Chapter 95: He Even Reconstructs Wrists [2] While Kanghyeok put on his gloves and mask, then fitted the appropriate blade onto the scalpel, the others had to move even more busily.
First, Yeoni and Dolseok carefully wiped down Gwanghae's right wrist and hand, all the way up to the elbow, with Betadine antiseptic solution.
Before long, the pure white mattress had become soaked with the brown disinfectant, but no one blamed anyone for it.
Only the eunuch standing behind them looked a little uneasy.
But what could he do?
The treatment had already begun.
"He's breathing well."
True to his obsessive nature, Heo Jun checked the prince's breathing almost every second.
No matter how many times Kanghyeok told him it was unnecessary, it did little good, so he finally let him do as he pleased.
"Yes, he's fine now too."
"He's breathing well."
Still, it was too noisy to leave alone, so Kanghyeok had to signal for him to do it with hand gestures instead.
"Teacher Heo. Just make a circle with your fingers. I need to concentrate."
"Ah, yes. My apologies."
"Like this?"
"No, no. That looks more like the verification mark on a shady website… Like this."
Kanghyeok flinched when he saw Heo Jun's hand gesture, then immediately corrected it.
What the hell is this?
Of all things, he had made something too close to an okay sign and made everyone uncomfortable.
Clicking his tongue, Kanghyeok turned back toward Gwanghae's wrist.
Yeoni was quickly sketching the series of preparations.
If only she had something like a pencil, it probably would have been much easier.
It was a pity that she did not.
"So I'm just on standby?"
Only Makbong sat there with a bored expression.
He looked like some lord lounging around, which irritated Kanghyeok, but there was not really anything for him to do.
Being useless is sometimes a good thing too.
Suppressing the urge to smack him—he would have if he had not already been wearing gloves—Kanghyeok nodded.
"Yeah. Just stay on standby for now."
"Yes, young master. Outside… I'm not allowed to go out, right?"
"Of course not. Do you think this is some ordinary house? This is the palace, the palace."
"I know. Understood. I've got at least that much sense."
Makbong chuckled and leaned back against the wall.
It looked like he was about to take a nap.
Yeah, sleep. That's better.
Kanghyeok shook his head and inspected the scalpel.
Fits right in the hand. Blade's in good shape. Very good.
As he checked the spot where he would make the incision one last time, Yeoni handed him the local anesthetic syringe.
It was an injection containing a mixture of lidocaine and epinephrine, and the effect was quite good.
That was because the anesthetic effect of lidocaine could be enhanced by the vasoconstrictive effect of epinephrine.
"Young master, the anesthetic is ready."
"Good. You've gotten smooth enough now that I don't even have to say anything."
"Dolseok and I have been handling simple procedures together."
"Right. You two are earning good money now too."
Chuckling, Kanghyeok inserted the syringe into Gwanghae's wrist.
The incision range was about five centimeters.
It was not an exaggeration to say it covered almost the entire wrist.
For this kind of surgery, it qualified as a major operation.
"That's done… Teacher Heo. His Highness isn't reacting at all, right?"
"No. He hasn't moved a bit."
"Good."
"He's breathing well."
"Ah, yes, yes."
"He's still breathing well."
If Kanghyeok answered, it felt like Heo Jun would just keep going.
Ignoring him with effort, Kanghyeok picked up the scalpel.
Then he lightly pricked the tip into the wrist.
"He still hasn't moved at all, right?"
"Yes. And he's breathing well."
"Okay. The anesthesia worked. Let's open it up."
Kanghyeok began drawing the scalpel in earnest.
The thin skin of the wrist split open.
Since Gwanghae was still very young and exercised diligently, there was almost no fat to be found.
The thick white ligament beneath appeared almost immediately.
Just as Kanghyeok had described before, the sturdy, thick-looking ligament ran around the wrist in parallel.
"So this is that…"
Dolseok asked as he pulled the cut edge toward the palm side.
"Yeah. This is the transverse carpal ligament."[2]
"It really does look tough."
When Yeoni pulled the opposite cut edge toward the elbow side, the structures underneath also came into view.
