After the patient was successfully anesthetized, Zhou Can prepared to perform the surgery standing at the principal surgeon's position.
"Xiao Zhou, this is your first time performing this type of surgery; there are a few points you must pay attention to." Before Zhou Can made the incision, Teacher Liu conveyed the precautions, highlighting the extremely high risk of the operation.
"During the operation, it's necessary to avoid damaging important anatomical structures such as the carotid artery, internal jugular vein, vagus nerve, hypoglossal nerve, and accessory nerve."
This was a standard reminder.
Even if Teacher Liu hadn't mentioned it, Zhou Can would've been careful during the procedure.
"This disease can cause inflammation to recur repeatedly, so it's advisable to surgically remove it promptly after controlling the acute inflammation. If the fistula is small, has no secretion or very little secretion, or if the patient is a child under two years old, surgery should be postponed."
If the surgical indicators do not align, then surgery must resolutely not be performed.
Otherwise, it could lead to overtreatment, with disadvantages outweighing the benefits.
Zhou Can listened attentively, taking these precious diagnostic and treatment experiences to heart.
"It goes without saying that a fistulogram must be performed before surgery. This operation is prone to causing severe bleeding, so preparations for a transfusion should also be made."
Teacher Liu continued to guide Zhou Can and the junior doctors on some key points of the surgery.
For this kind of fistulogram, iodine oil is commonly used.
The purpose is to clarify the direction, depth, and pathway of the fistula.
Some fistulas may have more than one direction, which requires even greater caution.
If a radiographic examination is not done before surgery and one proceeds recklessly, even a surgeon with extensive experience could falter.
"For this patient, use two horizontal incisions. If all the fistula openings are in the lower third of the neck, two horizontal incisions should be used. Make a transverse fusiform incision around the skin of the fistula opening in the lower neck, and at the bifurcation of the Cervical Artery, make another larger transverse incision."
Teacher Liu had already marked the incision sites in advance.
But he still explained it once more to Zhou Can and the others.
"If the fistula opening is high, a single transverse incision will suffice. The incision site should be determined based on examination results, avoiding major vessels and important nerves."
Neck surgeries have always been regarded by doctors as high-risk areas.
Zhou Can, after nearly a year of internship, struggled to get the opportunity to suture the neck even once, and Teacher Liu only reluctantly agreed.
If it weren't for Zhou Can's significant accomplishment in a thyroid surgery, he wouldn't have agreed at all.
This minor matter reveals how high the medical staff's risk assessment of the neck area is.
Now, not to mention suturing the neck skin, even allowing Zhou Can to handle the scalpel was conceivable.
Zhou Can's progress had been so great in the past year and a half.
Normally, a general surgery doctor goes from the end of their internship to being capable of independently making an incision in a patient's neck area, even just a simple cut through the epidermis to open a wound, would require at least six years' time.
Three years of standardized training, three years of surgical practice as a resident doctor, then the senior doctors would consider giving an opportunity to practice cutting through an epidermal layer of the neck.
And that would have to be a high-year resident doctor who performs excellently.
Unreliable or impetuous doctors, don't even think about it.
In fact, surgeries on the neck are basically Level 3 or above major operations.
The risks are extremely high.
Even attending physicians serve only as the first assistant in such operations.
Zhou Can carefully followed the marked incision spots and made a horizontal cut. While cutting, Teacher Liu was undoubtedly very tense, his hands instinctively clenched into fists. He was worried that Zhou Can's incision speed would be too fast and accidentally sever the patient's major neck artery.
Plasma had already been prepared.
In case of an emergency, transfusion and rescue could be started immediately.
This also showed how much faith Teacher Liu placed in Zhou Can's development. Essentially, he was taking a risk with his career and livelihood.
[Cutting Experience +1.]
[You have successfully made an incision in the patient's neck for the first time, rewarding 100 Incision Skill Experience Points.]
Zhou Can didn't expect to earn a 100-point Cutting Experience reward just like that.
He was genuinely pleased in his heart.
Making a neck incision was not too much of a challenge for him, actually.
It felt no different than making an incision in the skin during abdominal or thoracic surgeries.
After the Incision Skill was promoted to an attending medium level, his tactile feedback from the surgical scalpel seemed to have become clearer. When cutting down, he could more precisely and clearly know whether it was the epidermis, the subcutaneous tissue, or other structures such as blood vessels or muscles being cut.
Their touch feedback was different for Zhou Can.
It is precisely this sense of touch that allows surgeons to miraculously avoid important tissues like nerves and blood vessels with the sharp tip of the scalpel.
After making the incision, it was actually quite difficult to distinguish the sinus tract clearly with the naked eye.
But this did not stump the doctors.
They thought of a method: after cutting open the neck, they first inject Methylene Blue into the fistula opening, which makes it easier to identify the sinus tract during the separation process.
Subsequently, Zhou Can took up the scalpel to make the incision, cutting through the skin, subcutaneous tissue, and neck muscles according to the design, then used hemostatic forceps to clamp the fusiform skin containing the fistula opening, and proceeded to sharply separate along the sinus tract.
This separation process may sound simple, but the difficulty in execution was extremely high.
It required gradual separation from the bottom up to the bifurcation of the Cervical Artery.
"Xiao Zhou, when separating along the sinus tract up to the bifurcation of the carotid artery, you should use a 1% Prilocaine block on the carotid sinus to prevent carotid sinus syndrome from occurring," Teacher Liu timely reminded Zhou Can during the surgery.
Zhou Can swiftly completed the corresponding operations and then made a second transverse incision at this plane, pulling the already separated cord-like tissue of the sinus tract out through this transverse incision in the skin.
Even though Zhou Can proved his ability with the first neck incision, when he made the second incision, Teacher Liu was still very anxious, fearing that Zhou Can might encounter some mishap.