Chapter 139: Chapter 139 - 0135 Ilizarov

Hermes’ surgery is scheduled for next week, and a discussion is needed this afternoon.

This surgery is a major one, in which a large portion of the tibia will be discarded, leaving only the healthy parts at both ends and removing all the infected bone tissue in the middle.

Then, using Ilizarov’s technique, an external fixation frame will be used to lengthen the healthy bone tissue at both ends, extending from both ends towards the middle until they converge.

To accomplish bone elongation, an external fixation frame has to be fitted to the calf. With a screw on it, the frame will move along with the bone tissue as the screw is turned.

The elongation process will begin two weeks after the surgery, and extend by one millimeter each day. Hermes will need an extension of over thirty centimeters, which would take approximately a year.

This is just the ideal situation. If any abnormalities occur in the bone formation process midway, the elongation will have to be halted.

Having completed Luo Xiaohu’s surgery in the morning, Yang Ping didn’t have much to do in the afternoon. So, he decided to sleep in the on-call room, enter the system space, read for a long time, dissect several experimental subjects, and train his ability to construct images.

He also spent five thousand points to purchase training on five hundred cases of specialized surgery involving external fixation frames.

Upon returning to the ward from the first floor, Director Tian had already translated Tan Boyun’s opening speech into English and handed it over to Zhang Lin.

His posters were almost ready as well. Zhang Lin sat in front of the computer, reviewing them one at a time and going over them several times.

“Is this really a Japanese doctor? Are we sure there’s no plagiarism?” Little Five, sitting next to Zhang Lin, was still wrestling with this issue.

Zhang Lin ignored him, but Little Five remembered that Director Tian was familiar with the guest speakers and had been to Japan, so his knowledge was broad. He pointed to the photo on the computer and asked, “Is this really a Japanese doctor?”

Director Tian smiled and said, “Yes, she is the guest of the conference, a doctor from Tokyo University Hospital. FUJIWARA is her name, very proficient in sports medicine.”

“Have you seen her in person?” Liang Fatty showed great interest.

“When I was a visiting scholar there, I saw her in person,” confirmed Director Tian.

“Is she as beautiful in reality as she is in the photo?” Little Five was still skeptical about the photo.

Director Tian smiled, “She is even more beautiful in person. Do you know her height?”

“How tall?” Zhang Lin asked as the provided data didn’t mention her height.

“One meter seventy-eight!” Director Tian announced the number.

“She’s that tall? As tall as me! Only Song Zimo can handle her; even Elder Brother would just barely manage!” Zhang Lin exclaimed in surprise.

Having said so much, Director Tian was getting impatient, “You lot, pour me a glass of water; stop talking and let me speak.”

Immediately, Little Five gave him a glass of water with a smile. Only then did Director Tian continue, “And if you thought that was surprising, wait until you hear what she does part-time. Would you like to know?”

What does she do? Everyone showed great interest; this sounded juicy.

It is Japan, after all! The possibilities were endless — some had already thought up certain acronyms…

Director Tian took a sip of water, “Fatty, get out your weight-loss supplement snacks. I need some energy to talk as I’m running out of ATP.”

Reluctantly, Fatty pulled out a few chocolate balls from his bag and handed them over. Director Tian unwrapped one and popped it into his mouth.

Everyone watched him eat, waiting for him to reveal what she did part-time.

Teasingly, Director Tian took a sip of water and said, “She is a part-time model, a famous one in Japan who ranked in the top ten at the World Elite Model Competition. She has even participated in Paris’s Victoria’s Secret Show.”

“Might as well not hold the conference anymore and just watch her walk on the runway,” Liang Fatty suggested.

Zhang Lin scoffed, “Fatty, do you think everyone is as vulgar as you are? You should be a bit more refined.”

