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Werewolves exist in organised societies hidden from humanity at large and over the course of their history they had certain lycanthropy-related problems to overcome. While their condition comes with perks, it also has downsides. In particular in terms of medicine, werewolves are immune to most diseases and poisons and they have a very high healing factor - that is to say their wounds and injuries heal very rapidly. Sounds awesome at first, but it comes with its own set of problems.

Healing factor

Werewolf healing has its limitations. The following mostly pertains to their human form, as in beast form their healing factor goes into overdrive but the same principles remain.

As far as speed of healing is concerned, it depends on the size of the wound as well as general condition of the werewolf. For example, a gunshot wound will take a few minutes to heal, but having multiple gunshot wounds will slow this process down (healing will be spread equally, a second injury will slow down the healing of the first injury and so forth)

Additionally there are limitations to what can be healed. For example:

  • A severed limb will not regrow, but the wound itself will close.
  • A bullet wound will heal but the bullet - if stuck inside - will remain inside rather than be pushed out.
  • A broken bone will mend, but if dislocated, it will not be pulled into its correct position on its own

What this means is that despite the awesome healing potential, there are still situations when doctors and surgery are needed - for example an othopedic surgery to break improperly healed bones and set them back into place or a surgery to remove bullet or shrapnel from inside the body.

And this is where my problem lies.

How to operate on a rapidly-healing werewolf?

Any incision made during the surgery will quite literally start to heal before the surgeon's eyes. Unless the entire surgery lasts no more than a few minutes, that's a problem. Additionally, the side effect of being immune to poisons also renders werewolves virtually immune to anesthesia and sedation, which means surgery will need to be done on a conscious and feeling patient. As pain is transformation-inducing, this also means operating is only possible in daytime, so any multi-hour surgeries become an even greater problem.

With some additional assumptions:

  • Modern medicine (2010s-2020s)
  • Surgery will be performed by a trained team of medical proffessionals who are aware they're operating on a werewolf

The question is: How to perform surgery on a rapidly healing werewolf with greatest chance of success and minimal harm/discomfort* to the patient?

*I'm not expecting the patient to be comfortable during a no-anesthesia orthopedic surgery, all I'm saying is "no needless torture". Emphasis on needless.

If any data is missing let me know in the comments and I'll do my best to provide missing information.

Info added in response to comments:

Can werewolves heal from nerve damage? - For the most part yes. If the nerve is severed or torn then yes. If the nerve is severed and then a large portion of it is removed from the body then it's a bit more tricky and full recovery may not be possible depending on how much of original tissue is missing.

How is the werewolf regeneration spread out? - There is indeed a "healing per time budget", which is spread equally among all the wounds. There is no mechanism for prioritisation, all wounds heal simultaneously, but the more wounds there are, the slower the process is. There comes a point where the werewolf would be wounded enough that the healing process can't keep up with blood loss, which could be called the leading cause of werewolf mortality.

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    $\begingroup$ Can werewolves heal from nerve damage? $\endgroup$
    – Halfthawed
    Commented Jul 26, 2022 at 12:35
  • $\begingroup$ @Halfthawed Added response to the question. For the most part yes, they can. $\endgroup$
    – JANXOL
    Commented Jul 26, 2022 at 12:56
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    $\begingroup$ Don't discount that most surgeries would not need to take as long as they do these days, since the patient can heal. Removing a bullet: apple corer. Badly healed bones: Crush the broken part from the outside and reset in a cast. Human surgery is very delicate because we won't heal if the surgeon behaves like john the ripper - but a werewolf would. Modern medicine would use the werewolf's own healing powers, so they don't have to 'make incisions' - they would only have to 'get in there with the cleaver' - much faster. Do you have any examples of longer lasting surgery a werewolf may need? $\endgroup$
    – user97385
    Commented Jul 26, 2022 at 13:06
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    $\begingroup$ As much as removing a bullet with apple corer amuses me, I'm not entirely convinced it would work. Bullets tend to fragment inside the body, some types more than others. Finding and getting out all the pieces of shrapnel, especially when the patient was shot with buckshot, for example, is not a fast task even if you hack and saw at it. It may be embedded in a bone as well and leaving it inside a werewolf poses a problem as it will move around every time when they transform. $\endgroup$
    – JANXOL
    Commented Jul 26, 2022 at 13:48
  • $\begingroup$ How is the werewolf regeneration spread out? Is it evenly distributed, for example if they are currently healing a major torso wound, would a broken toe heal at the same time or does the werewolf have a limited "healing per unit time budget" that is somehow automatically distributed to the most serious injuries first? If this is the case, it would be possible to deliberately "injure" the werewolf in such a way that all of their regeneration budget is spent trying to fix something that can't be fixed while the surgeons operate somewhere else $\endgroup$
    – Dragongeek
    Commented Jul 27, 2022 at 17:28

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Not all anesthetic options are poisons. You can induce a loss of consciousness by restricting blood flow to the brain, by restricting oxygen in their available atmosphere or replacing the oxygen with something else. Nitrous Oxide has been used as a dental anesthetic for centuries (since 1793 in fact), induces numbness throughout the body and a sense of euphoria. Unless your weres have a radically different neural biochemistry than humans, nitrous will at the very least reduce the discomfort. In higher concentrations it can cause loss of consciousness, and brain damage or death can occur if there isn't sufficient oxygen in the mix... so make sure it's carefully administered.

