SgtMcMuffin Posted May 29, 2019 Report Share Posted May 29, 2019 (edited) This thread is a compilation of surgical procedures that are basically the same no matter what, like biotechs. However, many surgical procedures depend on the situation and consequently, a guide cannot be written, and a person can only learn from experience and shadowing someone. BIOTECH ALL CREDIT FOR THIS GOES TO @Jun Nagase, (I did do some grammatical fixes) Welcome to the UCFMIMDCS book on Biotechnological Limb Surgery United Citizens Federation Mobile Infantry Medical Department Center and School This book will cover in full the various procedures necessary to outfit a Trooper with biotech limbs of all kinds. 2299 Version Foreword This book is provided by the United Citizens Federation Mobile Infantry Medical Department Center and School for the purposes of teaching Field Medics and Orderlies in the field of Biotechnological Limb (BT) attachment surgery for both surgeons and surgeons assistants. While this book will cover Biotechnological Surgeries, henceforth referred to as BT Surgeries, ranging from common to rare, certain special occasions may arise that this book does not cover. In the event of a special occasion BT surgery you are uncertain of that this book does not cover, refer to a more seasoned surgeon for advice. Note that two primary types of BT exist; Old pattern and New pattern. Old pattern are those you are likely most familiar with, and the simplest. New pattern BTs have basic senses built into them. These senses are touch related; texture, pressure, temperature. These senses are built to mimic the natural sense of touch but are in the end utilitarian. As such, none of the senses can experience pain. You won't feel pain from your BT burning or being crushed or shot. Author: Mary Hamilton Legend Page 1 - Foreword, Legend Page 2 - Pre-Operation Page 3 - Biotech Limb Attachment Surgery Page 4 - Post-Operation Page 5 - Biotech Limb Rehabilitation Exercises Page 6 - Repairs, Battery Repair, Recharge Unit Repair Page 7, 8 - Servo Repair, Nerve Cluster Housing, and Computer Repair Page 8 - Biotech Eye Surgery Part One Page 9 - Biotech Eye Surgery Part Two Page 10 - Biotech Eye Rehabilitation Exercises Page 11 - Biotech Eye Repairs and Cleaning Page 12 - New Pattern vs Old Pattern Pre-Operation General Pre-Operation Procedures Before beginning the surgery, these things should be taken into account for all surgeries, regardless of the type of BT. Ensure Biotech is delivered to the surgery room and packaging is undamaged. Damaged packaging may lead to contaminants on the BT entering the bloodstream. Note which type of BT is used. Check patient records for allergies and previous medical records that may apply, ask in person in case of incomplete records Ensure all required equipment is available and properly sterile in the surgery room, including general anesthesia gas tank being adequately filled. Ensure BT Base plate is of correct pattern type Ensure the surgery room is properly sterilized Ensure crew is aware of surgery taking place to prevent walk-ins, causing possible contaminants and subsequent complications with the surgery Ensure recording camera is turned on for the duration of the surgery When starting the operation, ensure the door is locked and all participants are wearing scrubs, nitrile gloves, hair nets, and surgical masks Place oxygen mask located on the side of the surgery table on top of the patient's face Attach vitals monitors to the patient Ensure oxygen mask is properly fitted over the patient's face and turn on general anesthesia gas flow Ask the patient to count down from ten to ascertain when they go unconscious Ensure patient is properly unconscious and hooked up to vitals monitors before proceeding with the surgery Ensure incision area(s) are shaved with an electric razor Failure to complete any item on this list could lead to severe complications and even patient fatality. (except the recording camera.) Biotech Limb Attachment Surgery This segment will cover common biotech surgery. Limbs are frequently lost in the Mobile Infantry, as such this is one of the relatively common surgeries you will face in your medical career in the Mobile Infantry. Ensure patient is properly unconscious Mark incision points on the stub with dotted lines using a surgical marker Sterilize incision areas with antiseptic skin agent (generally applied with a cotton piece) Make initial incisions along dotted lines Peel back skin and hold in place using small strips of surgical tape Isolate open blood vessels and cauterize as necessary Isolate and remove any remaining unnecessary bones, ligaments, and tendons (any below the ulna and radius in the case of hand BT surgery for example) Isolate tendons and ligaments in the open stump, hold out with clamps Carefully isolate nerve clusters in the open stump, keep in control with small clamps Drill into the side of the bone for attachment (radius in the case of a hand replacement), two on top and two on the underside, ensure they are in their correct position by placing the BT baseplate on the bone and drilling through premade holes on the plate