Director Tian continued, “She’s a rising star in Japanese sports medicine. Her brother is a specialist in traumatic orthopedics, and I guess she’s accompanying him this time. Although not common, there are other cases like her. Take Japan’s Sony Corporation Chairman, Norio Ohga, who is also a conductor for the Tokyo Philharmonic Orchestra; or Hedy Lamarr, the American inventor of CDMA telecommunications technology who also happened to be a Hollywood star and was the first woman to appear fully nude in a film. You’ve heard of Bohr, right? The creator of Bohr’s Law which we studied in high school. Not only was he a physicist and a Nobel Prize winner, but he also played as the goalkeeper for Denmark’s national football team. I’ll tell you this: several Olympic gold medalists happen to be full-time doctors! If you invite me to dinner sometime, I can tell you more.”

Director Tian was brimming with knowledge as he spoke eloquently.

“Wow, what a legend!” Liang Fatty helplessly shook his head.

“Fatty, you’re one too, an anesthesiologist by day and the Chairman of the Sanbo Food Association by night.” Zhang Lin said seriously.

Liang Fatty didn’t get angry; instead, he proudly reminisced, “A true hero never brags about his past glories. But I tell you, I really did start the Food Association in college, and I served as the first chairman. There are always costs associated with doing things; look at my body shape now, that is the price I paid.”

Fatty gestured towards his waistline.

“What a guy!” Zhang Lin and Little Five gave Fatty a thumbs up.

“Look, this is her photo from the Victoria’s Secret Show in Paris!” Zhang Lin found a picture of the Japanese female doctor on the internet.

“Wow!” Little Five and Fatty stretched to take a closer look.

“Keep your distance, don’t get your nosebleed on me.” Zhang Lin sidestepped to avoid them.

“This is not photoshopped, she’s really beautiful. Those legs alone could bring nearly ninety percent of men worldwide to their knees!” Fatty swallowed a mouthful of saliva.

In the photo, Fujiwara was on the runway, sparkling in her trench coat, super-short shorts, and sunglasses.

Suddenly, Director Tian stopped speaking and coughed a few times.

Without knowing who, a hand lands on Zhang Lin’s shoulder, and without a thought, Zhang Lin immediately switches the screen: “Hmm, this patient is indeed troublesome.”

“Yes, very troublesome!” Little Five stroked his chin.

“Extremely troublesome!” Liang Fatty nodded as well, his brows furrowed.

A bunch of drama queens, actors whose professional calling had been delayed by medical school.

“You guys did well today. Are you reviewing Wang Changxin’s case?” Professor Zhang Zongshun walked in through the door.

Wang Changxin is the patient’s name, such a wealthy name at that.

“Hmm, just getting familiar with it in advance!” Zhang Lin stood up, seemingly enlightened.

Some damned hand accidentally hit the computer keyboard and brought up Fujiwara’s picture.

Professor Zhang glanced through the gap between their bodies, “What is this?”

Zhang Lin looked back, the picture had popped up, calmly he said: “Screen saver, screen saver image.”

“Oh!” Professor Zhang didn’t probe further.

“Where is Yang Ping?”

“Studying in the duty room!”

Actually, he’s sleeping in the duty room.

“What about Song Zimo?”

“Practicing arthroscopy in the lab!”

He’s indeed practicing arthroscopy.

“Are all the people here? Let’s discuss Wang Changxin’s case later.” Professor Zhang briefly took a head count.

“Director Han is in the administrative building, he hasn’t returned yet.” Director Tian moved a chair for Professor Zhang to sit.

“That’s fine, you guys prepare first, we’ll wait for Director Han. The suggestion for this case discussion was made a few days ago, you all have read the book, right?”

“Yes, we did! We did!” Little Five and Zhang Lin responded in unison.

Everyone went to the teaching room to wait for Director Han, Director Tian made a phone call, Director Han was on his way back, and before long, Director Han was back.

The discussion began. It was Little Five’s patient, and Little Five completed the case report.

“Little Five, all of you have studied the case and read up in advance, tell us about your opinions on this case.” Director Tian moderated.

Little Five looked at the screen: “The diagnosis for this patient is not problematic. He has chronic osteomyelitis of the right tibia, supported by imaging examination and bacterial culture. The best approach would be to thoroughly excise the infected tibial tissues. Then, bone elongation would be performed using an external fixator, and the defect would be temporarily filled with calcium sulfate containing vancomycin.”

Yang Ping had already talked to them, and he got the main points down.

