Chapter 488: Taking the Leap: A Challenger’s Scalpel

With his surgical experience, Zhou Can knew it was nearly impossible to repair this patient’s finger tendons. The only viable solution was to transplant a tendon.

Normally, each finger has a flexor digitorum superficialis, flexor digitorum profundus, and an extensor tendon.

With their contraction and relaxation, these allow the fingers to bend and straighten.

While the anatomy seems simple enough, whenever adhesions are involved, surgery gets incredibly tough. This kind of fine operation really puts the chief surgeon’s skill and experience to the test.

No matter how confident Zhou Can was, facing a level two surgery like this definitely rattled him.

Seeing Zhou Can hesitate, the patient couldn’t help but plead, begging him to do whatever he could. Even if the treatment failed, he promised not to hold the hospital responsible.

At this point, the patient’s father spoke up, telling Zhou Can that they’d arrived days ago, staying in a motel for four days.

Because his appointment slots were so rare, they simply couldn’t get one.

In the end, they paid two hundred yuan to a ticket scalper just to book a spot.

Their son was the only child. He was already twenty-five, but an accident had left his right hand disabled, impacting his job prospects, relationships, and daily life. To afford his surgeries, his father rented seventeen acres of farmland and took a logging job back in their hometown’s forest.

He added that he’d endure any hardship, no matter how tough.

As long as his son’s hand could be healed, he’d spend whatever it took.

Then he told Zhou Can that after his son was injured, he worked tirelessly at rehab and endured pain that most people couldn’t imagine.

In the end, Zhou Can was moved by this father and son.

He called in Dr. Xu to consult and form a surgical plan together.

The patient had been admitted just yesterday, completing every necessary pre-op check. Then, the nurses and attending doctor shaved the hair on his hand and foot and trimmed his nails, making sure everything was ready.

There were three options for tendon source: the first is allograft, using a donor’s tendon.

This comes with complicated paperwork and a waiting period.

But tendons aren’t as scarce or in demand as corneas, kidneys, or hearts, so the wait usually isn’t too long or expensive.

However, allograft tendon carries the risk of rejection.

And for families already struggling, the cost is still a burden.

The second option is artificial tendons.

With advancements in technology, artificial tendons are now available and fairly mature.

But the cost is still high and there’s also risk of rejection and inflammation.

All transplants—whether artificial or human donor—carry rejection risks. Many organ recipients need lifelong medication to prevent that.

So, neither of the first two options is ideal for this patient.

To complicate things, the patient had already undergone two corrective surgeries, making this transplant even harder.

After discussing with Dr. Xu and weighing all the factors, Zhou Can chose to take a tendon graft from the patient’s own foot—either a plantar tendon or the extensor digitorum longus.

This surgery was incredibly risky.

If anything went wrong, the patient’s right hand might not recover, and the toes could lose their movement too.

After many discussions with the family and the patient, they agreed. That’s how they arrived at today’s operation.

“You two watch closely. For finger surgeries, we usually start with a zigzag Brunner incision on the palm side.”

Zhou Can explained surgical techniques in real time as he worked.

By slanting the zigzag cut to one side, the scar avoids landing right on the tendon, making it easier to suture the finger while flexed.

Once he dissected the patient’s finger, he saw evidence from the previous doctor’s operation.

That doctor clearly had good technique—the surgery had been done with real finesse.

But the correction method he used was a bit puzzling.

Of course, Zhou Can didn’t criticize the last surgeon’s approach. Instead, he quickly finished dissecting the finger and started harvesting the tendon from the patient’s foot.

At this point, Yang Zhi and Pu Dingdong still couldn’t help much with such high-difficulty procedures.

If the surgical assistants were skilled enough, they could work in synch with Zhou Can during the operation.

Just as Zhou Can finished prepping the hand for the transplant, the assistant had also harvested the plantar tendon.

[Incision Technique EXP +1. Tissue Separation EXP +1. Higher-difficulty plantar tendon dissection: bonus EXP +100.]