Ensure proper fit for the BT baseplate and secure with screws Remove clamps and attach ligaments and tendons to the BT baseplate on their respective positions as marked on the plate itself Carefully assign nerves into the BT plate nerve center, this procedure takes by far the longest. Note that new pattern BTs have more nerve connection points and will take longer to perform Once complete, ensure all nerves are safely held in position and close the BT plate nerve center Remove tape from the skin and place the skin over the BT nerve cluster, ensure a seal between the BT bone attachment point and the visible part of the BT. No parts of the plate where nerves, tendons, and ligaments attach must be visible when closed, graft skin if necessary Stitch incisions, flush with saline and wipe with sterile wipes Attach BT limb to the baseplate attachment point, ensure proper attachment to the attachment point Once fit is confirmed, remove BT limb and bandage stump Transport patient back to their original room and continue to monitor vitals await the patient awakening Once the patient is awake and aware, remove bandages and reattach BT limb, ask them to move individual 'muscles', such as fingers, toes and the like. If the BT is a new pattern BT limb, gently press on the BT and ask if the patient feels anything. What they feel likely wont make any sense to them, but they should feel something if the BT functions Most cases will show limited movement at best, this is normal. Ensure each 'muscle' is able to move to confirm nerve cluster is assigned correctly Once the functionality is confirmed, explain the learning procedure they must undergo to learn to use their new BT limb. This will be covered on a later page The procedure may vary from BT to BT, though a limb surgery is by far the most common. Eye surgeries, however, do occur at times when eye damage is beyond repair, or when the eye is entirely missing. Post-Operation General Post-Operation Procedures Once the surgery is complete, these things should be taken into account. Move the patient to their room, ensure vitals are being monitored Ensure all used disposable equipment is safely disposed of in biowaste bins Ensure the surgery room is properly sterilized Ensure all reusable equipment is properly sterilized and stored in their proper locations Ensure recording camera is turned off post-surgery and log video file accordingly Ensure surgery is properly logged in the database along with any possible complications, anomalies or anything generally noteworthy Biotech Limb Rehabilitation Procedures for teaching Troopers to use their new biotech limb This page will go over the methods used for teaching troopers the best ways to properly learn to use their new limb so that it may mimic their original limb best as it can. Some people will learn faster than others, so consistency is key. Some Troopers may have trouble accepting their new state of being, in which case if you suspect significant trouble coping, you should refer them to a psychologist for evaluation and assistance. Losing a limb is a highly traumatic experience and many Troopers experience depression, sometimes for extended periods of time after losing a limb. Fine Motor Control Exercises Fine motor control is highly important especially for those with BTs that replace their hands. It's vital to function in the Mobile Infantry to be able to finely manipulate small and delicate objects. This point will cover exercises that teach a Trooper to finely manipulate everyday objects in a safe environment. A. Utensils Give the trooper who's lost a hand a fork, instruct them first to grab the fork as one would normally, then instruct them to pick up various small items like a small ball, a pen, and eventually food with the fork. Have them eat foods that frequently rely on the use of forks, knives, and spoons to get them used to every day fine-motor control. Eating with utensils uses more fine motor control than most realize. 1. B. Eggs Eggs are small, delicate objects that easily break if dropped or mishandled. Regularly hand a trooper with a new BT hand an egg and tell them to perform various tasks. At first, simply instruct them to pick up the egg without dropping it or cracking the shell. Once they can comfortably pick up an egg, instruct them to place them in specific spots. This will teach them to know how much pressure to exert on an object to pick it up without dropping or squeezing it and teach them to put it down gently, without releasing too soon. 1. C. Small puzzles. Give a trooper a puzzle including small pieces. Things like placing a pin inside a neatly fit hole, later putting the thread in a sewing needle et cetera. This will teach them to finely manipulate objects. 