sinovels Chapter 1409 Surgery is an Art
Chapter 1409 Surgery is an Art
Chapter 1409 Surgery is an Art
Sisi sat in her wheelchair, her hands folded on her knees, her gaze fixed on her right thigh. Even through her hospital gown, she could feel the scars, stretching from the middle of her outer thigh all the way to above her knee, like a winding river recording her struggle against osteosarcoma.
Her mother pushed her to the plastic surgery clinic, where the doctor was waiting for her. Her surgery was divided into two stages. The first stage was the implantation of a skin expander, which had already been completed.
"Sisi, you're here."
The nurse called her name, and her mother pushed her through the corridor into a room much larger than a typical examination room. There were already three people in the room: a neatly dressed middle-aged doctor, a young female assistant, and a foreigner standing by the window. The man turned around, and Sisi paused, startled.
Ivan, he's here again. He was the one who performed the last surgery.
Ivan had golden curly hair like the feathers of some kind of seabird, and his eyes were a clear blue with an unexpected, almost pious light.
“Hello, Sisi,” he said in Chinese, his pronunciation a little strange but fluent, “I’m Ivan, Professor Yang’s friend, and now I should be your friend too.”
Sisi knew he wasn't just Dr. Yang's friend. Ivan Kovalenko was a world-leading plastic surgeon, a magician in the field of reconstructive surgery. His appointment list was booked three years in advance, and even if ordinary patients were willing to pay exorbitant fees, it was difficult to secure a surgery with him. But Sisi was no ordinary patient. She was the world's first osteosarcoma patient cured using Yang Ping's method, a living proof of Yang Ping's theories, and more importantly, she was Yang Ping's future student.
Ivan was Yang Ping's loyal follower.
“We didn’t talk much last time, but this time I have plenty of time for a thorough discussion. I’ve seen your medical records,” Ivan said, walking up to her without immediately offering her a seat. He bent down slightly to bring his gaze to her level. “No, it’s not just the medical records. I’ve read Professor Yang’s paper on your case, and his follow-up study. You were his first patient, the first clinical trial volunteer for K therapy, and also the world’s first clinically cured case.”
He paused for a moment, his gaze still fixed on her right thigh, even though it was covered by her pants.
“But these scars,” he continued, his voice softening, “will not be a problem.”
Looking at him, Sisi suddenly understood why Yang Ping had invited this person. The way Ivan looked at her wasn't like he was looking at a patient, but rather like he was looking at a precious object in need of careful restoration. And this object was precious because it was connected to Professor Yang. He was Yang Ping's follower, and she was Professor Yang's most important patient, his future student—the chain of their relationship was clear and strong.
“Professor Ivan,” Sisi said, “I’ve looked up your information. Last year you declined a surgical invitation from a member of the British royal family because you ‘didn’t want to work during your holidays.’ Why are you willing to change your schedule for me?”
Ivan paused for a moment, then laughed—a hearty, uninhibited laugh.
"Because you are Professor Yang's first patient, it's that simple. I've been waiting for this opportunity for several years, and it's an honor to perform surgery on you."
“Surgical plan,” Ivan walked to the lightbox on the wall and posted several of Sisi’s X-rays and skin texture analysis diagrams, “I call it ‘map redrawing.’ It’s not simply cutting off the scar and suturing it back together; that would only create new scars. What I’m going to do is use skin expanders and local flap transfer to redistribute the skin tension on the right thigh, allowing the scar to be hidden in the natural skin folds. For the main incision, I’ve designed a continuous combination of Z-shaped and W-shaped reshaping, utilizing the intermuscular space on the outer thigh; for the auxiliary incisions, I will use a series of small geometric reshaping techniques combined with skin abrasion; the needle tract scars may require fractional laser treatment.”
"In short, I will make the scars disappear completely, so that it will be difficult to tell with the naked eye that you have had surgery. Please believe me, I can do it."
"Of course I believe it!"
“I told you the whole procedure could be completed during the holidays and wouldn’t affect your schooling, and everything is going as planned,” Ivan said confidently. “The first surgery was very successful, and now we’re preparing for the second surgery. This time, we’ll use preventative scar treatment to make the result even better.”
