This doctor is already middle-aged, and he's only just started practicing medicine.

Chapter 28 Improved Tang Method!
Tuesday, October 7th.

In the emergency department of Longxian People's Hospital, Chen Song laid his palms flat on his hair and above his eyebrows, smearing his hair upwards until it was completely deformed.
"Xiao Lu, what did you just say? You want to do flexor tendon sutures in Zone 2?"

"Do you even know what you're talking about? Do you know what the flexor tendons in Zone 2 used to be called?"

Lu Cheng has a good memory and knows the history of hand surgery. He replied, "No Man's Land Tendon".

The so-called "no man's land tendon" is actually steeped in a history of surgical bloodshed and tears.

The name first appeared in early 20th-century battlefield medical records. At that time, for tendon injuries to the hand caused by gunfire, military doctors found that the survival rate of repair in this area was almost zero: after surgery, the tendons would either rupture or adhere, as if it were a forbidden zone designated by death.

Bunnell's classic textbook in the 1940s directly referred to it as the "forbidden repair area," and this sense of despair was first named "no man's land" by Littler, the father of American hand surgery, in 1950.

In the 1960s and 1970s, hand surgeons attempted staged reconstruction using silicone rods, but there was still a 50% chance of infection and joint stiffness...

The improvement was only achieved after the emergence of the Tang method and the Tsushita suture method between 1980 and 1999.

However, as of 2020, the excellent functional recovery rate of the flexor tendons in Zone II was still only 88%, and the probability of a second surgical release was still 12%!

These cold, hard numbers aren't just something to be carelessly filled in; they're statistical data earned from the 'rigidity and re-fracture' of millions or even tens of millions of patients.

It was only in 2023 that the term "no man's land" was revised to "repairable zone" in academic papers, after a seventy-year journey undertaken by countless predecessors in hand surgery.

The modified Tang technique is very difficult to learn, and even now not every hand surgeon is proficient and specialized in it.

"Since you know that, you still dare to say that you want to try to perform flexor tendon sutures in Zone 2?"

"I've also recently read some relevant literature, and scholars still define the tendons in this area as 'no man's land' without microsurgical techniques and a rehabilitation team!"

"I can't handle this!" Chen Song, like a cat whose tail had been stepped on, abandoned his 'cat-like' arrogance.

While he did undergo surgery for tendon rupture and injury at Xiangya No. 2 Hospital, he did not have the flexor tendon injury repaired in Zone 2.

Lu Cheng looked calmly at Chen Song and said in a clear, smiling voice, "Teacher Chen, based on what you just said, can I understand that even if Director Xiang came to the countryside, he might not dare to perform this second-zone tendon suture?"

"Whether he dares to do it or not is hard to say, but he certainly wouldn't dare to do it lightly."

After shaking his head, Chen Song stared at Lu Cheng and said, "Don't tell me you've learned the Tang method and the modified Tang method for suturing?"

“If you don’t have enough skill with the simple Tsushita suture technique, it’s very difficult to properly handle the flexor tendons in Zone 2.”

For flexor tendon suturing in zone 2, the modified Tang method is the first choice, followed by the Tsushima suture method. Only when all other options are exhausted should the modified Kessler method be used.

It's fair to say that the majority of secondary surgeries for the second zone flexor tendon are due to the modified Kessler and Tsushita suture techniques, while the modified Tang technique contributes far fewer secondary surgeries.

For the second zone tendon, the modified Tang method is like a cat playing with a mouse – a perfect match. However, the modified Tang method is not the only way to treat the second zone tendon.

If a dog is clever enough, it can be used to catch a mouse, though it might be barely acceptable.

"It should be about the same..." Lu Cheng looked at his panel carefully and smiled knowingly.

【缝合系技能：缝合术（专精4/20）（技能点-2）、肌腱缝合术（熟练7/10）（技能点-2）、改良kessler（（熟练5/10）（技能点-2）、津下缝合术（包括滑动型）（熟练3/10）（技能点-2）、改良Tang法（熟练6/10）（技能点-16）】

[Current remaining skill points: 0.1]

This skill was created by Lu Cheng after exhausting all the skill points he had accumulated over the past few days.

