Chapter 127: A Daring Transplant Operation

A mangled right thumb paired with a clear X-ray of the right foot’s bone.

He couldn’t help but feel shocked.

Could it be… Chief Resident Shen’s plan to reconstruct a new thumb for the patient actually involves harvesting the right foot’s big toe and transplanting it to the missing thumb spot on the right hand?

This ingenious case of surgical trickery was truly a stroke of genius.

Only an extraordinary mind could devise such a plan.

In ancient times, those who built palaces for emperors were hailed as master craftsmen; modern doctors can genuinely earn that title too.

Although the concept was bold and clever, the transplantation posed enormous challenges.

At least, that was Zhou Can’s understanding.

Replanting a severed finger is less challenging because the amputated digit matches perfectly with the stump in size, tissue type, and structure.

The blood vessels, tendons, nerves, bones, even the skin, can align flawlessly.

However, the big toe of the right foot is vastly different from the thumb.

How can they be connected?

If the surgery failed, the patient’s loss would be disastrous.

Not only would they lose the right foot’s big toe, rendering the healthy foot disabled, but they would also have to endure exorbitant medical fees and the pain of the operation.

It would be like paying to suffer.

“Transplanting a toe to serve as a thumb carries tremendous difficulty and risk. In all my years, I’ve never seen a surgery like this!”

Dr. He excitedly rubbed his hands together as he spoke.

“The toe-to-thumb transplant is a genuine Grade Four procedure. Do you really think it won’t be challenging?”

Dr. Shan was not much older than him.

As an attending, his experience far exceeded his.

“We, as physicians, must dare to innovate. There have been two successful cases of toe-to-thumb transplants in major hospitals in Magic City. As long as we remain cautious, meticulous, and rigorous during the operation, our success rate shouldn’t be too low. I’ve already discussed the risks with the patient, and he’s willing to take the chance.”

Chief Resident Shen subtly guided his team’s thinking.

He was instilling in them excellent medical ethics and clinical principles.

A top-notch chief physician not only leads with superior technique but also inspires generations of doctors with his noble spirit.

“This surgery has several critical challenges. I cannot do it alone. Dr. Shan is adept at microsurgery when it comes to vascular and nerve anastomosis, so I’ll leave the blood vessels and nerves to you. Dr. Chi is a pro at tendon reconstruction and repair, so that’ll be your task. I will handle amputating the patient’s toe and creating an incision at the missing thumb site for bony contact and subsequent flap repair.”

Chief Resident Shen laid out the surgical division of labor.

“For the toe amputation, controlling bleeding, repairing the foot’s wound, and suturing must be handled by an intern. Which one of your interns is up to the task?”

Even within the same team, there was competition among the doctors.

Both Dr. Shan and Dr. Chi were excellent, but being outstanding individually wasn’t enough.

An intern under them who was equally competent could earn significant extra credit.

“My intern, Yang Fuhai, is excellent at controlling bleeding, and Dr. Gan is brilliant at wound repair. They working together should be very reliable.”

Dr. Chi acted quickly.

He immediately swooped in, snatching the opportunity for his interns to gain hands-on experience.

“My interns, Dr. Tang and Dr. He, are actually quite competent as well. The trainee, Dr. Zhou, isn’t lacking either.” Dr. Shan, regardless of his skill and seniority, couldn’t match Dr. Chi’s team when it came to seizing training opportunities.

He simply couldn’t compete with them.

So he could only offer minimal help to his interns.

“The wound after toe amputation is complex. Dr. Chi’s two interns have far more surgical experience. They should handle it this time, and we can give others more opportunities later.”

In the end, Chief Resident Shen opted for the two interns with more surgical experience.

Dr. Yang and Dr. Gan exchanged glances and smiled.

Meanwhile, Dr. Tang and Dr. He looked visibly dejected.

The patient was soon taken into the Operating Room and administered inhalational general anesthesia for safety.

The Anesthesiologist diligently monitored his vital signs throughout.

The surgery began swiftly,

following the planned procedure.

After amputating the patient’s toe, Chief Resident Shen processed it and then stored it in cold preservation.

Immediately, he began preparing an incision at the missing thumb site for the impending transplant.

Dr. Yang and Dr. Gan had already sprung into action.

They managed hemostasis, bone filing, nerve closure, and other vital tasks on the patient’s foot wound.

Both were senior interns with ample operating room experience, demonstrating impressive surgical skills.

Dr. Yang’s hemostatic skills were at a solid intermediate intern level.

Almost approaching an excellent intern’s performance.

But he still lacked a bit.

Dr. Gan’s debridement skills were equally outstanding, barely reaching an excellent intern’s standard.

No wonder Dr. Chi had complete confidence in his team.

Dr. Shan’s intern, Dr. Tang, lagged significantly behind these two; as for Dr. He, he was even further behind.

At the outset, Dr. Yang’s hemostasis was quite good and Dr. Gan’s debridement also performed well.

But problems soon arose.

While debriding, Dr. Gan accidentally reopened a vessel that had already been ligated.

He then discovered that the nerve closure was also proving difficult.

To make matters worse, the suturing process was failing.

The wound was too deep and too wide, making it impossible to approximate the skin on both sides.

One misstep led to another.

The two doctors became flustered, nearly coming to blows.

After the thumb amputation, the patient’s artery was spurting blood everywhere.

Both Dr. Yang and Dr. Gan got splattered with blood.

Dr. Gan even had specks of blood on his face.

The chaotic scene brought a frown to Chief Resident Shen’s face.

Dr. Chi then stepped in to smooth things over with his interns.

“They were likely handling this type of amputation wound on their own for the first time, so their inexperience shows.”

“Ma’am, can I let my interns—Dr. Tang and Zhou Can—take over? I believe Dr. Yang and Dr. Gan really lacked experience. Their surgical gowns are practically covered in new stains!”

Dr. Shan seized the opportunity to speak up once again.

With a humorous analogy, she vividly pointed out their disarray.

Dr. Yang and Dr. Gan blushed deeply.

Even as seasoned senior interns, their poor coordination and lack of foresight had led to a total mess.

“Opportunities should be equal for everyone. Let Dr. Tang and Dr. Zhou handle it! Otherwise, you’d say I’m playing favorites!”

Chief Resident Shen, unable to watch the spectacle any longer, agreed to Dr. Shan’s proposal.

He also saw it as a chance to test Zhou Can’s surgical ability.

After all, rumors are just rumors until seen with one’s own eyes.

Yesterday, witnessing Zhou Can’s tissue separation technique was nothing short of astounding.

“Dr. Shan, assigning a senior intern and a trainee is quite an interesting arrangement!”

Dr. Chi’s gaze then shifted to the departing Zhou Can.

Regarding Dr. Tang’s skills, he was fairly knowledgeable.

What piqued his curiosity was that Dr. Shan hadn’t deployed Dr. He, whose surgical skills were inferior, but instead sent a trainee. There was no doubt this decision carried deep meaning.

It clearly showed her confidence in this trainee surnamed Zhou.

Dr. Chi had even heard rumors these past days that Magic City’s Orthopedics had acquired an exceptionally strong trainee.

But in his opinion, no matter how good a trainee was, how strong could they be?

Soon enough, Zhou Can demonstrated just how formidable the trainee’s surgical skills could be.

The moment Zhou Can took over, he immediately secured the foot’s base with a ligature.

Bleeding stopped instantly.

Then, calmly and methodically, he used forceps to stretch a severely contracted vessel and ligated its deep root single-handedly with skill and confidence.

After finishing with that vessel, he moved on to the next.

“Dr. Zhou, why was it that Dr. Yang’s initial ligation went smoothly, but after debridement the vessels became loose and couldn’t be ligated again?”

Dr. Tang wasn’t shy about asking questions.

Zhou Can’s demonstration left him momentarily stunned.

Working under Dr. Shan, Zhou Can’s stellar performance naturally brought him acclaim.

Dr. Yang, though embarrassed, was eager to know the answer.

“The human circulatory system has its own self-preservation mechanism. For instance, if a vessel is severed or damaged, bleeding ensues. The body combats this by causing the vessel to constrict. Not only small vessels but even major arteries, if left too long, can severely hinder treatment.”

Zhou Can explained the underlying reasons in detail.

Dr. Yang’s hemostatic and ligation skills were certainly above average for an intern.

While dealing with fresh wound vessels posed little trouble, when Dr. Gan’s debridement loosened a ligated vessel or cut it again, re-ligation became exponentially more difficult.

Because by then, the vessel had already constricted and shrunk.

Dr. Yang was greatly enlightened by this explanation.

At the same time, he observed with envy how Zhou Can made short work of vessels that he found nearly impossible.

Zhou Can’s hemostasis and ligation skills were clearly leaps ahead of his own,

almost rivaling Dr. Chi’s competence.

A trainee superior to an attending?

Instinctively, he glanced towards Dr. Chi.

He caught Dr. Chi’s wide-eyed look – had his mask not been in the way, his mouth would have been agape.

Dr. Chi was clearly taken aback by Zhou Can’s display of surgical prowess.

He muttered under his breath.

Swallowing hard, he said,

“Dr. Shan, where did you find such a remarkable trainee? No wonder you paired him with Dr. Tang to handle the wound.”

“Hehe, now you see his strength! Who would have thought that not bringing in a trainee would cost you so dearly—I’ve truly hit the jackpot this time.”

Dr. Shan’s interns simply couldn’t compare to Dr. Chi’s team now.

Now that Zhou Can was on board, the dynamics had changed completely.

A single trainee could take on two opponents.

After swiftly handling the vessels and nerves, Zhou Can turned to Dr. Tang.

“Leave the debridement with me. You handle the bone filing, okay?”

“No problem.”

Dr. Tang’s greatest strength was his unambitious nature, always happy to let newcomers shine.

Zhou Can aggressively debrided the patient’s foot wound,

leaving nothing behind – any excess tissue, muscle, or tendon was excised without mercy.

In the end, an inset wound was formed: a central depression bordered by preserved skin.

【Debridement EXP +1.】

Gaining this experience wasn’t easy.

【Congratulations! Your Debridement Technique has reached Grade Four. Current EXP: 1 / Attending Level: Lower Tier.】

This medical skill had finally advanced to the attending level.

It wasn’t an easy achievement.

Compared to other techniques like injection, hemostasis, suturing, or ligation, which could earn more EXP per operation, debridement opportunities were relatively scarce – only about 350 in every 1000 Grade One surgeries.

And each debridement only earned 1 EXP point.

However, after leveling up, he was delighted to discover that his debridement skills had also greatly improved.

For example, when handling the same wound, he could now anticipate how best to clean it for optimal suturing and healing,

even foreseeing potential infection or long-term impacts on the patient’s life.

He developed a clear strategy.

Furthermore, when facing nerves, vessels, critical organs, or tumors during debridement, he now had a much more comprehensive understanding.

And his methods became far more refined.

For instance, looking at a wound that was already treated, his upgraded technique easily revealed its shortcomings.

He then revised the wound treatment.

Take that nerve, for example – previously, he only considered how to shut it down, knowing almost nothing about the effects on nerve function post-healing.

Now he could clearly foresee that once the wound healed, wearing shoes would cause the toe bone to repeatedly compress and irritate the nerve,

which would definitely affect the patient.

So he improved its position, adding a layer of fat for cushioning, ensuring it wouldn’t be a problem.

This was just one detail,

yet it clearly demonstrated a significant step up in his debridement technique.

Sometimes the difference between a chief and an attending was minuscule,

but this tiny difference could mean the world in surgery.

For instance, in tumor resection – an attending might leave a tiny residue near a nerve out of caution,

risking tumor cell spread and early recurrence.

But a chief would remove every last trace, ensuring the patient’s long-term health.

In surgery, that minuscule difference could spell the difference between success and failure.

Once Zhou Can’s debridement technique hit Grade Four, he was truly elated.

“Dr. Tang, leave the bone filing to you! File it down to about here, and try to smooth the tip of the toe bone a bit.”

This was to ensure that, once healed, the wound wouldn’t be re-opened by any sharply defined bones.

“Understood!”

After all, Dr. Tang, as a senior intern in Orthopedics, could easily handle bone filing.

He completed it swiftly.

“Dr. Zhou, how is it? Any more tweaks needed?”

“It’s excellent!”

Zhou Can gave a thumbs-up,

inspecting the wound before proceeding to suturing.

He sutured the wound into a duckbill shape,

a common technique for amputation wounds.

An attending’s average suturing combined with average ligation and lower-tier debridement could still yield impressive results.

After finishing the sutures, he didn’t boast by reporting up to Dr. Shan or Chief Resident Shen.

Instead, he humbly deferred to Dr. Tang.

“Dr. Tang, do you think the suturing is acceptable?”

Most of the operation had been completed by him, yet he sought Dr. Tang’s opinion despite outperforming him.

This gracious gesture earned Dr. Tang’s deep appreciation.

Who could refuse the charm of someone so unassuming?

“I think the suturing is excellent.”

Dr. Tang beamed.

“Dr. Shan, could you please check if the suturing on the foot wound needs any improvement?”

Dr. Shan, who was currently examining the transplant site that Chief Resident Shen had constructed, walked over for a thorough review.

“You two did a fantastic job! After the surgery, I’ll have Chief Resident Shen take another look.”

Her satisfaction with Zhou Can and Dr. Tang’s performance was evident, earning her much respect.

After all, when had her team ever outperformed Dr. Chi’s?

Today was the first—and only—instance.

It was a debut performance.

“Damn, the suturing is so flawless that I wouldn’t believe he’s just a trainee even if I were to beat him to death.”

Dr. Yang and Dr. Gan were utterly shocked.

Today, their eyes were truly opened.

There are always people better than you.

Zhou Can had not only surpassed them in one discipline,

but in nearly every aspect of surgery.

This left them feeling profoundly defeated.

“Dr. Shan, how about this: I perform more surgeries regularly. Why not let Zhou Can work with me as an assistant?”

As an attending, Dr. Chi often operated solo with his junior assistants.

Their income was tied to surgical commissions.

Moreover, when it came time for reviewing candidates for Associate Chief Physician, academic achievements, total surgical volume, the quality of surgeries, and success in high-risk procedures all played a crucial role.

Dr. Chi, being a senior attending, was already striving for a promotion to Deputy Senior.

Having a powerful assistant would greatly boost his chances.