1. D. New Pattern BTs The brain is slow to learn to interpret more complex signals such as the senses related to touch. It's important that the trooper observes as their BT limb touches various objects such as a tufted carpet, a squishy ball and a warm plate. Picking up objects of varying weights also helps the brain to recognize the pressure senses in the new pattern BT limb. It's especially important early on that the brain is able to see what is causing the input, so if the object is warm (which ordinarily is not visible), make sure it's obvious that it's visibly warm. Such as, a plate with steaming food or a coffee cup with steaming hot coffee. Note that some minor sensation of pain may occur in the first few days as the brain begins to learn to interpret the signals from the BT. If sensations of pain persist past the first two weeks, surgery may be required to correct misplaced nerve endings. Once fully functional, the Trooper should never feel any pain from their BT itself. Phantom pain may still occur, however is significantly less likely in a new-pattern BT and will likely last for a much shorter duration if phantom pain does occur. 2. Reaction Speed Exercises Reaction speed is important for a Trooper. Being able to quickly and properly react to threats is vital for combat roles. These exercises will help a Trooper learn to react properly with their new Biotech limb. This is mostly for Troopers who have full limbs replaced, though just hands need this too. 2. A. Squishy ball Throw small softballs at the Trooper and tell them to only react with their new Biotech limb. Instruct them to catch it with their BT hand, or return the ball with a kick from their BT leg. This will teach them to move their limb in accordance with an oncoming object and catch it. 2. B. Throwing balls Throwing items, mainly softballs, is a safe way of teaching a Trooper to use their arm effectively to throw objects. By throwing balls into specific areas or passing the ball between them and someone else will teach them how to properly manipulate their BT arm and hand to accurately throw objects like grenades or magazines and teach them how to manipulate their BT to release in a timely manner. Biotech Limb Repairs Biotechnological limbs are frequently damaged by various means, from general wear and tear to misuse to accidental and combat damage. While engineers may be able to fix the simplest damage and superficial damage, it takes someone trained specifically in the intricate functions of a biotechnological limb to properly and safely restore damaged biotech to full function. This segment will teach you how to properly and safely repair military-grade biotechnological limbs to full functionality without causing further damage. Before conducting repairs, please ensure to shut down the BT entirely as to prevent injury. Power Source Your average biotechnological limb is powered by a small, portable and replaceable long-lasting battery along with a small motion recharging unit. Battery The battery in a biotechnological limb is sized proportionally to the size of the BT itself and the required power output for extended combat use. For example, a single finger has a tiny power pack inside it providing enough power to last up to three weeks of constant combat deployment (with the motion recharge unit disabled), providing sufficient power to simulate the strength of a finger. Similarly, a full arm holds a battery in the upper arm capable of sustaining the BT on its own for a similar length of time, providing enough power to simulate a well-trained soldier's strength. For safety reasons, if damage to the battery pack is suspected it must be replaced immediately. Damage to the battery pack could lead to violent combustion and severe damage to the BT and the user. Motion Recharge Unit All standard military-issue biotech limbs are fitted with proportionally small motion recharge units, converting the average daily motions into small amounts of power to recharge the battery. While the motion recharge unit itself cannot sustain full power to a BT, the constant daily charge will, in most cases, be sufficient to keep a BT fully charged at the end of the day assuming both recharge unit and battery are in full functioning order. Should you find a motion recharging unit damaged in biotech, a simple replacement is the simplest fix as the motion recharge units are relatively simple and cheap to replace, often kept in stock wherever BTs are stored and used. Should a replacement not be possible, ensuring the unit is not rusty or sticky and is properly oiled can help increase the output. Ensuring no parts of the housing unit is dented, and if it is, fixing said dents, can help fix and increase a damaged or low-output unit, as dents can cause friction inside the unit, reducing its charge. Alternate power/recharging All standard military-issue biotech limbs are fitted with some form of recharging socket, depending on size. Plugging the BT into a power source will recharge the battery directly. It is also possible, if necessary, to open up the BT limb and directly wire into the connection between the battery and the motion recharge unit to recharge the battery that way, should a suitable plug not be available, or the BT socket damaged somehow. If necessary, an alternate battery can also be fitted to the BT, though BTs may have reduced functionality when connected to non-standard batteries. For voltage, please refer to the inside of the respective BT cover. Servos All biotechs are fitted with servos to function the various daily