“Preventative scar treatment,” Sisi said, “I read about it in the literature, in the preprint paper Professor Yang showed me last month, about spatial reprogramming of fibroblasts.”
Ivan raised an eyebrow in surprise, then smiled. “You are indeed his future student,” he said, “and have already started reading preprints. Yes, that research, but the technology is still a few years away from clinical application. But that's only for ordinary people. For you, it's readily available. Technically, it's very mature; what's immature is the legal and regulatory framework.”
He turned to the examination bed, gesturing to lie down: "Let me examine your right thigh. Everyone except my female assistant, especially men, please leave."
Yang Ping is in his office in the laboratory.
The phone rang; it was Ivan.
"Your future student is very capable. She accurately cited my paper from three years ago on the new technique of expanding skin flaps, as well as my paper on preventative scar treatment. She has already begun her studies."
"How did the checkup go?"
"The skin quality on her right thigh was better than expected. Although the scar was noticeable and extensive, the deep tissues were healthy and well-vascularized. I designed three surgical plans, which she approved. She even raised a technical question about the incision direction, specifically how to better follow the tension of Langer's line."
"Thanks!"
"You're welcome! I should be thanking you for giving me this opportunity, but I have a question for you: why don't you perform the surgery yourself? I've heard that your plastic surgery skills are certainly no less than mine."
Yang Ping answered truthfully: "Because I'm not good enough. In terms of functional reconstruction, I'm definitely better than you. But in terms of aesthetic judgment, I don't have the talent and lack sufficient training. This is also one of the reasons why I'm not interested in plastic surgery. I like to do surgery, but plastic surgery is an exception."
There was a long silence on the other end of the phone. Then Ivan said, “You know, Professor, this is the first time I’ve heard you say this. In my mind, you’ve always been perfect, always right, always capable of getting everything done. Now, you’re willing to acknowledge your limitations, willing to show those limitations for your student. This makes you more like a mentor than a medical machine. I will take good care of her; although it’s just a scar surgery, I will do my best.” The surgery was scheduled for 7 a.m. on Monday.
Sisi lay on the operating table, her right thigh exposed to the operating light. The scars were even more pronounced under the bright light, like a rough map marking the multiple surgeries from several years ago. When she counted to twenty-three, the anesthesia took effect. Her last conscious thought was of Ivan's voice, humming a song in some language she couldn't understand.
Yang Ping stood to the side, wearing a scrub suit. He and Ivan had agreed that he would not intervene today, but would only be an observer.
Ivan's movements possessed a unique rhythm, unlike Yang Ping's precise restraint, but rather a flowing, almost dance-like fluidity. He first injected diluted adrenaline saline around the scar to reduce bleeding while simultaneously dissecting the subcutaneous tissue. Then, he began designing the incision, not a simple excision, but a series of complex geometric alterations, Z-shaped and W-shaped interlacing, like some ancient weaving pattern.
"The key to Z-plasty," Ivan once told Director Lan of the plastic surgery department, "is not geometric calculations, but understanding the language of skin tension. Every scar speaks, telling you the pressure it endures, telling you the direction it wants to release. What you have to do is listen, and then rearrange these tensions, letting them harmonize. The highest level of judgment in plastic surgery is not calculation, but feeling with your heart, like a musician."
“Notice the direction of tension here,” Ivan said, gently lifting a skin flap with his fingers. “If I suture it at this angle, it will create shearing force during postoperative movement. But if I adjust it by five degrees—only approximately five degrees, of course—following the direction of muscle contraction…”
"Adapting to mechanical vectors in three-dimensional space is like a cell adapting to a morphogen gradient during embryonic development. Macroscopic surgery and microscopic mechanisms follow the same geometric principles."
"The stitching motion was smooth and precise, just like a pianist playing the piano."
"Remember, for us, surgery is an art!"
Director Lan couldn't understand the analogy at first. But now, watching Ivan's actions, he began to understand what it meant.
