The titanium mesh drawn by Yang Ping is actually not a real grid. To be precise, it is a raised titanium alloy plate without any mesh on it, but with raised rib-like reliefs.
In addition to the titanium alloy plate, there are also screws that fix it to the bone.
Because the drawing was very detailed, Constantine handed it over to the 3D printing laboratory of Harlachen Orthopedic Hospital, and engineers quickly printed out the titanium alloy plate and matching fixing screws based on the drawing.
As the world's top orthopedic hospital, this laboratory often uses titanium alloy to print various customized internal fixation equipment and various artificial prostheses.
The titanium alloy plates are sent to the sterilization room for sterilization, and then packaged and sent to the operating room.
Constantine knew how to remove the ribs surgically and then install titanium alloy plates. This operation was not difficult for him.
Just like copying an article is not difficult, writing an article is difficult.
For him, coming up with this solution in an emergency was the difficult part.
With the titanium alloy plate in hand, the cardiac surgeon prepared to perform emergency surgery on the little Duke. He would remove the ribs and install the titanium plate. Removing the ribs would temporarily relieve the compression on the heart to a certain extent.
This decompression method is more common in surgery, such as craniectomy decompression in cranial surgery, which removes part of the skull to allow the brain tissue to expand. Posterior indirect decompression in spine surgery removes the posterior lamina to allow the spinal cord to expand.
Drift backwards to avoid being squeezed front and rear.
Use a titanium plate as a shield to create an artificial space where the heart can beat freely, so that the heart is not exposed to the outside.
The little Duke is currently dying, but with the support of ECMO, surgery is not a contraindication. In order to save his heart, the risk is worth it.
Constantine decided to take action and implement this idea.
The little Duke was sent to the operating room, where Constantine was the surgeon and cardiologist Norton was in charge of medical treatment. Other orthopedic surgeons were temporarily unable to help.
The strict division system of modern medicine allows doctors to focus on the skills within their specialty and strive for excellence. At the same time, it also limits doctors' thinking and skills to the scope of their specialty.
Marcus being able to contact August means that he can get technical support from that mentor at any time.
Marcus is usually unable to compare with these big guys, but now he is regarded as the key figure in solving the crisis, and Constantine asked him to guard him under the operating table.
After general anesthesia, it took a long time to position the patient. The little Duke’s deformed body made the operation very difficult no matter how he positioned himself.
Brush hands and disinfect shop sheets——
"I'm going to cut the skin off," Constantine announced to Marcus.
"Cut it!" Marcus agreed.
The cardiac surgeon held the scalpel like a pen, and usually performed this operation with a single stroke.
But the spiral spine left the little Duke's body in a state of severe deformity.
Normally, a man's chest is like a plain, which is very easy to operate. At this time, the little Duke's chest is like a complex mountainous terrain.
Cutting the skin is a difficult task. Thinking about the instructor who wanted to correct the spine, Constantine couldn't help but frown.
Finally, I cut through the skin and peeled off the ribs.
As long as the ribs that compress the heart are involved, all the front ribs are removed, and five centimeters of the back ribs are left for fixing the titanium plate.
Constantine followed this plan carefully. He originally thought it would be an easy task, but now he felt a little bit stuck.
It was so difficult to peel off each rib. It was all caused by the deformity.
Fortunately, this is not a heart transplant. If it were a heart transplant, how would you hold the donor heart in your hand?
After finally cutting off the ribs, Constantine was already sweating on his back.
Without the compression of the front ribs, the heart is liberated and drifts forward, with part of it beyond the plane of the thorax and completely exposed outside the body.
This still beating heart finally overthrew the oppression of the ribs for more than twenty years and ushered in the sunny day.
"Marcus, wipe my sweat for me." Constantine moved his head out of the surgical area.
He just wanted to make sure Marcus was in good condition.
Marcus quickly used a tissue to absorb the sweat from Constantine's forehead.
With Marcus present, Constantine continued the operation. He placed the titanium plate in the rib defect area, and the titanium plate rose like a protective shield, creating a spacious space for the heart.
The titanium mesh that simulates the normal thorax is fixed on the sternum on the right side and on the remaining posterior ribs on the left side. The artificial space is very generous and the vicious cycle will be terminated.
Constantine was very satisfied with his operation. The silver shield gave the little Duke a bit of a sci-fi temperament.
all the best!
"Close your chest!"
But Constantine immediately discovered a brand new problem: the skin could not cover the titanium plate.
The deformed thorax resulted in a very small area of the left precordium. The surface area of the thorax molded by the titanium plate is now close to normal, and there is a large area difference between them.