motions. These are especially prone to wear and tear damage. In order to repair a damaged servo, replacement is an easy option. Should a replacement not be available, please ensure all wiring in the servos are undamaged, ensure circuits are undamaged and clean, ensure the motor is undamaged and clean, ensure gears are not rusted, sticky or damaged and is properly cleaned to reduce wear and tear. Please note that most BTs come with multiple servos per range of motion, both for the sake of strength and for the sake of reliability. If a range of motion is completely disabled, it likely means the main gear connected to the servos is damaged and needs replacement or repair, or the nerve cluster minicomputer is damaged as opposed to a servo being damaged. The exception to this is fingers and toes, which generally only have a single servo functioning their respective range of motions. Nerve Cluster Computer/Nerve Cluster Housing Unit All biotechs are fitted with small computers used to decode nerve signals from the nerve cluster housing unit and transform them into usable signals for the BTs various functions, primarily servos. In order to repair a nerve cluster computer, the easiest option is a simple replacement. Please note that in some rare instances, the computer may have been adjusted for the specific person. If a replacement is not available, attempt to identify which part of the computer is damaged; CPU Motherboard Power Unit Circuitry Data Storage Unit Sensory Receptors Software CPU If the CPU is damaged, there is no option but replacement as the CPU is likely too small and intricate to be repaired outside of a dedicated BT parts repair shop. Motherboard If the motherboard is damaged, there is also no option but replacement. Power Unit If the power unit is damaged, it is highly recommended to replace the unit. If a replacement is not possible and function is necessary, it -is- possible, though not recommended, to try to create a small power unit from spare parts to replace the damaged one, usually done so with assistance from an engineer or technician. These power units are made to regulate power output to various parts of the computer. Please refer to the individual parts for power requirements and ensure their needs are met and not exceeded. Circuitry If the circuitry is damaged, handing off the BT to either a dedicated BT repair shop or if necessary, a skilled engineer or technician is recommended. It is possible to re-circuit damaged parts if necessary. Data Storage Unit If a Data Storage Unit is damaged, replacement is required. Ideally, this is done with a dedicated BT data storage unit, however should one not be available, it -is- possible to download software onto a repurposed generic data storage unit, such as a solid state drive, and convert it into a functioning unit for the BT. Sensing Receptors If the receptors responsible for sensation in new-pattern BTs are damaged beyond minor scratches they should be disabled via the access hatch on the BT base plate. There, individual sectors of sensing receptors can be disabled. Due to the complex nature of the receptors, they cannot be repaired in the field and requires specialist tools to repair. Individual sectors can be taken off of the BT limb itself if engineer-level tools are available, and be replaced with functional replacements. If necessary, all sensation of touch can be disabled in the access panel on the base of the BT. Nerve Cluster Housing Unit The nerve cluster housing unit is there to hold the nerves in place, read nerve signals and transmit them to the nerve cluster computer. If this is damaged, complete replacement is required along with extensive surgery to replace and repair all nerves connected. Biotechnological Eye Replacement Surgery As happens, eyes are damaged beyond repair in the field and in accidents. To our luck, our brightest have created biotechnological eyes to fix this type of damage. However, for standard combat deployments, these eyes function with little difference from a natural eye, but with a lack of sensation. As such, a person with a BT eye will no longer feel pain or discomfort in the BT eye when exposed to bright light, even as far as flashbangs will not produce discomfort. It will still, however, overload the optic and temporarily blind the eye, as it would a normal eye. Due to rehabilitation time and power limits, BT eyes cannot perform things like night vision, thermal vision, zoom or even light emission. It would either drain the power too much and/or take too long for the brain to learn to use to be a useful addition to the standard military biotech eye. Pre-Operation For eye surgery, a sterile environment is especially important as the surgery will be dealing with a direct connection to the brain, and any foreign objects could cause severe complications and fatality in the patient. Otherwise, the same procedure as standard Pre-Op applies. Operation, Part One Part one of the operation consists of establishing the base computer on the end of the optic nerve and inserting the battery and motion recharge units. Open empty eye socket and sterilize inside Remove any unnecessary