Lu Cheng also knew that suturing the flexor tendons in Zone 2 was very difficult, so he didn't inform Chen Song immediately after the modified Tang method reached a proficient level. Instead, he waited until the modified Tang method reached (proficient 6/10) before giving Chen Song this hint, after all, the history of the no-man's-land was there for all to see.

Moreover, to be on the safe side, Lu Cheng plans to wait until his modified Tang method reaches at least (proficient 10/10) level, or even specialized level, before he goes on to perform flexor tendon suturing in Zone 2.

Better safe than sorry, prioritize insurance, and try to minimize the failure rate and the need for a second surgery.

As a surgeon, Lu Cheng knew that no surgery other than suturing was guaranteed to be "successful," and highly difficult procedures always had a chance of failure.

As long as your surgical failure rate is no higher than the local average, you are an 'expert'!
Currently, when it comes to flexor tendon sutures in Zone II, apart from the top teaching hospitals in China, the rate of secondary surgery in any tertiary hospital is around 7% to 8%, and even in top-tier hospitals, the rate of secondary surgery is around 5%...

It's not that the doctor's skills are lacking, but rather that the tendon rupture in this area is difficult to treat and requires a very high level of expertise.

"Really? Are you kidding me?" Chen Song's hand continued to slide upwards, and the hair that had been pressed down stood up inch by inch again—

Chen Song's voice was sharp: "Lu Cheng, do you think I haven't tried to learn the improved Tang method, so you're deliberately setting a trap for me?"

Lu Cheng's micro-expression was serious, and his voice was earnest: "Teacher Chen, how could I possibly trick you? You've been working so hard to teach me how to perform gallbladder-preserving and spleen-preserving surgeries lately, and you've given me so many opportunities to perform surgeries..."

"I'm not going to have the flexor tendon repaired in Zone 2 right now; I'll have to wait until next month or the month after next."

Chen Song secured many opportunities for Lu Cheng to perform procedures, such as the incision, suturing, and hemostasis procedures in gallbladder-preserving and spleen-preserving techniques that Lin Qianlong couldn't learn. Lu Cheng was allowed to perform these procedures himself.

This surgery was far beyond Lin Qianlong's capabilities, so Lin Qianlong and the others did not covet it or aim too high.

Lu Cheng seized the opportunity to go on stage and do some small things within his power.

Chen Song said irritably, "As if saying it wouldn't be outrageous if it were done next month or the month after?"

"You're saying that after I leave, I can do the improved Tang method? That's an absurdly high learning efficiency, isn't it?"

"This stitching technique is very difficult to learn..."

Earning a million a day or a million a month is an outrageous income in the eyes of ordinary people.

Chen Song's eyes and expression were particularly serious as he scrutinized her, saying, "I'm not sure if you can do it. You'd better do what you always do: record your practice of the techniques and send it to me."

"This time I have to hand them over to a more professional person for review. Only if he also thinks you can handle it will there be no problem!"

"Okay, sure!" Lu Cheng nodded gently, replying cautiously.

Chen Song asked again, "Does your hospital have microsurgical instruments? The tendon suturing in Zone 2 requires the use of microsurgical instruments."

After listening, Lu Cheng gestured towards Peng Kunkun's direction with his lip, thinking that Chen Song's question was a bit "idiotic"!
Chen Song immediately understood what Lu Cheng meant.

Peng Haibo is the director of orthopedics, in charge of the overall development of orthopedics. His own son wants to develop in the direction of hand surgery, so how could he not purchase a set of microsurgical instruments for hand surgery?

Moreover, it's brand new and has already arrived. "Director Xiang" will arrive next month and we can start using it immediately.

Chen Song stood up, straightened his posture, put his hands behind his back, and lowered his voice: "This brother is really unlucky to be in the same generation as a pervert like you..."

After saying that, Chen Song, the "cat," haughtily left. After taking a few steps, he turned his head and tilted his chin to look at Lu Cheng again, his gaze distant...

(End of this chapter)