Pointing at one of them, Kanghyeok spoke.
"See that thick white one?"
"Yes, young master."
"That's the median nerve.[3] If that gets cut… you can pretty much say the hand becomes almost unusable. And there's not just one or two important things like that in here, which is why there's such a thick ligament protecting them."
"That's amazing."
Dolseok kept nodding.
Yeoni wore a similar expression.
Watching the two of them, Kanghyeok was reminded of his first year in medical school.
Back then, he had also been stunned just like them.
There are people who become even more convinced of God's existence after learning anatomical structure.
That was how scientific and systematic it was.
Kanghyeok pointed out the other structures they needed to be careful of one by one.
Mainly the ones that would be disastrous if they damaged them while pulling the tissue back.
"This and that one. See those pulsing?"
"Yes."
"They're arteries. If you touch them, it's a disaster."
"Yes, sir."
"These are ligaments too. So you can't touch them either, right?"
"Yes. But then doesn't that mean you can't touch any of it?"
"Hm?"
As always, there was something quite sharp about Dolseok's questions. Annoyingly so.
At first glance, it was a valid point, so Kanghyeok kept his mouth shut for quite a while.
If not for Heo Jun whispering beside him, he probably would have stayed that way for another full minute.
It seemed like Heo Jun was talking to himself, but everyone could hear him clearly.
"His breathing is fine."
"Ugh."
Kanghyeok snapped back to himself and glared at Dolseok.
"Yeah, punk. Don't touch any of it."
"You could've just said that from the start—"
"Makbong."
"Oof."
Now that he looked at it, Makbong was useful in moments like this.
Kanghyeok was wearing a surgical cap, mask, and gloves, so he could not easily use his hands.
If he did, it would be contamination on the spot.
But Makbong was always ready to smack Dolseok across the back.
Even now, when his eyes had been half-closed.
"Anyway, there's a long way to go. This surgery… won't be dangerous, but it will be difficult."
"Yes, yes, young master."
"Only hold the places I tell you to hold."
"Yes."
Kanghyeok decided to deal with the palm side first, the side Dolseok was pulling back.
"All right, lift it upward like this."
"Yes."
He pinched the skin above the transverse carpal ligament with forceps and handed it to Dolseok.
Dolseok was actually rather talented at this kind of work, so he was able to follow Kanghyeok's instructions well.
"Good. Stay exactly like that."
"Yes, young master."
"Yeoni, shine the light properly inside here."
"Yes."
Kanghyeok inserted a pair of fine scissors into the gap Dolseok had made.
Then he gradually removed the white connective tissue that was holding the ligament and skin together.
A technique sometimes called tunneling.
"Hoo."
Now Kanghyeok set down the scissors and began pushing the connective tissue aside with his fingers.
Since he had already cut away the firmer parts with the scissors, simply pushing was enough.
As his hands kept moving, the tunnel gradually widened and deepened.
It reached the point where the muscles forming the palm and their ligaments were fully visible.
At the same time, a deep smile appeared at the corners of Kanghyeok's mouth.
"Bingo."
Using the forceps, he pointed to a white structure that spread through the palm like the ribs of a fan.
Dolseok could not see it, but Yeoni, Yeoju, and Heo Jun could see it clearly.
Naturally, since it was a structure they were seeing for the first time, curiosity rose at once.
"What is that?"
"That is the palmar aponeurosis.[4]"
"What's that?"
"Look carefully. See these four ligaments running inward here?"
Kanghyeok even twisted his body around to explain.
These brats need to learn properly so my life gets easier later.
Yeoju was especially important.
If she drew it well, teaching would become much easier.
Had Heo Jun not already successfully completed a hemorrhoid surgery once?
Kanghyeok had directly assisted him as the first assistant, of course.
Even so, the one who had actually performed the operation was Heo Jun.
At this rate, Kanghyeok would no longer have to personally dig around in anuses himself.
Unaware of his dark inner thoughts, Yeoni and Heo Jun kept nodding.
With utterly innocent expressions.
"We can see it."