Just like if a person with a distended abdomen can shrink the abdomen very small, and if the pants fit just right, and he inflates the abdomen again, the pants will definitely burst. This is caused by the difference in front and rear abdominal girth.
Now the little Duke has a relatively insufficient skin area due to the difference in surface area between the front and back of his left chest.
Constantine tried to adjust the skin, but the skin could only cover part of the surrounding titanium plate, leaving most of the rest exposed.
As a cardiac surgeon, he never had to think about skin coverage; that was the job of an orthopedic trauma surgeon.
Constantine stood on the operating table, looking at the exposed titanium alloy, and suddenly thought, isn't this an orthopedic hospital? Why are you still afraid of skin defects?
"We are facing the problem of insufficient skin coverage. Please ask an orthopedic traumatologist to help cover the exposed titanium plate."
Constantine stopped the operation and ordered the circulating nurse.
In less than ten minutes, the orthopedic traumatologist rushed to the operating room and carefully asked the cardiac surgeon about his dilemma. It turned out that the problem was to solve the problem of skin defects, which is the specialty of the orthopedic traumatologist.
This is a difficult problem for cardiac surgeons, but a common occurrence for orthopedic trauma surgeons.
To solve the problem of skin defects, in addition to simple skin grafting, there are also various flap surgeries. There are more than a hundred surgical procedures, and there is always one suitable for the little duke.
This chapter is not over yet, please click on the next page to continue reading! The orthopedic trauma surgeon stands on the footrest, one meter away from the operating table, observes the defect location and area, and mentally designs a suitable flap surgery.
Flap surgery is based on the idea of tearing down the east wall and repairing the west wall. There will be certain damage. If it is a final operation, this is not a problem. If it is a temporary operation, this needs to be considered.
The east wall was demolished to repair the west wall. As a result, the west wall will soon be demolished and rebuilt. Whether the east wall should be demolished or not requires weighing the pros and cons.
The trauma orthopedic surgeon heard that this was a temporary operation, just to solve the problem of heart compression. To be cautious, he had to understand some conditions.
"Excuse me, what is your next treatment plan?" the orthopedic traumatologist asked cautiously.
Next step?
Heart replacement?
Maybe not so fast.
The current surgical plan was not proposed by Constantine, he was just a heart surgeon.
So Constantine had no answer.
The operating room fell into silence. You looked at me to look at you.
"Mr. August said that he and his instructor have already boarded the plane, and the next surgical plan is scoliosis correction with ECMO surgery." Marcus was once again very proud, he said in the audience.
How brave is it to carry out spinal correction with ECMO? Who is this instructor? He is so unreasonable.
"Then, does this need to be covered with skin?" Constantine asked Marcus.
"There are small holes on the periphery of the titanium plate for suturing the skin. As long as the periphery is covered with sutures, most of the center is left exposed." Marcus instructed Constantine.
Fortunately, there was no rush to do it, otherwise the skin flap transferred from the back would have to be disassembled immediately, which would be a huge waste.
Then listen to the instructor. Constantine decided to sew the skin on the titanium plate and only cover the periphery. The instructor said it can be exposed, so let it be exposed.
Constantine started to sew up the skin stitch by stitch, leaving most of the titanium plate guard exposed except for the periphery.
Several spine surgery experts remained silent in the audience, but they were still able to operate like this.
Under the titanium alloy plate is a heart.
Constantine touched the heart shield with his gloved hand and began to make full associations.
For patients with artificial heart replacement, can they do this and open a window and keep it closed at ordinary times?
If it is necessary to perform maintenance, inspection or replacement on the artificial heart, it is very convenient to open the window, operate it directly, and close it again when you are done.
"Marcus, the chest has been closed, what should we do next?" Constantine asked his assistant to cover the surgical incision with sterile dressing.
Marcus replied: "Waiting for August and the mentor's plane to land."
——
Ning Qi's private jet is an Airbus ACJ350, hosted by Narada Airlines. It is said that there are only a few of them in the world, and there is only this one in China.
The 270-square-meter cabin on the aircraft is very luxurious and spacious, with conference rooms, kitchens, dining rooms, bedrooms, bathrooms, and leisure and entertainment areas.
The flight attendant knew that today's flight was to send Mr. Ning's best friend, Professor Yang, to Germany.
Mr. Ning personally ordered that in order to allow Professor Yang to rest well and ensure a good sleep, the luxurious master bedroom was opened to Professor Yang, while the other bedrooms were reserved for Professor Yang's assistants.
