medical simulator

Page 441

It is theoretically possible to build a high-rise building that goes directly into space, tile the Great Wall, and fill the sea with sand, but the amount of work is huge and requires meticulous micro-operations.

When Zhou Cheng spoke, the hand of the hospital chief standing directly opposite Zhou Cheng shook.He was really frightened by Zhou Cheng's thoughts.

The eyeballs protruded a little, and he sniffed inexplicably, then immediately came back to his senses, clenched his hands, and looked carefully at the surgical field, for fear that his unnecessary activities just now caused irreversible damage.

Fortunately, Li Xuande is a person who has experienced many battles and has seen many worlds, so he turned his head to look at the hospital chief, and asked, "Xiaofu, have you talked about this?"

The name of the general inpatient is Fu Qiangxue, and his Adam's apple rolled up and down twice with the movement of swallowing: "I didn't talk about it specifically, but I told my family members that it is not ruled out that I will take bone from the healthy side for bone grafting. And taking tendons for tendon transplantation."

"I can go out and talk again if need be."

This is a surgical method that Fu Qiangxue can't even imagine. How can he predict things like a god?

The operation that Zhou Cheng proposes now is an impossible operation within the theory, outside of the operation. Is he a god?can be expected.

"Then go out and say something later!"

"Xiao Zhou, let's make a muscle first, to test the possibility and operability. Where is it more appropriate to start with this one?" Li Xuande immediately made another decision.

He is a professor-level doctor. When the patient was sent, he had no immediate family members, and his condition was urgent. Therefore, it was the chief on duty who ordered the immediate operation.When encountering an operation that is difficult to handle, he has a certain degree of cutting first and then playing the right.

Otherwise, what should the patient's family members do if they don't show up?Naturally, if you don't go out to talk at this time, you still don't want to give too much expectation to the patient's family, so as not to be even more disappointed when it happens.Mood swings are severe.

Zhou Cheng understood Professor Li Xuande's meaning, this kind of thing can be done as soon as it can be done, and can't be dragged down.

Since you have such an idea, let's try it first. If it can be established, then go to talk to the family members. If it can't be done, amputate directly from the thigh to save your life!

Zhou Cheng said without hesitation: "Professor Li, how about this? The patient's impact force should be from the front, so the nourishing blood vessels in the rear biceps femoris may still be relatively complete."

"Let's take one of the inside and try it out for rebuilding."

Take the affected side first to test the feasibility of the operation, and take the ones below the range of amputation, which will not cause unnecessary wounds to the patient.Naturally, Zhou Cheng would not make things difficult for Li Xuande.

"This is the best." Li Xuande took a deep breath.

If the leg was not saved, and the healthy side was cut, it is not so easy to explain to the family members of the patient. Although it can also be explained, it is for the sake of limb preservation, but it can be avoided and avoided as much as possible.

The patient's injury was destructive, and the quadriceps was almost rotten. This was after being rested, so the biceps femoris at the back of the femur was naturally exposed.

It was cut by the fracture fragments of the femur, but it has not been sutured yet.Because the blood vessels in the upper segment were clamped, there was not much bleeding, but there was also a small amount of collateral circulation bleeding out.

After Zhou Cheng found one of the biceps femoris, he was not in a hurry to take blood vessels. Instead, he carefully sorted out and recalled the anatomy, especially the pioneering anatomical theory, and then took a deep breath. tone.

Said: "Give me the sharp knife."

Zhou Cheng entered the state, concentrating on it, and didn't pay special attention to calling these. He had to put all his energy on his hands and the arrangement of the operation.

No one cared that Zhou Cheng didn't have a title in his order. Professor Li Xuande personally handed the handle of the sharp knife to Zhou Cheng. Zhou Cheng held it, and then carefully moved it from the broken end so that the tip of the knife faced upwards.

He needs to find the completed nutrient artery first, and the nutrient artery is very thin, and the tip of the knife is easy to hurt. At this time, controlling every variable factor will increase the success rate, although there are not many operations.

However, if it accumulates, the improvement obtained will be very impressive.

It didn't take Zhou Cheng too long. He found the trophoblast artery in about 1 minute. Professor Li Xuande knew that such a trophoblast artery existed, but he usually looked for it based on the shape of the artery, from the large artery to the small artery. I found it this way.

Like Zhou Cheng, he has never challenged the method of directly picking apart the muscles.

Therefore, I also feel quite shocked. I feel that if the operation has reached the fine level, it will be able to achieve such a surprising and scalp-numbing form.

It must not be cut open with a single knife. Zhou Cheng carefully exposed the nourishing blood vessels that are slightly smaller than the diameter of wool, and did not dare to clamp them directly with blood vessel forceps. Instead, he cut a sterile glove to cover it. Then it was handed over to the chief inpatient.