“This tibial elongation needs at least thirty centimeters, this length is very rare, would there be any complications from nerve and blood vessels? Zhang Lin, what do you think?” Director Tian followed up.

“Well, this is, um -” Zhang Lin scratched his head.

Song Zimo took over: “This is different from elongating a shortened deformed limb, there’s no need to consider the extension limit of nerves and blood vessels. This is because only the bone tissue is being lengthened, there’s no need to lengthen the blood vessels and nerves. In theory, however long the original was, it can elongate that much, there’s no limit.”

Song Zimo’s knowledge is solid, and he has been known as the terminator of Director’s round questions.

“There are two types of elongation devices to choose from: external fixators and intramedullary nails. Among these two, the external fixator is more suitable for this patient. The retained proximal and distal tibia can each accommodate two sets of fixation pins, so there’s no problem installing the external fixator.” Director Tian added.

Generally, people only know that external fixators can be used for elongation. They don’t know that there’s another type of specialized intramedullary nail that can also be used for elongation.

“What are Yang Ping’s thoughts?” Professor Zhang called upon Yang Ping whose comments tend not to be very proactive.

Yang Ping collected his thoughts and said: “Every detail has been thoroughly discussed by everyone, there’s really not much left to say. When inserting the needle, pay attention to going through the intermuscular space. That way, during elongation, the interference with muscle strength training is miniman.”

Song Zimo looked over. It’s easy to say to insert the needle through the intermuscular space, but it’s really hard to do it completely in practice. He seemed to make everything look simple.

Collecting everyone’s input, Director Han summarised their teaching points, adding a finishing touch: “Ilizarov Tissue Distraction Regeneration Theory states that slow traction of biological tissues produces a certain tension that can stimulate tissue regeneration and active growth. The manner in which this growth occurs is similar to fetal tissue development, where the same cells divide. In simple terms, it’s using slow and continous traction to get the tissue back to its fetal period growth stage. This technology has revolutionised traditional pressure bone healing theory.”

Yang Ping deeply respects the pioneers of these medical theories. These people have big imaginations and rich imaginations.

Professor Zhang added on to the origin of the theory: “Ilizarov was a rural doctor in Siberia in the Soviet Union during the 1950s and 60s. This technique was the result of an accident. The initial purpose of his external fixator design was to treat a fracture patient. Every day, by turning the screw on the external fixator, the fractured ends could be tightly compressed, which would promote fracture healing. Once, when he was on leave, he instructed a nurse to adjust the screw on the external fixator daily. The nurse was very serious and acted strictly according to his medical advice; the only mistake she made was turning the screw in the wrong direction. By the time Ilizarov came back, the patient’s fractured ends had been separated, but surprisingly, new bone callus had formed. Inspired by this phenomenon, he invested a lot of time and effort into research, eventually proposing the Tension Stress Rule, or the Theory of Traction Tissue Regeneration. The Soviet Union then invested a lot of manpower and resources into research, perfecting this theory, resulting in the mature theory we have now. This theory is fully deserving of the Nobel Prize, but at the time of the US-Soviet Cold War, naturally it did not win. China began implementing this technique in the 1980s. There was a time when this technique was abused to lengthen normal people to increase their height; it caused many complications such as skin necrosis, muscle weakness, non-union of bone, nerve injury, and so on. In October, 2006, the Ministry of Health ordered a ban on osteotomy to increase height for ‘medical cosmetic treatment’, that is, it could not be used to increase the height of normal people. It can only be used for congenital deformities, trauma, infection, tumors, and other reasons for bone defects and unequal limb length, as well as limb deformities caused by disease.”

The discussion not only made the patient’s diagnosis and treatment plan clearer and more comprehensive, but it was also a great opportunity for young doctors to learn. Through clinical cases, experience is accumulated, the knowledge of a category of diseases is acquired with each typical case.

After such a discussion, everyone had a basic understanding of Ilizarov’s magical technique.

After the meeting, Yang Ping received a WeChat message from Su Nanchen, asking Yang Ping to go to the First Affiliated Hospital for consultation.

Going for a consultation? It’s to The First Affiliated Hospital!

Is there a mistake?!