The steward knew that the master bedroom was Mr. Ning's most private space and was never open to anyone else. This time, Mr. Ning made an exception and left it for Professor Yang, which shows the importance of Professor Yang.
The comfort of the master bedroom far exceeds that of the other bedrooms.
There is a king-size bed and a walk-in dressing room with heated floors.
On the wall opposite the bed, there is a huge TV.
The master bedroom is also equipped with a separate bathroom, which also has heated marble floors, marble basins and towel heaters. The bathroom has an oversized shower cubicle to ensure a good shower experience for the master.
After a ten-hour flight, he had to undergo surgery after getting off the plane. Yang Ping needed a good rest on the plane, so Ning Qi specially ordered the flight attendant to open her master bedroom to Professor Yang, and also ordered that other guests cannot enter the master bedroom.
Therefore, the stewardess hung a temporary notice board in the master bedroom: Professor Yang is only allowed, others are prohibited.
Because the matter was urgent, Yang Ping did not take Robert and Takahashi with him, only August accompanied him, which inevitably made Robert and Takahashi happy.
August thought that only people like the Duke had such luxurious private jets, but he did not expect that the professor's friend also owned such luxurious private jets.
It seems that my Chinese mentor not only has excellent medical skills, but also has an extraordinary social circle and is a person of great energy.
Yang Ping and August rested on the massage chairs in the private theater on the plane, and used the multimedia here to watch the video data of the little duke to prepare for the next step of orthopedic surgery.
The Internet on the plane allows August and Marcus to stay in close contact and keep track of the little Duke's condition at any time.
"The cardiac decompression has been completed. Dr. Constantine of Charité Hospital performed the surgery. The operation went very smoothly. The little Duke has returned to the ward with the titanium plate. I just sent the drawing you drew to Marcus for them to prepare.
Surgical instruments." August reported the latest changes in the little Duke's condition.
Yang Ping lay on a chair to rest and said nothing.
August knew he was listening, so he continued talking regardless of whether there was a response or not.
"It has been confirmed that the 3D printing laboratory in Harlachen can complete the production of these instruments. The engineers will work overtime after receiving the drawings. When we arrive, these instruments should have been turned into sterile packages and sent to the operating room."
Yang Ping does not doubt the industrial production capabilities of the Germans, especially 3D printing technology, and Harlachen Orthopedic Hospital should be at the forefront of the world.
Videos and pictures were still playing on the multimedia screen, and the two of them were chatting about preparations for the operation, when the flight attendant came in.
"Professor Yang, this is your favorite Longjing."
The stewardess brought two cups of fragrant tea.
Yang Ping likes tea the most and has no interest in other drinks.
I'm afraid this is Mr. Ning's order again.
This chapter is not finished yet, please click on the next page to continue reading the exciting content! Yang Ping sat up, thanked the stewardess, and took a sip of tea.
"Doctor Ao, do you need any other drinks? I'll ask the bar to prepare it." The flight attendant was polite and thoughtful.
August hesitated and shook his head: "I only drink tea."
"We are right at the door. If you need anything, please give us any instructions." The stewardess exited the private theater and stood at the door.
The chef is preparing delicious snacks, and the wine cabinet at the bar contains a variety of famous wines, but Professor Yang does not drink.
A private jet is like a mobile luxury apartment, so you don't feel like you are flying.
"Your friend is very considerate." August also learned to taste tea.
He's still figuring out what friends mean.
"Titanium alloy artificial thorax, this kind of variable type, can your hospital print it?" Yang Ping did not chat with August, and kept analyzing the surgery.
"Okay, don't worry. Even if they encounter difficulties, they will contact the manufacturer in Munich to solve the problem. Why is it designed this way because of insufficient skin?" August fixed the screen on the drawing of the titanium alloy chest.
"After orthopedic surgery, the surface area of the thorax increases, and the original skin is insufficient. If covered with a pedicle or free flap, the trauma will be too great and there is a risk of infection. With this design, the artificial thorax will be relatively small after implantation and will slowly expand after surgery.
The skin acts as an expander, so the skin expands slowly, so there is no problem of insufficient area." Yang Ping said while lying down to rest.
The two of them went over the little Duke's case information again. Yang Ping was a little sleepy and was going to take a shower and rest. There was a major surgery waiting for him after getting off the plane.
The stewardess led Yang Ping to the master bedroom. August saw the sign at the door and consciously stopped.
"There is a separate bathroom and dressing room inside. If you need our help, there is a dedicated phone number beside the bed. Good night."
The flight attendant introduced with a smile, and then took August to another bedroom.