leftovers via scalpel (no natural eye muscles will be necessary, the optic nerve should not extend beyond 2 centimeters from its entry point to the brain) Insert nerve cluster housing unit into the eye and secure, begin assigning nerves from the optic nerve into the nerve cluster (this takes a very long time, sharing this step with a second senior medical person is recommended) Once nerve cluster has been assigned and confirmed, u the nerve cluster housing unit and place into the optic nerves entrance to the brain, then carefully secure with small drills into the premade screw holes, then secure with screws Attach the nerve cluster computer to the end of the nerve cluster housing unit, ensure proper fit Attach the battery pack to the side of the inside at 45 degrees clockwise or counterclockwise depending on which eye is being replaced, by means of drill and screws (battery pack should be fitted towards the outside of the head, ie if replacing patients left the eye, attach battery at 45 degrees clockwise from surgeons perspective) Attach motion recharging units to the side of the battery pack, ensure proper fit and connection Connect battery pack with a nerve cluster computer and ensure it is powered (small green LED) Operation, Part Two Part two of the operation consists of attaching the eye muscles to the nerve cluster computer and anchor points, then finally attaching the BT eye to the nerve cluster computer and the muscles to the eye. Because relearning is a lengthy process, the muscles have been made to mimic the eyes natural muscles, as such please refer to the image below the steps. Attach both lateral rectus muscles to the nerve cluster computer and their anchor points (refer to nerve cluster computers connection points, LLR and RLR (left and right lateral rectus), refer to anchor points on nerve cluster housing unit with same designations) Clamp ends of both lateral rectus muscles and keeps out of the way, muscles will be long and flaccid until powered on, allowing them to hang out of the eye socket Repeat with inferior rectus muscle Attach inferior oblique muscle, secure anchor point by drilling into the maxilla and securing with a screw Remove trochlea and replace with artificial trochlea attached to the superior oblique muscle, secure with the drill and subsequent screw Attach superior oblique muscle to nerve cluster computer and housing unit anchor points, clamp out of the way Repeat with superior rectus muscle Turn on the nerve cluster computer Insert biotech eye's connection to the nerve cluster computer Connect biotech eye to the battery and ensure it is powered Insert muscles into their anchor points, refer to anchor point labels on the biotech eye Fully insert the biotech eye, roll eye up 90 degrees and press a small button next to the inferior rectus anchor point on the eye itself, return the eye to the neutral position In ~10 seconds, muscles should come to life and keep the eye in place inside its socket Page 10 Biotech Eye Rehabilitation To train a Trooper to use their new biotech eye, task them with fairly standard eye exercises. Since single eye biotechs are most common, patients will be unable to use both eyes at once as the brain has not learned to coordinate them together yet. Place an eyepatch over the other eye while early rehabilitation exercises take place. During early stages, an eyepatch must be worn over the biotech eye while moving around to prevent confusion in the patient as they will struggle to coordinate their movements with an eye that does not yet function to their expectations. Later, eye coordination is trained and eyepatches will no longer be necessary. Single eye exercises Point to point Task a trooper with looking from one point to another while keeping their head still. A simple task that will teach their brain how much input to give on the muscles to efficiently look between points in the world. Later, ask them to look from point to point while turning their head slightly as well, this will teach the brain to be able to look to points efficiently while moving. Tracking Task a trooper with tracking objects. At first, something simple like a pen, then ask them to follow your face as you pace around. Later task them with tracking more erratic motions, such as a TV show. Finally, throw balls at them and ask them to catch it. These will teach them to effectively track objects and use the information to coordinate their body's movement. Ask them to keep their eyes on a single point while rotating their head, effectively tracking while on the move. Reading Task a trooper with reading once they're capable of some level of tracking and point to point movement. Generally, books are preferred, though subtitles are also effective. Double eye exercises Point to point Task a trooper with looking between points with both eyes, essentially the same as with single eye exercises. This time, it will teach the brain to coordinate the movement between both eyes so they do not give conflicting information. Tracking Task a trooper with similar tracking exercises as the single eye exercises, this will teach their brain to coordinate their eyes to track