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

Chapter 7 Tendon Repair and Modified Kessler Suture Technique!
Several days passed in the blink of an eye.

On Thursday, July 6th, Lu Cheng went off work with Chen Song and entered his "rest day"!
At 1 p.m., Lu Cheng's parents went out to work. After eating a large bowl of self-service rice at the community center, he rushed back home feeling very full and immediately went into the training room where the air conditioning had been turned on.

The heat in July was truly unbearable. Lu Cheng's short sleeves were completely soaked with sweat as soon as he walked from the doorway home.

While pulling his collar to let the cold air in and cool him down, Lu Cheng opened his notebook: "Besides mastering the basics, tendon suturing also requires learning the corresponding techniques. The simple and easy-to-learn introductory technique is the modified Kessler suture."

"Next, we get the Tsushita suture technique and the modified Tang technique..."

Suturing is a fundamental skill. Once you've mastered a certain level of basic skill, it means you've reached a certain level of control over the distance and force used in suturing, and you can handle the details very well when suturing.

However, simply using the simplest interrupted suture is still insufficient to deal with complex conditions like tendon injuries.

According to Professor Chen Song's analogy, mastering the basics is like developing internal strength, while sewing techniques are like applying specific moves.

Animals the size of a cat can all kill mice, but the one that is best at catching mice and has the most specialized skills is the 'cat' species.

Lu Cheng then turned to the next page and looked at the 'stage' progressive training method that he had compiled from the internet.

[Breakdown of Planar Puncture Positioning (30 minutes/day x 3 days):]

Draw two parallel lines on the silicone plate (spacing equal to tendon diameter).

Vertical needle insertion: Insert the needle at a 90° angle with the tip 1.5mm from the edge, and exit from the opposite side at equal intervals (error ≤0.2mm).

Cross-stitch practice: Complete 10 sets of "X-shaped cross-stitching," ensuring symmetry on both sides. (Completed)

Lu Cheng licked his lips, finding them a bit salty and greasy. He quickly ran outside to wash his hands and face. After the last drop of water dripped down, Lu Cheng looked at the mirror opposite the sink—

Looking at himself in the mirror, with his defined features, mature and composed demeanor, and handsome appearance, Lu Cheng thought to himself, "If I were a girl, I would definitely marry myself..."

After stopping YY (a Chinese online chat program), Lu Cheng looked at the rules on the panel again—

[Suturing Skills: Tendon Suturing (Beginner 3/5), Modified Kessler Suturing (Beginner 1/5)]

[Currently, 16.3 skill points remain.]

Technique practice improves faster than basic skills practice, but it's impossible to "defy fate" in just a few days. After four days of hard practice, both tendon suture and modified Kessler suture only increased proficiency by 1 point.

This progress was made only with the guidance of Professor Chen Song; otherwise, it might have been even slower.

After arriving at the emergency department, I gained nearly 15 skill points in 6 days and worked for 3 days. This efficiency is more than twice as fast as in the orthopedics department!
I don't know if you need to clear levels to go from beginner to proficient.

Let's ignore that for now and add it first.

In an instant, Lu Cheng's face turned sour.

【缝合系技能：肌腱缝合术（熟练0/10）（技能点-7）、改良kessler缝合术（熟练0/10）（技能点-9）】

[Remaining skill points: 0.3]

"Persuading someone to study medicine is like being struck by lightning!!!" Lu Cheng cursed...

Then, Lu Cheng looked at the notes he had made in his notebook:

[Tendon longitudinal penetration (chicken leg tendon practical exercise)]

Initial knot locking: Key points of operation—longitudinal penetration 1cm from the cut end → tie a triple square knot (tension should be just enough to cause slight wrinkling). Common mistakes—over-tightening can lead to tendon strangulation (blood supply blockage).
Core double-needle proximal puncture: Key points of operation—insert the needle vertically 8mm from the tendon rupture end, and exit at a 45° angle on the opposite side (5mm from the rupture end) → reverse the operation to complete the distal end. Common mistake—misalignment of the needle insertion angle causing suture exposure.
Wire pulling verification: Key points of operation - Wire pulling verification requires simultaneous pulling of two wires to ensure that the cross-section is tightly aligned without misalignment. Common error: Single wire pulling causes rotational distortion.

Training target: Complete 10 anastomoses within 20 minutes. Standard: Anastomotic tensile strength ≥ 15N (tested with a spring scale).