Seeing that big bump in his tissue separation experience made Zhou Can beam with joy.

Incision Technique had already reached Chief Physician level. The next promotion needed a million EXP points. If he only earned 1 point at a time, it might never happen in his lifetime.

Even a windfall of 10 or 100 points still made leveling up daunting.

Still, Zhou Can was confident that, over five or ten years, he could max out all his core surgical skills to level seven.

His surgical team was growing, and soon he could hand off routine operations to others while he focused on tackling the toughest cases.

Just like this hand tendon transplant.

Don’t be fooled by its level-two ranking—the difficulty was sky-high. The precision and technical demands were on par with level-four major surgeries.

Level two surgeries are just less risky and less complex.

That’s about it.

Thinking that level-one surgeries are always easy or that only chief physicians can handle level four operations is just narrow-minded.

There are level-one surgeries out there that are incredibly tough.

Even level four has some fairly routine ones, but there’s no such thing as an easy surgery above level three.

Dissecting the finger tendons had already earned Zhou Can a good chunk of experience.

Because of severe adhesions, he worked extra hard to preserve the patient’s flexor digitorum superficialis.

This part had been even tougher than taking the plantar tendon.

After harvesting the plantar tendon, he went on to dissect a neighboring blood vessel.

This vessel was extremely fine yet couldn’t be cut—since it supplied blood to part of the foot.

There’s an old saying: people thrive on change, trees die when moved.

Why do trees so often die after being transplanted?

Because the roots get injured.

The same applies in surgery. Any blood vessel, nerve, tendon, or even subcutaneous tissue that can be preserved should be, to minimize patient trauma.

Some irresponsible doctors just cut things off for convenience.

That’s completely unethical.

A patient might suffer for life from the consequences of one careless cut, living with lifelong pain and inconvenience.

[Tissue Separation EXP +1 +1… Bonus EXP +100.]

[Congratulations! Your Tissue Separation skill has advanced to level six. Current EXP: 1 / entry-level Chief Physician.]

He’d been longing for this upgrade, and finally, with relentless work, his separation skill hit level six.

After the upgrade, Zhou Can found he had a fresh perspective on dissecting and freeing organs and tissues. Now, the main trunk of the vessel was almost freed—just a few small branches left.

This was essentially a terminal blood vessel.

Not quite a capillary, but the tier just above.

With his old skills, separating such a fine vessel took ages and there was no guarantee of success. This had nothing to do with magnifying glasses.

The thinner the blood vessel, the more delicate its wall—making it much easier to damage.

One careless move could tear it.

Even in neurosurgery, Wu Baihe is called the Peak Scalpel. Yet when faced with something this tiny, even she would just snip it.

She’d maybe save the crucial one or two, but there’s no thinking beyond that.

Now that his Tissue Separation was level six, Zhou Can wanted to really push its limits.

He was genuinely curious how powerful a level-six separation skill could be.

He didn’t dare call it ‘top notch’ just yet.

A skill had to hit level seven—then it was truly elite.

“Hand me a number 27 scalpel blade, let’s give it a try!”

Zhou Can turned to Qiao Yu.

“Ah… I didn’t expect you’d want such a tiny blade. Xiaolan, could you grab one from supply for me?”

“Okay!”

Ma Xiaolan rushed off to fetch it.

The operating room stored basic instruments and there was a supply room for all the common tools and blades they needed.

Once, when Zhou Can worked in the old OR, Dr. Xu got angry that someone opened a pack of supplies from storage but didn’t use it.

“That small a blade—are you planning to separate some peripheral nerves?”

Qiao Yu was puzzled why Zhou Can, who’d almost finished separating the plantar tendon, suddenly needed such a small blade.

Usually, an 11 blade is plenty sharp for dissecting vessels. For cutting skin, the number 10 is most popular.

“I want to preserve as many tiny blood vessels as possible for him. That way, we’ll minimize foot damage.”