Fu Qiangxue carefully pinched the two ends of the rubber band, not daring to use any force. He was afraid that even his mother would be overturned if he was not careful about this fragile blood vessel...

Blood vessels are actually very fragile.

Zhou Cheng then carefully followed the route of the blood vessels with a sharp knife and continued to walk inside.This is not called walking, but walking.

The nourishing blood vessels are not as clear as the large blood vessels, and the small branch-like blood vessels that are almost invisible to the naked eye are crawling around the lumen of the blood vessels, which can be easily broken.

However, Zhou Cheng's knife always avoids them carefully.

No one dared to speak, even Professor Li Xuande's eyes were extremely focused at the moment, holding his breath secretly, one was worried about Zhou Cheng, and the other was secretly wondering why Zhou Cheng did this?

Continue to explore, probably after reaching a certain length, Zhou Cheng's opening is about six centimeters in length.

This time, Zhou Cheng chose to clamp the proximal blood vessel, and then, Zhou Cheng did not cut it with a sharp knife, but chose to continue to slowly peel off the branches of the nutrient vessel layer.

When Zhou Cheng performed this operation, even the person who had just watched Li Xuande, who Zhou Cheng was looking for to nourish the arteries, still felt his scalp numb.

If dancing on a sharp knife is an art, then Zhou Cheng's process of finding the branch that nourishes the artery with a sharp knife is also an art.

It seemed that they were a little worried, unbelievable, worried about Zhou Cheng's operation.

But Zhou Cheng's hand was like a stone fixed in the air, it was very stable, there was no shaking up and down, it just followed the shape of the branches very carefully.

About two centimeters in, Zhou Chengcai cut off the branch with a sharp knife.

Well, such a small blood vessel can be cut directly without affecting it at all. You can cut it casually, and you don’t need to stop the bleeding.

One, two, everyone gradually got used to it...

You know it in your mind, but the hand that is about to move is asking what you are thinking.

After more than ten minutes passed, Zhou Chengcai carefully opened such a nourishing artery, and the branches were all there, and the shape was relatively complete.

Afterwards, Zhou Cheng moved the "blood vessel that I don't know where to find" to the previous muscle bed, just when Professor Li Xuande was about to ask, what Zhou Cheng would do next.

Impressively, Zhou Cheng sent a silk thread over with tweezers with extremely fine tips for some reason. After sending it over, Zhou Cheng used a fine needle to sew a stitch on the blood vessel, only passing it through, without tying a knot.

How did it just happen?

Everyone didn't see clearly.

Then, I saw that Zhou Cheng pinched the two ends of the thread with both hands to prevent the thread from being knotted or tangled, and one of his hands gently pulled it hard.

In an instant, the nourishing blood vessel with branches got into the hole, and Zhou Cheng's choice is just right, the end of the thread he pulls has a relatively large lumen, which is like smoothing the hair. The blood vessels were all stuffed into the cavity of the original nourishing artery taken by Zhou Cheng.

After doing this, Zhou Cheng carefully tied up the other end of the nutrient artery he just took with a thread, and left the thread outside for later pulling.

"Huh!~" Zhou Cheng breathed a sigh of relief after concentrating on doing these things.

Said: "Professor Li, I will suture this nutrient artery to the blood vessel next. If it is unobstructed, then the blood vessel reconstruction of this muscle is basically done."

Li Xuande was stunned. Zhou Cheng seemed to say it casually, but in fact, it was almost impossible to repeat it. His skills have not yet reached such a level: "Aren't the branches stitched?"

Zhou Cheng shook his head: "It's not necessary. The arterial blood flow that nourishes the artery has a very small lumen, and the blood volume is actually quite limited. Moreover, even the blood leaking from the branches is mostly distributed in the muscle layer."

"The rich tissue in the blood will promote the reconstruction of blood vessels. After a certain degree of blood reaches the muscle tissue, a blood clot will be formed to a certain extent. The blood clot will form a thrombus, which will block the branches of blood vessels."

"Furthermore, the diameter of the thrombus is quite small, so even if it refluxes into the blood circulation, the reaction caused is quite limited. We routinely use half-dose anticoagulation after surgery, so we don't have to worry about it at all."

"And, after the blood flows, the tissue has a certain blood supply. After the blood supply, a new collateral circulation or capillary network will be formed. The capillary network established by the muscle tissue will be more suitable for itself."

"And, because the initial blood supply and communication between the muscles are not great, this is equivalent to delaying the duration of the re-irrigation injury to a certain extent. We all know that the re-irrigation injury is actually the breakdown product in the necrotic muscle tissue. Metabolic limits are exceeded."

"us……"

What the hell!

