Chapter 168

               

Vrrrm.

Kang-hyuk stared at the electric saw Jang-mi handed him.
It was a straightforward saw, powered by a foot pedal.

The blade was diamond-coated, capable of grinding through anything.
Even the shinbone of a grown adult man would stand no chance.

“You ready?”

“Yes.”

Jaewon answered with a determined look, already holding a large syringe filled with nothing but saline.
Simple, but in [osteotomy] it played a crucial role.
(T/N: Osteotomy is a surgical procedure where a bone is cut to shorten, lengthen, or realign it.)

“If you mess up, the bone burns. And if the bone burns, then what?”

“It won’t fuse.”

As Jaewon said, a charred cross-section couldn’t fuse unless the burned surface was removed.
For wounds to heal, healthy edges had to meet.
That was why burns were harder to recover from than most other injuries.

“And the bone dust? What happens then?”

“It clouds the field of view.”

“Good. Then you should also know how to handle it manually.”

Kang-hyuk advanced the snarling saw.

Gulp.

Jang-mi swallowed dryly. She was holding the incision edges open, doubling as a nurse and surgical assistant because of the trauma center’s chronic lack of staff.

Complaints would have been natural, but she gave her all.

Claaang.

The saw bit into the shinbone.

Eyes locked on the blade, Kang-hyuk spoke. He couldn’t afford to waste a day when it came to training Jaewon.

The fortunate part was Jaewon didn’t intend to waste a day of learning either.
It made for a perfectly matched teacher and student.

“Why can we harvest the fibula?”

There were no easy lessons. He asked, and if Jaewon didn’t know, he’d be torn apart.

“Because the tibia supports weight-bearing, so function isn’t compromised much.”

This kind of reconstruction—taking flesh, muscle, or bone from one site to repair a defect elsewhere—was called a [flap surgery].
(T/N: Flap surgery is a reconstructive technique where tissue is moved from one part of the body to another, often with its blood supply.)

Artificial bone that perfectly replaced real bone would have been ideal, but no such thing existed.
So they used fibula or scapula grafts to patch defects.

The rule was simple: remove tissue only where the function wouldn’t be severely compromised.

“Hm. Right. So how much can you safely take?”

“Leave at least 10 centimeters on each end.”

“Correct. It varies a bit by institution, but that’s about right. What’s gotten into you today?”

Even while cutting, Kang-hyuk nodded in surprise. Usually Jaewon stumbled on the second question.

“The center’s been a little quiet lately. I studied.”

“Quiet, huh. Hm.”

“Not that it’s a good thing…”

Realizing he sounded too cheerful, Jaewon backpedaled. But Kang-hyuk was already lost in thought—though his sawing remained flawless.

‘The helicopter issue still isn’t solved.’

No medevac meant fewer patients arriving alive. And even if they did, many couldn’t be saved.

‘Damn it.’

Accidents hadn’t stopped just because helicopters couldn’t fly. It only meant more were dying unseen.

‘Well… at least the floor leader stepped in. Hopefully he can push it through.’

He thought briefly of Assemblyman Park Sung-min, whose impression—rare for a politician—was actually trustworthy. For now, he was their only option.

Kang-hyuk refocused.

“Alright. First cut’s done.”

A crack—and a segment of fibula came free.

“We need two more pieces. Get the saline ready.”

“Yes.”

“If you hit a vessel under there, it’ll be a nightmare later. That plate’s locked solid, right?”

Even though he’d never once let the blade touch the plate, Kang-hyuk pressed Jang-mi anyway. Over-preparation was always better than under-preparation when it came to patient safety.

“In a hospital, too much is always better than too little.”

“Yes, professor. It won’t budge.”

She tapped the plate wedged between bone and vessels. Somehow, Kang-hyuk had set it perfectly—firm enough to stay put, yet harmless to surrounding tissue.
All she had to do was keep it steady.

“Good. Let’s keep going.”

“Yes.”

Only when everything was confirmed perfect did Kang-hyuk resume sawing.

Craaaang.

His osteotomy was as flawless as his incisions—mesmerizing to watch.