"Right. That's what holds them firmly in place. If that didn't hold them like that, the position of the finger ligaments could shift."
After all, fingers were parts of the body that moved constantly.
So they needed some kind of solid support.
One of those supports was this palmar aponeurosis.
"But why did you go looking for this? This isn't even the part that's hurting, after all."
It was Heo Jun, who had observed Gwanghae the longest and from the closest distance, who asked.
As he said, this was not the lesion.
Just as that fact proved, there was no damage visible on the inside of the palm.
Except, of course, for the damage Kanghyeok had just caused by opening it up.
"That aponeurosis isn't all useful."
"Is that so?"
"If you look carefully at the aponeurosis… from the index finger to the little finger, it holds the ligaments in place. But what about the thumb?"
"Uh… it looks like it's just attached to the muscle."
"Right. That side doesn't really have much function. It's just stuck there."
Of course, once medicine advanced further, they might learn why it was attached there.
But from what he had experienced so far, cutting out that part did not seem to cause any particular problems.
For a surgeon, that was an excellent thing.
The fact that the human body also had parts that could be swapped out like a spare tire.
"Then?"
"I'm going to remove that."
"Why?"
"Just keep watching."
"Ah, yes."
Heo Jun did not press for more.
He merely went back to checking whether Gwanghae was breathing properly.
Kanghyeok had told him several times that this was a drug that had already gone through enough clinical testing to be safe.
Still, Heo Jun was the type to do his assigned job with all his might.
That's a good thing.
Thanks to that, at least when it came to Gwanghae's breathing, Kanghyeok did not have to worry at all.
Without taking his eyes off the aponeurosis, Kanghyeok held out his hand.
"Give me the scalpel."
"Uh… yes."
Since one of Dolseok's hands was free, he promptly passed it over.
Using the scalpel, Kanghyeok carefully separated the part where the aponeurosis attached toward the thenar eminence.[5]
Naturally, there was muscle beneath the ligament, and it could not be damaged.
Doing such delicate work in a place this narrow and dark, like a tunnel, was almost impossible.
"Ugh. Fuck."
It was difficult enough that even Kanghyeok found it taxing, and the curse slipped out on its own.
Since Kanghyeok normally never showed this side of himself during surgery, everyone's eyes widened at once.
Because of that, even Heo Jun had to lower his voice more than before.
In any case, it meant the surgery was frighteningly difficult.
Even if he could not help, the least he could do was avoid getting in the way.
"Ah, damn."
Heo Jun's worry was unnecessary.
Kanghyeok had no room to care about the sounds around him right now.
So this… this is hard.
As expected, there was always a reason people did not use a certain technique.
Who would reconstruct things during surgery for carpal tunnel syndrome?
Most would simply take the easy route and cut the transverse ligament to relieve the pain.
If this weren't Gwanghae…
He would have cut it without hesitation.
That was the problem with great figures of history.
Even the smallest thing could not be treated carelessly.
If the country ended up collapsing because of it, that would be a disaster.
Still… it's working, more or less. As expected… I really am a genius.
After that rather frivolous burst of self-admiration, Kanghyeok finally managed to cut free the small piece of ligament.
Just in case, he looked inside, and as expected, it was clean, without a single injury.
"Done. Ah, damn."
Muttering to himself, Kanghyeok lifted out the dazzlingly white, tough ligament.
Only then did Dolseok, who had barely dared breathe properly until now, let out a sigh of relief.
Yeoni, who had watched the entire process of how Kanghyeok removed it, felt much the same.
Of those present, the only one still composed enough to ask a question was Heo Jun.
"What in the world are you planning to use that for, after all this trouble to remove it?"
Heo Jun pointed at the ligament, which was not actually all that large considering the amount of effort it had taken.
By contrast, Kanghyeok looked thoroughly satisfied.
"As I said before… His Highness's illness is caused by another structure being compressed by the wrist ligament."
"Yes. I have heard that much."
"Then if we lengthen that ligament a little, won't that solve the problem?"
"Ah?"
"That's exactly what I'm about to do now."
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