For spot anesthesia I recommend a return to the classics: ice. When you chill flesh the capillaries contract, restricting blood flow to the area and incidentally starving the sensory nerves. That's why you can't feel things very well with cold fingers. Go too far or leave it too long however and the lack of oxygen to the tissues results in tissue death, so this one is for short operations only. We're not trying to kill the patient with localized frost-bite after all.

Now that we have the patient sufficiently docile and numbed up, let's look at the surgical problems of the healing factor.

In modern surgical procedures - at least the ones that aren't done through keyhole surgery - it's standard procedure to hold the surgical wound open with the use of retractors. Here are some examples (via Google Images):

Surgical Retractors

(Trust me, this is a rabbit hole filled with torture instruments. Investigate at your own risk.)

Retractors keep the surgical wound open so that you can muck around inside without having to constantly fight the skin's natural tendency to close up. The same principle can be applied to a regenerating body with a few minor modifications.

Let's use wider more solid contact surfaces. Instead of those little loops and pins, let's put big plates on there so that the flesh doesn't just grow around the retractor. For classical werewolves we may be able to use an alloy with a tiny bit of silver in it, just enough to inhibit the regeneration without causing the flesh to burst into flame or something. We're trying to save their lives, not slay them.

Once the wound has been open for long enough, the body will heal the cut surfaces and start grown skin over it just like an amputation. That's a good thing for our purposes since the new skin will help protect the incision site. At that point we can remove the barriers and use our normal retractors to keep the healed surfaces spread open, but most of the bleeding will have stopped. Our support team can then focus less on wound management (suction and gauze application to clear blood and other fluids from the surgical site) and more on trimming regrowth from the site itself. Your support team will need special training in managing regeneration during surgery, so it'll need a couple of specialists for this part.

Once you're done with the surgery the normal closing stage, with sutures and so on, is replaced with a quick removal of the new skin in the incision. The edges of the incision can then be positioned and immobilized to allow them to heal properly.

On the upside, surgery on a werewolf is a sprint, not a marathon. Extreme regenerative abilities means you can skip over a whole bunch of the things that you have to do to keep a strictly human patient alive. After all werewolves can live through some pretty crazy stuff. You don't have to be slow and gentle with these guys, just get in there and get the job done as quick as possible so that they can be shipped off to recovery. Just about any surgery is day surgery when you heal like they do.

Depending on how the were transformation works, and what effects it has on existing wounds, it might be best if you can induce a transformation shortly after surgery. Some stories about weres have them healing non-critical wounds during their transformations, either to or from were form, maybe both. Hospitals dealing with lots of werewolf surgery might have recovery rooms that simulate moonlight or channel stored moonlight or something to facilitate brief changes. You decide what works for you here.


As fun - and occasionally nauseating - as it is to speculate about how actually you'd do this, it's sometimes just as if not more interesting to speculate on how the various techniques were developed. Does your world have a history of brutal experimentation done on werewolf prisoners? Was some version of Josef Mengele cutting open Jewish werewolves (is that even a thing?) at Auschwitz? And he's just the best known (and most reviled) example that comes to mind. On the other hand, was there some version of Joseph Lister discovering a regeneration-inhibiting formula to enable proper surgery for werewolves? Did William Morton go on to find a substitue for ether that worked for weres?

So much back story, so little time.

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Victorian style: fast!

Before anaesthesia, speed was of the essence. In creatures immune to anaesthesia fast surgery is still welcome. For your fast healing werewolves speed serves double duty - it gets the surgery done before the wound can close.

https://www.bbc.com/future/article/20200624-how-agonising-surgery-paved-the-way-for-anaesthetics

From first cut to severed limb dropping into a box of bloodied sawdust, surgeon Robert Liston could remove a leg in 25 seconds. His operations at University College Hospital in central London in the early 1840s were notorious for their speed, intensity and success. The chance of dying from a Liston amputation was around one in six – much better than the average Victorian surgeon.

The speed of the procedure had its advantages. With no pain-relief available, it shortened the almost unimaginably horrific trauma of surgery. The screaming patient would typically be held down on a wooden bench by "dressers", who would also assist with ligatures, knives and dressings.

Fellow werewolves will serve as dressers. They are at less risk from getting nicked or cut by fast flying knives because they are werewolves.

