguli oris were slightly thinner than those of the zygomaticus major, their arrangement was more vertical, and their direction was different from the fibers of the buccinator.
Relying on the tactile sensation of his fingers, he identified, bundle by bundle, which were the torn ends of the levator anguli oris and which were the normal fibers of the buccinator.
Then he inserted the needle.
First stitch.
Second stitch.
Third stitch.
The levator anguli oris was divided into three bundles, with six torn ends.
He placed five stitches, each one achieving alignment in a single attempt, with no rework.
Levator anguli oris repair complete.
It took five minutes.
"Deep muscle repair is complete."
Lu Chen put down the 4-0 thread and switched to 5-0.
"Next, we will suture the SMAS layer."
The SMAS layer is the Superficial Musculoaponeurotic System of the face, located between the subcutaneous tissue and the deep muscles; it is a very critical layer in facial Plastic Surgery Department and cosmetic Suturing.
Once this layer is sutured well, the skin tension will be evenly distributed, making it less likely to leave scars.
Lu Chen placed seven stitches on the SMAS layer.
The spacing of each stitch was terrifyingly uniform; to the naked eye, it looked as if it had been printed.
The on-duty doctor was already stunned.
He had worked in the Emergency Department for three years and had seen at least a thousand Suturing procedures, but he had never seen anyone achieve this level of quality on the SMAS layer.
This was not Suturing; this was a handicraft.
SMAS layer Suturing complete.
Lu Chen changed the thread again, to a 6-0 skin suture.
"The last layer, the skin layer, using a continuous intradermal cosmetic Suturing."
Continuous intradermal cosmetic Suturing is a common Suturing method in the Plastic Surgery Department; it does not leave needle marks on the skin surface.
The suture runs continuously within the dermis, and after the Suturing is done, no thread ends are visible on the surface.
The advantage of this Suturing method is that it leaves almost no needle scar after surgery, but it requires extremely high operational precision.
Especially when performing continuous intradermal cosmetic Suturing on irregular, jagged wound edges, the difficulty doubles.
Because the wound edges are not neat, one must precisely adjust the needle entry angle and depth at every turning point of the jagged edge to allow the skin edges to perfectly appose.
Lu Chen did not hesitate in the slightest.
His fingers gripped the needle holder, and he began inserting the needle from one end of the wound.
The 6-0 suture was extremely thin, glistening faintly under the shadowless lamp.
The needle tip pierced into the dermis, then ran horizontally within the skin, crossing the irregular wound boundary, and exited at an equivalent depth on the opposite side.
Between entry and exit, the skin edges automatically apposed.
After the thread was tightened, that segment of the jagged wound edge closed together, with no misalignment between the apposition surfaces.
Then he continued.
The next jagged point.
The needle entry angle was slightly adjusted to adapt to the change in the direction of the wound edge.
Needle exit, apposition, tightening.
Three adults watched from the side.
Section Chief He Zhongfeng watched Lu Chen's hands moving along the wound, and a very complex feeling welled up in his heart.
How many times had he targeted this person?
How many tricks had he played behind the scenes?
Colluding with Jiang Weibang to suppress his scores during assessments.
Secretly pulling strings to delay the consultation time of the Department of Thoracic Surgery.
Using Dr. Ma Xu to block him in the General Surgery Department.
Forcing the quota for the provincial assessment on him, expecting him to make a fool of himself.
And the result?
Every single time, this person had used his own ability to turn the situation around.
Not only had the attempts to finish him off failed, but now he had to beg him to save his own relative.
This feeling, to be honest, was particularly uncomfortable.
But after watching the operation of the hands before him, Section Chief He Zhongfeng found that he couldn't even maintain the feeling of discomfort.
Because he was stunned.
He had seen surgeries, seen Suturing, and seen many doctors on the operating table.
But he had never seen anyone's hands capable of such stability.
On such thin thread, on such a narrow wound, and under such irregular wound edge conditions, the result was as if it had been done by a machine.
No.
A machine could not do this kind of work.
Because every turning point of the jagged edge was different; the angles were different, the depths were different, and the thickness of the wound edges was different.
These variables could only be adjusted by the real-time perception of fingers; no machine could do it.
Only a human could do it.
Only this person can do it.