“Click.”
Imagawa Ori tightened the final locking screw into place.
Under the C-arm’s fluoroscopy once more, the plate was perfectly positioned, the screw lengths were appropriate, and the fracture reduction was beyond reproach.
She confirmed it one last time with the depth gauge.
“Remove the K-wires.”
Imagawa Ori let out a long breath.
The plate fit the bone flawlessly, and the fractured ends, constrained by the plate, were as stable as bedrock. This highly difficult surgery could basically be declared complete.
All that remained was irrigating the incision, placing a drainage tube, and suturing the muscle and fascial layers one by one...
That was all the assistant’s work. As the lead surgeon, she could leave the table ahead of time.
Kiryu Kazusuke responded at once, removing the eight K-wires one by one.
Imagawa Ori took off her bloodstained gloves and tossed them into the medical waste bin. She had already been about to turn and step down.
“Can you handle the suturing?”
But after glancing at Kiryu Kazusuke, she still stopped.
K-wire technique and intraoperative decision-making were one thing; suturing was another.
At the end of the day, Kiryu Kazusuke was still a newcomer who had only been in training for half a year.
Unlike K-wire manipulation, suturing required a great deal of practice to grasp its knack. There were not many clever shortcuts to speak of.
So, naturally, she assumed that even if Kiryu Kazusuke could do it, he would probably only know the most basic interrupted sutures from the textbook—crooked and uneven, like a centipede.
“Otherwise, have Takigawa scrub in again.”
Imagawa Ori glanced at Takigawa Takuhei, who had been spacing out ever since earlier, and added another sentence.
After all, he was still nominally the first assistant.
Although he had been replaced midway, letting him complete the final suturing could be considered leaving him a bit of face, sparing him from being too embarrassed in front of the nurses.
Not far away, Takigawa Takuhei also subconsciously wanted to raise his hand and say he could do it.
Of course he wanted to.
Being chased off the table was indeed humiliating, but something like pride had long since ceased to matter after he had failed the specialist certification exam for several years in a row.
If he could get back on the table now, perhaps he could even take the opportunity to ask Kiryu Kazusuke for guidance.
For someone who had struggled in the mire of the specialist exam for years, he desperately wanted to improve.
But...
Kiryu Kazusuke shook his head. “I have no problem.”
Having just obtained “surgical incision suturing,” his hands were itching, and he yearned to suture.
Although this skill could not directly reverse the course of an operation, it was just as important.
Suturing was not as simple as merely closing an incision.
Perfect suturing required clear layering, neat approximation, and moderate tension.
It could minimize scar hyperplasia, reduce the risk of infection, and promote wound healing. It was the key factor that determined the final cosmetic result and functional recovery of the surgery.
Poor suturing, with crooked stitches and uneven approximation of the skin edges, would either be too tight and cause local ischemic necrosis, or too loose and lead to wound dehiscence.
For a construction worker like Suzuki Shinya, whether the scar on his wrist looked good might not be that important.
But if infection or limited mobility resulted from suturing problems, it would undoubtedly greatly diminish the overall effect of the surgery.
Imagawa Ori only glanced at him in slight surprise, but did not insist.
Seeing this, Takigawa Takuhei stopped thinking about it as well.
However, he did not leave. Instead, he walked to the other side of the operating table and found a place where he would not interfere with the procedure but could still see clearly, preparing to observe.
His thoughts differed from Imagawa Ori’s.
Kiryu Kazusuke’s miraculous K-wire technique just now had already thoroughly won him over.
Now, he very much wanted to see whether this resident physician’s suturing technique was also as extraordinary as his K-wire technique.
At the operating table.
“Normal saline. Irrigation.”
Kiryu Kazusuke did not begin suturing immediately. Instead, he first instructed the circulating nurse.
The nurse quickly handed over an irrigator filled with normal saline.
He took it and began carefully irrigating the operative field, thoroughly removing bone fragments, blood clots, and necrotic tissue debris.
This was a standard step, intended to reduce the risk of postoperative infection.
But Kiryu Kazusuke did it with exceptional meticulousness, not missing a single intermuscular gap or fascial plane.
“Place the drain.”
After completing the irrigation, he skillfully placed a thin silicone drainage tube below the incision.
This tube could drain any blood or fluid that might accumulate deep in the wound after surgery, preventing the formation of a hematoma and compression of nerves and blood vessels, while also further lowering the infection rate.
“4-0 absorbable suture. Needle holder. Tissue forceps.”
He raised his head again and extended his hand.
The scrub nurse beside him was somewhat surprised and did not move immediately.
“Not 3-0?”
She hesitated for a second, then confirmed again.
The thickness of sutures was somewhat counterintuitive in terms of numbering—the larger the number in front, the thinner the thread.
Although 4-0 absorbable suture caused less tissue trauma and left a milder foreign-body reaction after suturing, which was beneficial to wound healing and appearance, its drawbacks were also obvious.
The thinner thread meant lower tensile strength. If excessive force was used when tying knots, it could easily break.
Moreover, it demanded even higher hand-eye coordination and operational precision from the surgeon.
The slightest carelessness could result in poor approximation of the skin edges.
Some resident physicians, let alone 3-0, might even choose 2-0 sutures that were less likely to break, just to be safe.
Takigawa Takuhei, standing to the side, also began muttering inwardly.
4-0? Seriously?
When he sutured, he used 3-0 most of the time. Although the scars he produced indeed did not look very nice, at least there would not be any problems.
After all, doing nothing also meant making no mistakes.
Even so, Takigawa Takuhei chose to believe.
So he leaned a little closer, unwilling to miss a single detail.
“That’s right. 4-0.”
Kiryu Kazusuke nodded and repeated his request.
This made Imagawa Ori stop in her tracks once again.
4-0 suture?
For a wrist incision with no small amount of tension, choosing such a fine thread placed extremely high demands on the operator.
Quite confident.
But she did not stop him. She merely stood to one side and decided to watch a little longer.
After receiving confirmation a second time, the scrub nurse took down a package of 4-0 absorbable suture from the suture rack, opened the package, skillfully clamped the needle in the needle holder, and handed it over.
Kiryu Kazusuke began operating.
Judging from his movements alone, there was not the slightest sense of unfamiliarity.
He first began suturing the deep fascial layer.
The tissue forceps in his left hand lightly lifted the fascial edge, while the needle holder in his right hand drove the curved needle in at a smooth angle, then precisely brought it out from the opposite side.
His wrist movements were small, but extremely efficient. Passing the thread, tightening, tying the knot—it was all done in one fluid motion.
The first knot was tied.
The stitch was neither too deep nor too shallow, and the knot tension was just right.
Imagawa Ori’s expression did not change, but waves had already risen in her heart.
This stitch was very standard—so standard that it did not look like something a resident physician could sew.
The resident physicians she had seen would have hands trembling like Parkinson’s when placing the first stitch, and when tying knots, they either could not tighten them properly or snapped the thread outright.
But Kiryu Kazusuke’s stitch was steady and practiced.
Perhaps it was just good luck?