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    $\begingroup$ Of course, there's also this story about Liston: "His most famous (and possibly apocryphal) mishap was the operation where he was moving so fast that he took off a surgical assistant's fingers as he cut through a leg and, while switching instruments, slashed a spectator's coat. The patient and the assistant both died from infections of their wounds, and the spectator was so scared that he'd been stabbed that he died of shock. The fiasco is said to be the only known surgery in history with a 300 percent mortality rate." From The Atlantic, "time me gentleman" $\endgroup$ Commented Jul 27, 2022 at 13:24
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The Wound-Healing Process

Phases of normal wound-healing Process

  • Hemostasis
  • Inflammation
  • Proliferation
  • Remodeling

Slowing the wound healing process

Following factors slow the wound healing process:

  • Skin Moisture: In order for wounds to heal properly, they need a certain degree of moisture and fluid. Dry wounds can cause lesions, are more susceptible to infection, and causes elongated healing times.
  • Chronic Conditions: People with cardiovascular conditions or diabetes are at the highest risk of slow wound healing.
  • Tissue hypoxia: If there is a limited supply of oxygen to the wound, it prevents the production of collagen, causing slow wound healing.
  • Medication: Anti-inflammatory drugs as aspirin and ibuprofen, can interfere with the inflammation stage of the healing process. Anticoagulants have the capacity to disrupt blood clotting, while immunosuppressants may weaken the immune system and enhance the risk of infection.

Conclusion

Inject some anti-inflammatory or anticoagulant or any special drug which will slow down the healing process by limiting the supply of oxygen to the wound or preventing the production of collagen. Make sure that the effect of the drug will go away after the operation is over.

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Freeze them first. Inject with a natural antifreeze chemical, Glycerol for instance. Thaw the local regen to be operated on and cut away!

Sever spinal cord induce paralysis. Repeat for duration necessary. Alternatively severing major nerve branches, Cervical nerves, Thoracic, Lumbar, Sacral, or coccygeal nerves, for the duration of the surgery.

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Silver

Use a silver scalpel. They won't be regenerating that cut so fast.

As for anesthesia, lace it with silver too. There are plenty of medicines made with it, it is mostly non-toxic. Since it won't be making any wounds but rather keep the healing factor it bay it shouldn't be (too much) lethal. Might help opening up the patient too.

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    $\begingroup$ 1. Are the werewolves vulnerable to silver? Or not regenerating from it? The question doesn't state this. It's common werewolf mythos but by no means should be universal. Especially considering it wasn't even originally part of it - silver works against witches. It's part of witch lore. It made itself into werewolf lore later. So, it is perfectly plausible to not include silver as a problem for werewolves 2. Even if werewolves are vulnerable, the exact effects still need to be clarified. In some cases, silver only produces "normal" wounds - the same as what a regular human would suffer. $\endgroup$
    – VLAZ
    Commented Jul 27, 2022 at 10:06
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    $\begingroup$ But werewolves don't recover from them in mere moments - they recover as a normal human does. It seems that's what you envision. Yet, there are many other takes on what silver does. It might burn werewolves, cause extreme pain, or be a toxic to them. Imagine doing surgery on a human using radioactive tools. I don't think it's advisable. $\endgroup$
    – VLAZ
    Commented Jul 27, 2022 at 10:06
  • $\begingroup$ @VLAZ "Imagine doing surgery on a human using radioactive tools" We do that to treat cancer.. Also: "But werewolves don't recover from them in mere moments - they recover as a normal human does" The question says they can heal from a gunshot in minutes. That's superhuman. $\endgroup$ Commented Jul 27, 2022 at 14:32
  • $\begingroup$ The statement about healing as human was related to injuries from silver. The two comments I have are a continuation of each other. $\endgroup$
    – VLAZ
    Commented Jul 27, 2022 at 15:30
  • $\begingroup$ As for radioactivity - would you be OK with a doctor jamming a radium scalpel in you? Or injecting you with it? Again, the statement is in relation to how some depictions of werewolves treat silver. I hoped it was very clear in the context suggesting silver for surgery which I followed up with explaining that it can be literally toxic to a werewolf (depending on how they are portrayed) and thus the analogy of "surgery" would draw parallels to that. Not that radiation therapy is pleasant and has no bad effects. But it wasn't what I was alluding to. $\endgroup$
    – VLAZ
    Commented Jul 27, 2022 at 15:35
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Cut the spinal cord and new medicine

Leas amount of discomfort is actually easy. All we have to do is cut it! It isn't easy to cut it, but my guess is that a werewolf community will eventually invent easy ways and tools to sever the spinal cord and keep it severed. Either by blocking or keep severing it.

The advantage? No pain or discomfort past the point of incision. With special tools like laparoscopy and the right area you can make the point of intrusion to cut the spinal cord as comfortable as possible.

new surgery

Although the above gives you time to work you still can use new medicine to make it easy. As mentioned we can use laparoscopy. It is basically a flexible tube that can be moved through the body. Often blood vessels are used to move from an easily accessible area, like blood vessels in the leg, to difficult to reach areas. As the tube is like a bullet the flesh can't throw it out. This way we can get to bullets if we want.

speed

On the other hand, do we need special tools? The patient doesn't feel it anyway. Cut them open quickly, remove the bullet and get out. Break bones and set them. Maybe even remove a whole bone if this grows back. With high speed you have little problem of things growing back before you've accomplished your task. It is also most comfortable for the patient. A quick rend of flesh when they don't feel it. It'll heal in a few minutes and you're done.

More complex situations need more time, but the body willl give it by adding more damage. This way we can keep someone from feeling pain below a certain point while doing all the required surgery and having nothing close on us prematurely.

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