“Wow…”

Even Captain Lee Dong-ju, who had just returned from military duty, whispered in awe from the back.

Not even orthopedic surgeons performed osteotomies this cleanly every day.

‘I knew he was skilled, but still…’

He had already been shocked when Kang-hyuk pieced together shattered gunshot fractures. That alone was rare even among top orthopedists.

‘I thought it was just overseas experience… but this…’

This was a procedure orthopedics commonly did, yet Kang-hyuk outshone even them.

“Alright, osteotomy’s done.”

Kang-hyuk himself looked unfazed. His colleagues, too, had seen enough miracles from him to not be surprised. This was just the start—the real challenge lay ahead.

“Take out the plate.”

“Yes.”

Jang-mi carefully removed it, making sure not to damage the underlying vessels.

Kang-hyuk watched her with satisfaction—until he noticed Jaewon’s gaze. It wasn’t like hers.

‘This punk…’

Jang-mi seemed indifferent. Jaewon, not so much.

‘Poor guy…’

Kang-hyuk wasn’t exactly blessed in character, but looks he had. He’d dated plenty in his school days, and from experience he could tell—Jaewon had no chance.

‘You’re already in the friend zone…’

He shook his head and tapped Jaewon’s hand in mock sympathy.

Jaewon flinched and blurted, “S-sorry! Master!”

He was so rattled it came out instinctively.

Kang-hyuk blinked. He hadn’t meant it that way.

“What the hell? I was just cheering you on.”

“Uh… don’t people usually pat the shoulder?”

“Contaminate you? Do you know how filthy your shoulder is?”

“Well… you’re not wrong…”

Even scrubbed in and gowned, only the front of the body was considered sterile. The shoulders and back were all regarded as contaminated.

So he wasn’t wrong—just irritating.

“Anyway, look at these bone segments.”

He pointed to the pieces he had just cut. Perfectly sliced, thanks to the saw and his skill.

But what mattered wasn’t the neat cut.

“See how each piece has an artery and vein?”

He had accounted for the vessels feeding the bone—right from the start.

Even Jaewon, who had studied diligently, had missed this detail.

“Ah…”

“Don’t ‘ah’ me. Without that, what’s the point? Dead bone is worthless.”

“Right… right.”

These feeding vessels supplied oxygen and nutrients. Without them, grafted bone was useless.

“See the artery and vein further down?”

“Yes.”

Kang-hyuk deftly hooked the tiny vessel bundle with a rubber band and pulled them gently aside.

“Take this, and attach it to the cut artery in the forearm.”

“Oh… vascular anastomosis?”

At that, Ji-min, who had been quietly waiting, suddenly bolted from the room before anyone could stop her.

Kang-hyuk stared at the half-shut door.

“Where’s she going? Bathroom?”

“No way she’s running like that just to poop.”

Jang-mi defended the junior nurse.

“Then why’d she bolt like that?”

“No idea…”

“Anyway. Yeah, vascular anastomosis. Micro-surgery of sorts. You want loupes for this?”

He looked at Jaewon. His tone sounded mocking, but Jaewon shook his head. He had 20/20 vision in both eyes.

“No need.”

“Yeah, I don’t use them either.”

“Still, most surgeons at least wear loupes, if not a microscope.”

“Other departments can. Trauma surgery can’t. You get used to luxuries, you’re doomed.”

It wasn’t just pettiness—trauma surgeons rarely worked in ideal conditions. They had to train for scarcity.

A grim reality, but reality nonetheless.

“Fair enough. So do we cut it right away?”

“You didn’t study all the way, huh?”

Kang-hyuk shot him a sharp look, almost pleased.

“Uh… yeah. We weren’t completely out of patients…”

“Excuses, punk. What if this had been the fibula’s only vessel?”

“Ah… what then?”

“What do you think? Didn’t you check the CT? There are two. This one’s fine to cut.”

“R-right.”

Half lesson, half scolding.

With renewed vigor, Kang-hyuk tied off the vessel with silk and, after taking scissors from Jang-mi, said:

“Alright. Cut it, and let’s move it up.”