Zhou Cheng is really amazing. His operation is not a temporary idea. Moreover, the theories he mentioned are actually common theories in internal medicine and surgery. It is just that they have been disassembled in detail. The theory can basically be considered. Yes, it's all considered.

After explaining, Zhou Chengcheng began to sew up the proximal end. The suturing of the proximal end can be relatively casual, so Zhou Chengcheng chose an artery that nourishes the muscles relatively well, cut it off, and grafted the blood supply over it.

After suturing in this way, the muscle bed is still not fully secured, but it is still necessary to see if it is connected at the bottom.

If there is no way, let go of the large blood vessels.

However, when it is released, the more distal end of the small artery from the nutrient artery has to be clamped to avoid serious bleeding.

After all the preparations were made, Professor Li Xuande and others basically ignored Zhou Cheng's fast suturing of blood vessels, but felt that such an operation was a trivial matter for Zhou Cheng.

Even if it looks hard.

But when people's knowledge grows, they will see the strangeness and say, "I let go of the proximal vascular clamp."

"En! It's hard work." Zhou Cheng nodded slowly, calmed down a little, and began to rest slowly.

It is a must for the surgeon to take advantage of every opportunity to rest his mind, otherwise, he will die suddenly and exhausted.

Li Xuande slowly let go of the vascular clamp, and the blood vessels immediately filled up.

However, because it is the nourishing artery, it took more than ten seconds for the blood to slowly seep out from the other side of the nourishing artery.

The amount is very small, and the blood is very red.

The surgeon was very happy to see the blood.

"That's it?" Li Xuande's expression brightened.ask.

Zhou Cheng nodded: "Although we haven't sealed off the broken ends of the branches of the nutrient vessel layer, the blood flow from the broken ends of the nutrient artery will naturally be distributed to the polished muscle bed through the internal channels."

"Therefore, to a certain extent, it will ensure that some muscle cells will not undergo necrosis. Part of the necrotic muscle tissue will be decomposed by phagocytes arriving in the blood, and will instead become nutrients for active cells."

Hearing this, Fu Qiangxue, the chief inpatient, couldn't help but interrupted: "Theoretical system for enhancing the activity of tumors? The physiological characteristics of fibroblasts?"

Fu Qiangxue, as the chief resident of the new star, naturally read a lot of literature, and as the most popular article on tumor theory in orthopedics, he naturally had to read a lot, so that he could get the topic more easily.

Zhou Cheng nodded: "Teacher Fu is right, but I think it's not just limited to tumors and fibroblasts, muscle cells can also have such a drive."

This is the content of pathophysiology. It is really shocking that Zhou Cheng took the theory to this step all of a sudden.

The knowledge is extensive and thorough, and the operation is so delicate that it is appalling. What else is there to say?It proves that Zhou Cheng's knowledge reserve and knowledge pool have really reached a certain level.

To convince the knowledgeable people, layman's theories and simple folk science theories are not enough.

Li Xuande took a deep breath, and then said: "Xiao Fu, go outside and talk to the patient's family."

"Xiao Zhou, shall we continue or should you take a break?"

Don't look at Zhou Cheng's operation just now, it is not a drastic move, but in fact it is a slow operation, a surprise operation, which is very labor-intensive and exhausting.

But what Li Xuande didn't know was that Zhou Cheng was actually very mature, so he was used to it, so it was a good thing, he hadn't used a knife like this for a long time.

When performing fracture surgery and joint surgery, there is no need to pay attention to so many details.

The operation then continued quickly...

With the previous experiment, and it was a successful experiment, so in the middle of the operation, we disinfected the healthy side and re-draped.

Then, Li Xuande discovered that when Zhou Cheng took the nourishing blood vessels from the tendon side, it was smoother than taking the nourishing arteries from the affected side, because on the surface, it saved at least a full third of the time.

Perhaps seeing the stunned gazes of Li Xuande and the associate professor beside him, Zhou Chengcheng explained: "The quadriceps is the muscle that I have been in contact with a lot, and it belongs to the surface layer and is on the healthy side, so there is not much burden when taking it."

Definitely yes, the muscles on the healthy side are all good, it’s nothing to take some nourishing arteries, it’s okay to cut all the muscles, naturally there is no psychological burden.

Li Xuande fell silent.

The associate professor next to him smiled slightly and said, "Mr. Zhou, no wonder Professor Liu Zhibin and Director Li insisted on inviting you."

"It really opened our eyes. What if every injured patient could meet a doctor like you, Xiao Zhou?"

Speaking of this, he shook his head again: "That's because too many people's luck is too good."

Zhou Cheng didn't take this kind of bragging to heart: "Teacher, you are too good-for-nothing."

Associate Professor Xie Fan hurriedly introduced himself: "My surname is Xie, which is the same as Jie for Answer. