Chapter 489: A Lesson in Precision: Mastering Tendon Transplant Surgery

“Dr. Yang, let me quiz you. Why should we deliberately leave some peritendinous tissue when harvesting a tendon for transplantation?”

Zhou Can tossed the question over to Yang Zhi.

“Is it so the tendon can be fixed more securely?”

Yang Zhi clearly wasn’t too sure himself.

Most people would think that keeping some peritendinous tissue makes suturing and fixation easier during tendon harvesting.

“Let me ask you, what’s the primary function of tendons?”

Instead of answering, Zhou Can fired back with a question of his own.

“It’s to help the body move! Like flexor and extensor tendons in the fingers, which let you bend and straighten them,” Yang Zhi replied without missing a beat.

He didn’t even stop to think before giving his answer.

Anyone in the medical field knows what tendons are for.

“So, why do flexor and extensor tendons allow your fingers to move?”

Zhou Can pressed on, a hint of amusement in his eyes.

“Isn’t it just because they contract and relax, letting your fingers bend and straighten?” Yang Zhi replied, his confidence quickly fading under scrutiny.

“That’s not quite it, Dr. Yang. For tendons to move the body, you first have to make sure they themselves can glide smoothly. If the bone is misshapen or if the muscle is tight or atrophied, the tendon won’t slide like it should, and that affects how the body moves. So, when I was separating the plantar tendon, I left some peritendinous tissue to let the transplanted tendon glide freely in its new spot.”

Zhou Can was in a good mood, so he patiently explained the surgical nuance to both of them.

These sorts of hands-on surgical tips are hard to learn from textbooks—they come from years of practical experience in the operating room.

“So that’s why! I’ve learned something new!”

Yang Zhi and Pu Dingdong both nodded, feeling like they’d truly gained something valuable.

Watching Zhou Can operate, they often picked up vital, practical insights that could never be found in a book.

And it wasn’t just surgical skills—sometimes it was about emergency rescues or different ways of thinking through a problem that paid off big time.

“Remember, after you’ve fixed the distal end of the transplant tendon, always test its reliability right away. If something’s off, you have to get to the bottom of it and fix it immediately. Never just ignore a problem you spot and close up the incision. Doing that will pretty much guarantee the patient’s hand won’t function properly after surgery.”

Zhou Can cautioned the pair, his tone serious.

What makes a great teacher?

It’s someone who teaches by word and by example—virtue, experience, and skill all at once. That’s the mark of a real mentor.

He tested the fixed plantar tendon—no issues there.

Only then did he start suturing the incisions on the fingers one by one.

He didn’t let the two assistants close up for him since this was an intricate operation, demanding absolute precision.

Neither Yang Zhi nor Pu Dingdong was quite up to the standard required here.

Next, he set the wrist in a neutral position and gently pulled the free tendon end until the fingers were flexed by about 15 degrees beyond the optimal function position.

From the radial to the ulnar side, each finger ended up with a slightly deeper bend.

It sounds straightforward, but there’s a lot of finesse involved in the actual execution.

For the main moving muscles, he had to sew in a traction line on their tendons and test how much movement he could get, adjusting until it was just right.

And on top of that, when applying greater tension, he had to use a needle through the skin to temporarily anchor everything in place before stitching the two tendons together. Once the fixation needle was out, he’d flex the wrist 40 degrees to the palm—the fingers should straighten out completely, and with the wrist fully extended, the fingertips had to come within 4 centimeters of the palm’s crease.

…He ran all the tests and everything checked out. Zhou Can couldn’t help but smile.

Patience is everything when it comes to hand tendon transplantation. Precision is crucial, and you have to get each intraoperative test perfect.

You absolutely can’t cut corners.

Plus, after the right tendon length is set, he joined the free tendon’s proximal end with the deep flexor tendon of the finger.

Given the difference in thickness between the preserved superficial flexor and the transplanted plantar tendon, he went with the pulvertaft weaving technique. If the donor tendon and host were the same size, he could’ve just stitched them together with a standard suture.

As he kept suturing he could feel his experience points rising fast.

His Suturing Technique had long ago climbed to level six. Now his Ligature Technique was lagging just behind but catching up.

He was eager for his Ligature Technique to reach level six too.

After all, suturing and ligature are like the closest comrades—hard to really excel in one while neglecting the other.

If only suture skill is high but the ligature is lacking, that’s a problem, especially in tough surgeries where weak ligature can really drag your overall skill down.

Ligature Technique progressed slower mainly because it was harder to earn big experience bonuses.

Getting an extra 10 experience points, like just now, was pretty standard.

Suturing tended to rack up rewards ten times as often compared to ligature.

That’s why his ligature skill always lagged far behind his suturing.

Still, he wasn’t too worried. Both suturing and ligature come into play in almost every operation, big or small.

At his current pace, Ligature Technique wouldn’t take long to hit level six.

Soon, he finished suturing both tendons together.

The real challenge in tendon anastomosis comes down to two things: first, the mismatched thickness between the transplanted plantar tendon and the retained superficial flexor; second, the extremely limited working space at the fingertip—the level of precision required is through the roof.

And even after the suturing, you still had to test it thoroughly to make sure the hand would be functional.

The technical difficulty here would make even senior chief surgeons balk.

This patient had already undergone two failed surgeries at a top-tier major hospital out of province, which says a lot about just how tough this procedure was.

Yet another medical skill had leapt to level six.

Aside from feeling pleased, Zhou Can realized he wasn’t nearly as excited—his attitude was steadier now.

It was like getting a ten thousand yuan monthly salary a few times; after that, it just didn’t feel like a big deal anymore.

He’d already brought several medical skills to level six, and his sights were set even higher: level seven.

He’d expected that taking just one skill from level five to six would take at least five to ten years.

Instead, it had only been about two years, and already multiple skills had hit level six ahead of schedule.

That was something he’d never imagined before.

Back when his surgical skills were only level four, he could only do a limited range of procedures—tougher surgeries meant mostly watching and learning.

Earning even 10 bonus experience points back then would have had him grinning half a day.

Now, most of his skills were level five or above, and he could take on a much wider range of challenging surgeries—opening the door to bigger experience bonuses.

His record so far? A whopping ten thousand bonus experience points in one shot.

It had only happened once but it was enough to send his spirits soaring.

And based on experience, if it happened once, it’ll happen twice, three times…

Right now, huge single bonuses weren’t common because he knew his limits and hadn’t dared tackle extreme difficulty cases.

But now, with multiple surgical skills at level six—especially the advanced ones—he finally had the confidence to take on tougher procedures.

He was sure that soon, bonuses of one thousand—even ten thousand—points would become routine.

Just like now, getting ten or a hundred experience points at a time was already the norm.

The better his technical skills, the more daunting the surgical tasks he could take on. Level seven might come much sooner than he ever guessed.

By now, the tendon anastomosis was finished, and the newly minted level-six Anastomosis skill couldn’t even come into play for this case.

But he was sure that it would bring him surprises next operation.

Now, he could try tackling some of the most challenging anastomosis procedures.

Including nerve anastomosis, widely recognized as the toughest out there.

With luck, he’d break new ground here too.

He already had quite the knack for nerve anastomosis.

He remembered back during the standardized residency program’s recruitment test, his anastomosis skill was pretty weak, but he could still get a lab mouse to recover partial nerve function after tail nerve repair.

It totally stunned everyone. Whether the others had PhDs or Master’s degrees, or were top students from domestically or abroad, he outperformed them all.

Now that his Anastomosis skill was at level six—the standard for a chief physician—he honestly couldn’t imagine what kind of results he’d get repairing a patient’s nerves now.

Zhou Can had always hoped to repay Dr. Xu for all the kindness he’d received.

But how could he do that?

A cash reward would be way too shallow.

And Dr. Xu would never accept it anyway.

The best way would be to help the patient from Dr. Xu’s medical mishap regain their health.

If Zhou Can could truly make that happen, the patient and family would see him as their savior. Their resentment towards Dr. Xu would also cool down.

If he found the right moment to plead on Dr. Xu’s behalf, he might just help lift the burden Dr. Xu had carried for so many years.

The aftermath of that failed surgery loomed large for Dr. Xu in the hospital—especially as Zhou Can’s reputation and clout had soared.

He’d quietly looked into the situation with a few people in the know.

Though he hadn’t seen the patient’s file yet, what he’d pieced together told him one thing: to get this person healthy again, perfect nerve anastomosis would be absolutely key.

…So with Anastomosis ascending to level six, he suddenly gained a huge dose of confidence in being able to help.

But the patient’s status was very special—powerful enough that even Tuyu Hospital was cautious. Even if Zhou Can could guarantee success, the family probably wouldn’t risk it.

It was like those imperial doctors of old, always being scolded useless or incompetent by the emperor.

But it wasn’t really that their skills were bad, it was that they didn’t dare use strong medicine.

“All medicine has some toxicity. Severe illnesses need bold prescriptions.”

That’s one of the core tenets of traditional medicine.

But the princes, princesses, and imperial consorts were all so precious. If the medicine harmed them, or things got worse instead of better, what then?

You could lose your head in an instant.

So those imperial doctors would rather get called useless than risk a heavy prescription.

Most would stick to gentle tonics instead.

After all, only top-tier doctors made it to the palace—they weren’t lacking in skills.

For ordinary folks like Zhou Can and Dr. Xu, this special patient was every bit as untouchable as royalty. Even if Zhou Can was willing, would the family actually agree to surgery?

This whole thing would have to be a long-term plan.

For now, all he could do was build up his reputation.

Soon, the ultra-challenging hand tendon transplant was done.

Both his Tissue Separation and Anastomosis skills reached level six during this operation. It was an incredible haul.

The experience left him with a deep sense of the rewards that come from kindness.

When he chose to take the case, the risks were sky high.

He’d worried plenty along the way.

But looking back, it was worth taking a measured risk.

Of course, that depended on the patient and family being reasonable. If they’d been the litigious or malicious type, he’d have done what most doctors did—play defense.

Mutual trust between doctor and patient, and a genuine willingness to stand in each other’s shoes, really can mean everything.

……

Time slipped by—days rushing past before he realized it.

Gradually, Zhou Can’s life and work got back to normal after the shadow of the killer incident faded.

Live and learn.

Now, whenever he’s dealing with female colleagues or patients, he’s extra careful to avoid misunderstandings with boyfriends or husbands.

Especially when talking to married female doctors or nurses, he keeps the door open if possible.

If the matter could be settled in public, he never brought it up behind closed office doors.

That young man who’d had the hand tendon transplant—after a few weeks in the hospital, most functions of his right hand had come back. To get full use again, though, he’d need a lot of rehab work.

That would be a long-term process—half a year at least, probably more.

The patient even called the hospital to thank Zhou Can personally for restoring basic function to his right hand.

Now, he’d landed a job assembling screws.

As he put it, he could earn a living and rehab his hand at the same time. Not bad at all.

Rumor had it, after regaining his confidence, he’d even met a girl at the factory he really clicked with.

The two were seeing each other, and the girl didn’t care one bit about his old injury.

Instead, she admired his courage and resilience.

If nothing unexpected happened, the kid might just end up with both a good job and a girlfriend.

That’s how life works sometimes—the harder you fight, the luckier you get.

Keep striving, refuse to give up, and fate might just crack open a new window when you least expect it.

Learning about the positive changes in that patient’s life made Zhou Can genuinely happy.

Helping people reclaim their health and live good lives again—that’s what makes being a doctor truly worthwhile.

On this particular morning, Zhou Can showed up at the hospital for work as usual.

While making rounds in the inpatient ward, a nurse came running up in a panic. “Dr. Zhou, Dr. Zhou, there’s a patient in shock outside. Dr. Ai asked for you to help consult!”

Dr. Ai Li was a well-rounded emergency doctor, nearly fifty years old now.

Yet she was still only an attending physician—which spoke volumes.

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