I bought the chicken drumsticks, but the 6-0 stitching was a defective wholesale product I bought online!

The silicone training board (with simulated sheath, blue/white dual-color) is made using rubber tubing and dyeing.

"Everything is ready, let's get started!!" Lu Cheng set up his phone's camera position and then clicked the start recording button.

Recording your own actions has many benefits. First, you can review them yourself and identify any gaps in your knowledge. Second, you can send the recordings to your teacher so they can correct any mistakes.

After all, when suturing this, the hand tremor while holding the needle needs to be less than 1mm! Most of the time, self-checking is required. That's how you learn medical technology.

Of course, while practicing, Lu Cheng also added a tiny bit of 'cheat' power to assist him.

Lu Chengdu had already mastered the operating techniques, so he had no other concerns when practicing.

One chicken leg, two chicken legs, three chicken legs...

About two hours later, Lu Cheng had finished processing all eight chicken legs.

The chicken legs were placed one by one in front of Lu Cheng, and Lu Cheng began to check them carefully.

Two minutes later, Lu Cheng took off his examination gloves in despair and covered his forehead.

Even with a skilled level of modified Kessler suture, there's still a 3/8 failure rate. What a joke!

Of course, this is also based on context. The diameter of the chicken leg flexor tendon is 3-4mm (near the human body's Zone II flexor tendon), making it one of the most difficult tendon training materials to suture.

"Sigh!" Lu Cheng had nowhere to vent his despair, so he could only sigh.

If the tendon suturing hadn't been so difficult, it wouldn't have been ordered to be abandoned by Director Peng at the hospital.

Lu Cheng then took notes, analyzing the reasons for his operational errors, treating it as a correction notebook.

"Failure Case 1: Cross-sectional gap > 3mm."

Root cause analysis: Insufficient tension in the terminal knot; Corrective measure: After tying the knot, pull the two sutures until the tendon turns slightly white.

"Failure Case 2: Exposed sutures on the tendon surface;"
Root cause analysis: The needle insertion depth was too shallow; Correction plan: Practice the "thread embedding method": Press down on the skin at the needle insertion point by 0.5mm with tweezers.

"Failure Case 3: Tensile test results in separation of the broken ends; "
Root cause analysis: The longitudinal suture did not run parallel to the tendon; Corrective measure: Use microsurgery to dissect the tendon to verify the suture trajectory.

"Success stories:..."

After recording everything, Lu Cheng took photos of it, and then cut out the video of the process and details of sewing the chicken legs separately.

Then she sent it to Chen Song, saying politely, "Teacher Chen, this is a case study of my failed operation today. If you have time, could you please help me review the reasons for the error?"

The training materials in the practice room can fail, but clinical practice does not allow it.

You can make mistakes on the college entrance exam, at most you'll just lose points, but if surgery fails, the consequences are far more serious.

It was already past four o'clock. Professor Chen Song sat in the "residential dormitory" arranged by the county hospital, sitting by the window, slowly enjoying the sunset while sipping a cup of tea.

He picked up the tea and put it down again, and he picked up the phone and put it down again, repeating this four or five times...

Chen Songcai's heart tightened as he began to reply, his answer detached from the question: "Xiao Lu, why don't you take the postgraduate entrance exam?"

"Although I'm a bit older, I'm not 'too old' yet!"

Chen Song is an associate professor, associate chief physician, senior researcher, and doctoral supervisor at Xiangya No. 2 Hospital. He is proposed to be promoted to chief physician and professor (senior level).
Lu Cheng's attitude towards learning is so positive!

With his exceptional talent, he has mastered the improved Kessler suture technique in just a few days. More importantly, even when asked questions, he breaks them down in detail and provides insightful answers.

Well-behaved and sensible, with excellent interpersonal skills, and smooth and tactful in speech and action, what reason could he possibly have not to love such a student?

In the five minutes that followed, Chen Song saw his chat window with Lu Cheng flashing repeatedly: 'The other party is typing...', disappearing, 'The other party is typing...'.

In the end, it all boils down to this: "Professor Chen, I've already completed my residency training, so I can't pursue a professional master's degree. It's too late for me to try for an academic master's degree at my age."

“Sigh…” Chen Song replied with one word and six dots.

What Lu Cheng thought of, he certainly couldn't have missed.

(End of this chapter)