Zhou Can smiled.

Soon, Ma Xiaolan returned with a number 27 blade.

There was also a number 34 and 36 available.

But the 27 would suffice for now.

Fitting the fine blade onto the handle, Zhou Can expected it to feel odd. But after advancing to level six, it felt perfectly natural in his hand.

It was as if he’d worked with such tiny blades all his life.

He started dissecting the first tiny vessel branch. The blade flew as if guided by an unseen force, his hand steady as a rock but the cuts as swift as lightning.

Fast Scalpel and Steady Scalpel Techniques combined perfectly in that moment.

As he alternated cutting and separating, both surgical skills simultaneously advanced to level six. Even the Fast and Steady Scalpel Techniques improved by leaps and bounds.

He couldn’t quite put it into words, but it felt amazing.

It was a feeling Zhou Can had never experienced before.

After much effort, he’d successfully separated the first small vessel branch.

He’d braced himself for rupturing it, but to his astonishment, he succeeded.

Still, it was far from perfect.

But surgery isn’t about chasing perfection. If you succeed and the patient recovers, that’s what matters.

Of course, with a solid foundation, striving for excellence makes sense.

Zhou Can knew his limits. Having just hit level six and just becoming an entry-level chief, chasing perfection here would be a mistake.

First off, it would hugely extend surgery time.

Second, if your skill isn’t there yet, pushing for perfection could spell disaster.

As the elders would say, you should eat according to your ability.

If you’re not ready for a grand feast, you’ll only end up letting your ambition outpace your life.

[Tissue Separation EXP +1. Separated a fine blood vessel: Bonus EXP +100.]

Zhou Can’s eyes lit up. He’d just discovered a new way to rack up big tissue separation experience points!

Whenever possible, he’d try to separate more small vessel branches. Not only did this net him 100 experience points, it also spared the patient unnecessary harm.

A true win-win.

……

With the plantar tendon secured, it was time to transplant it into the patient’s finger.

This phase of surgery was yet another test of meticulous skill.

It demanded not only expertise, but smart planning too.

“Dr. Zhou, why did you leave extra tissue around the tendon transplant?”

Dr. Pu Dingdong was curious and sought Zhou Can’s guidance.

Usually, during the operation, assistants should avoid asking questions. When the pressure is high and the patient’s condition is tricky, the chief can be wound tight as a drum.

They might get snapped at for the smallest thing, let alone a question mid-surgery.

Back when Zhou Can was an intern, the surgeon he shadowed was an ill-tempered associate chief. He berated the instrument nurse from start to finish.

That nurse, already in her thirties, was nearly in tears by the end.

Still, she stuck it out till the operation was done.

Then had to run to the bathroom to cry.

Sometimes, having a good-tempered chief surgeon makes all the difference for nurses and assistants.

And that leads to an interesting phenomenon.

In almost every hospital, large or small, the OR nurses are usually the most attractive in the entire staff.

There are a lot of reasons for that.

First, chief surgeons hold high status. In any department, a doctor with excellent surgical skills is respected.

That’s just how it goes.

They’re the department’s box office draw, the main engine bringing in revenue.

Even in Internal Medicine, doctors who excel at interventional procedures hold greater rank.

Second, chief surgeons are typically male.

Let’s be honest, most men notice appearances regardless of character. It’s just part of being a man.

No surgeon wants to spend hours operating across from an unattractive nurse. Surgery is mentally taxing and physically draining. To pull off a tough operation, you’re staring at a bloody field for hours on end.

That’s exhausting on the eyes.

Now, being able to look at a pretty nurse beside you not only helps ease eye fatigue, it lightens the mood too.

And as for those self-righteous types who put doctors on a moral pedestal and act like they’re above it all—well, they’re just a bit too naïve.

Whether it’s a male manager or a chief surgeon, any man would prefer an attractive woman around him.

Some company bosses even hire male secretaries just to avoid temptation, which honestly is just a sign they lack confidence.