Surgery Godfather

Chapter 2133: Chapter 1790: There Are No Such Miracles in Medicine (Part 2)

Atrophic scars: Below surrounding skin, such as acne scars and subcutaneous tissue defects after trauma.

Contracture scars: Across joints or body contours, leading to functional impairment.

Ivan emphasized: "The key differentiator lies in boundary behavior; hypertrophic scars are ’disciplined,’ knowing where the original injury is and not crossing boundaries; keloids are ’aggressive,’ forgetting their position and expanding indefinitely. This distinction essentially comes down to the presence or absence of three-dimensional gene guidance mechanisms." freēwēbηovel.c૦m

He displayed pre-surgery photos of Sisi, showing the primary incisional scar on the right thigh. ƒгeeweɓn૦vel.com

"This is a typical hypertrophic scar, because at the time of surgery, priority was given to tumor treatment and limb preservation. The incision was designed to be straight and long, concentrating tension, and early post-operative tension management was not systematically conducted. But it didn’t turn into a keloid because Sisi’s constitution isn’t prone to keloids; her fibroblasts are just ’confused’ rather than ’out of control.’"

"Professor Ivan," a plastic surgery department director inquired, "How do you predict if a patient will develop keloids? Are there genetic markers?"

"Currently, there are no clinically available genetic markers. I am exploring, and I believe the fundamental logic must lie in genetics," Ivan candidly stated, "but in our research, we found that in keloid patient fibroblasts, the expression of certain three-dimensional guidance genes is significantly reduced, especially those related to cell polarity and matrix arrangement. We are developing a risk assessment model based on these markers, which may enter clinical validation in two to three years."

He paused and looked at Yang Ping, who nodded slightly; this was their tacit communication: the theory is moving towards practice, but it needs time.

The lecture entered the core segment: Scar prevention.

"Prevention is better than cure, especially critical in the scar field. Once scars form, especially keloids, the difficulty of treatment increases exponentially. Based on the three-dimensional guidance gene theory, I propose the ’three-dimensional prevention strategy.’

The slideshow displayed three concentric circles:

First dimension: Mechanical environment control.

Second dimension: Biochemical signal regulation.

Third dimension: Cell behavior guidance.

"First dimension, mechanical environment," Ivan explained in detail, "This is the level surgeons can most directly intervene. Incision design should conform to Langer’s lines to reduce tension; suture techniques should align layers and eliminate dead space; early post-operative use of tension-reducing tape or skin adhesives can maintain wound edge stability. Traditional methods stop here, but three-dimensional theory tells us this isn’t enough."

He displayed a set of comparison photos: the same surgical incision with traditional suturing and ’tension-guided suturing’ post-operative results. The latter had visibly finer and flatter scars.

"What’s the key?" he asked, "It’s not about stitching tighter, but stitching ’smarter.’ In my suturing, I consider the skin’s three-dimensional tension vectors, it’s not just about closing the incision, but rebuilding the skin’s ’structural memory.’ Making the cells at the wound edges ’remember’ which direction they should face and how much force they should withstand."

A chief resident surgeon inquired, "How long can this ’memory’ be maintained? Won’t it disappear after stitches are removed?"

"Good question," Ivan said, "The effect of mechanical signals is triggering, not maintaining. After stitches are removed, we need interventions from the second and third dimensions to take over."

He clicked to the next page, showing a transparent silicone patch.

"Second dimension, biochemical signal regulation. The role of silicone patches isn’t just moisturizing and applying pressure; more importantly, they create a low-oxygen, high-humidity microenvironment, down-regulating the expression of TGF-β1 and TGF-β2 while up-regulating TGF-β3, the latter being the critical factor in promoting normal healing and inhibiting scar formation. Traditional silicone therapy is ’blind,’ we don’t know when to use or cease."

"Based on three-dimensional guidance theory, we developed ’responsive silicone therapy,’" he showed a graph, "by monitoring scar hardness, blood flow, and temperature changes, assessing fibroblast activity and dynamically adjusting treatment intensity. When cells are ’quiet,’ reduce interventions; when cells are ’restless,’ enhance suppression."

Sisi recalled her post-surgery care. Ivan indeed asked her to record the changes in scar hardness daily, uploading photos to a specialized evaluation system. At the time, she thought it was routine follow-up, now she realized it was part of the research.

"Third dimension, cell behavior guidance," Ivan’s voice became deeper, carrying a certain reverence, "This is the forefront and the most challenging layer. Professor Yang’s three-dimensional guidance gene theory plays a core role here."

The slide showed a complex illustration: fibroblast behavior in a three-dimensional matrix, spatial gradients of gene expression, nanoscale structures of the extracellular matrix.

"We are developing a ’bioactive scaffold,’" Ivan remarked, "it is not a passive filling material but an active guiding system. The scaffold’s nanofibers are arranged in specific three-dimensional directions, simulating the collagen structure of normal skin. When fibroblasts migrate into the scaffold, they ’sense’ this directionality and align along the preset path, secreting collagen."

"It’s like," he sought a fitting analogy, "giving cells a map, telling them where north and south are. In normal development, this map is drawn by genes; in scar repair, this map is lost; our scaffold is an artificially drawn temporary map, helping cells to find their direction again."