The main incision scar on Sisi's right thigh was skillfully deconstructed, and the skin flaps were flipped and interlaced like loose pages before being sutured. The originally straight, contracted scar was transformed into new lines that followed the skin's texture and natural tension. When Ivan finished the final suturing and gently moved Sisi's knee joint, Yang Ping saw that the skin movement became natural, no longer feeling taut or resistant.
The first surgery involved implanting skin expanders. Now, Dr. Lan knows the level of the world's top plastic surgeons. Even with several skin expanders, the implantation is perfect. The expanded skin is not only just right, but most importantly, the intersecting skin lines can be recombined to become continuous, natural, and without any sense of disorder.
It's a truly beautiful experience, requiring an extremely high level of aesthetic intuition.
The surgery lasted four hours. Yang Ping stood in the operating room for four hours.
Ivan took off his surgical gown.
"The surgery is complete. You'll see the results once the swelling subsides. But the real magic will appear a month later."
"Thank you," Yang Ping said.
“You’re welcome. But I have something to tell you…” Ivan leaned against the wall, rubbing the back of his neck. “I’ve been thinking about your theory, three-dimensional guidance, cell positional awareness. Do you know what the biggest problem with scar tissue is? It’s not the excessive deposition of collagen, it’s the chaotic arrangement. In normal skin, collagen fibers are orderly, like woven fabric; in scar tissue, collagen is chaotic, like a tangled mess.”
“What if,” Yang Ping finished for him, “what if we could re-establish that ‘sense of place’ in the early stages of wound healing, guiding fibroblasts to grow according to normal spatial patterns?”
“That’s about preventing scars, not treating them,” Ivan said. “My theory of preventative scar treatment is built on yours, and you’ll gradually see the power of this technique. It’s no exaggeration to say that your theory helped me overcome scars and conquer my past self.”
Sisi's recovery went more smoothly than expected, partly due to her own participation.
Two weeks after the surgery, she returned to the hospital to have her stitches removed. Yang Ping accompanied her, watching Ivan carefully remove the dressing. The swelling had subsided considerably, and the new incision lines were still quite visible, but their shape already revealed Ivan's meticulous design; they followed the intermuscular spaces on the outer thigh, blending naturally into the skin's texture like a river flowing into the sea.
Sisi didn't just passively accept the examination. She asked Ivan about every technical detail: why choose this angle, how to calculate the flap length, how to predict postoperative tension changes, and how to design the alignment of skin folds to make the recombined skin folds look natural and harmonious. Ivan answered each question one by one, sometimes explaining with diagrams, and sometimes having Yang Ping supplement the theoretical background. This three-way dialogue became a unique teaching scenario: Ivan taught the techniques, Yang Ping taught the principles, and Sisi learned.
“Your color will change further,” Ivan said. “It will lighten in three months and stabilize in about a year. All of this is under consideration. I will ensure the final color blends seamlessly with the surrounding normal color.” He had Sisi move her knees, bending and straightening them. “The skin moves with it; there’s no pulling sensation. That’s the redistribution of tension.”
“I want to document this process,” Sisi said, “as my first case study. Not as a patient, but as a learner. I want to track my recovery, take photos, measure, and record my subjective feelings. This can become a complete teaching case on the functional and aesthetic reconstruction of plastic surgery.”
Yang Ping and Ivan exchanged a glance.
“You can do that,” Yang Ping said, “but there must be ethical review, privacy must be protected, and the consent of all relevant parties must be obtained. Medical records are not just data; they are people's stories. If you want to use these stories, you must first respect them.”
“I understand,” Sisi said. “I will formally submit my application. Furthermore, I would like to invite you and Professor Ivan to be my co-mentors. This was a surgery you performed together, and you should jointly guide my research.”
Ivan laughed, a hearty, seabird-like laugh: "She has already learned how to make requests, how to build collaborations, and how to turn personal experiences into public resources. Your student is very smart. My God, she is just a high school student who hasn't even started school yet. I really envy you for having such a good student and being able to get involved in her education now. I can't imagine what kind of doctor she will become in the future."
“If she weren’t your student, I really would like to teach her plastic surgery.”