objects. Reading Task a trooper with reading with both eyes once some level of dual-eye tracking and point to point a movement has established. Page 11 Biotech Eye Repairs and Cleaning In order to repair components of a biotech eye, the eye itself must first removed from its socket and its anchors. To do this, relax the eye muscles by rotating the eye upwards 90 degrees and pressing the small button next to the inferior rectus muscle's anchor point. In ~10 seconds the muscles should relax, allowing the eye to come out of its socket. In the event of power failure to the eye, the muscles will automatically relax when power is cut, and no optical signal will be sent from the eye. For battery and motion recharge units, as well as nerve cluster housing and computers, same applies as in standard BTs described on page 6. Biotech Eye Repair In order to repair the eye itself, remove the eye completely from its socket and any connections and anchors to the inside of the eye. Carefully unscrew the four screws on the back of the eye and take off the piece gently, then remove all connections from the back plate of the eye to allow full removal. Once removed, access to the inside of the biotech eye is available. Most pieces inside the eye itself will require replacements in order to be functional again, with the exception of dirt within the eye. Carefully remove layer after layer of components to clean them effectively. Usually, dirt inside the eye is recognized by the eye struggling or being outright unable to refocus on objects at a certain distance (dirt preventing gears from properly rotating), or by strange mixed signals usually recognized by struggling to make sense of what the eye sees (dirt or loose connection to the optic nerve) Should it be necessary, the gears and optic itself can be replaced by non-standard equipment in emergency situations, however full functionality or safety to the wearer is not guaranteed. Before the eye is reinserted, it is highly recommended the eye is sterilized to prevent infections. Page 12 New Pattern vs Old Pattern In 2299 the Federation put a radically new pattern of BTs into standard service use. These new patterns BTs have built-in senses that help the trooper with more finely manipulating objects, particularly objects they cannot see. They also significantly reduce instances of phantom pain in lost limbs once the BT has been attached. Observation also indicates that instances of phantom pain are also lighter and disappear sooner in patients with new pattern BTs. The primary reason why Federal Research laboratories have focused on this particular upgrade to BTs is that, particularly with hands, it is difficult to know the 'when's and 'how's of objects you're manipulating. Such as being able to feel if the object is slipping from the grasp, or if you've even grabbed an object you're not looking at. With these sensory upgrades, Troopers will now be able to feel if they've properly grasped a magazine in their pouch without having to look down at what they're doing, or be able to manipulate objects that they cannot see. The Differences New pattern BTs have basic sensations of touch built into them. Pressure, texture, temperature. New pattern BTs have significantly reduced instances and severity of phantom pain. New pattern BTs require a new pattern of BT Baseplate that has expanded functionality. New pattern BTs have minor reliability upgrades in the nerve computer. Interchangeability By default, parts do not interchange between new and old pattern BTs. In surgery, the BT Base plate used for new pattern BTs is an updated, upgraded version which allows for two-way information flow, being able to both receive nerve signals from the brain and send nerve signals back to indicate sensation. As such, using an old-pattern base plate for a new pattern BT would mean the complete loss of sensation and would effectively turn the BT into an old pattern. Using a new pattern base plate for an old pattern BT is ill-advised without an adapter attached, as rogue signals may be sent up to the brain that could significantly disturb the wearer. The attachment points between new and old pattern are different by design, so one cannot accidentally attach an old pattern forearm to a new pattern BT base. Internally some parts may be interchangeable, particularly gears, motors, batteries and recharge units, and similar mechanical parts. Moving from Old to New In order to update a patient's BT from an old pattern BT to a new pattern BT, surgery is required to completely rework the entire BT base. The old BT base must be removed, meaning nerves must be unassigned from the nerve center and the base plate unscrewed, then replaced with a new pattern base plate with nerves reassigned into the more complex nerve center fitted to new pattern base plates. New BT bases only accept new BT limbs. Some experimental adapters have been developed to allow old BT limbs to fit onto new bases, requiring only some adjustment to the old BT's length settings. Edited May 31, 2019 by SgtMcMuffin Added procedures for new biotechs Link to comment
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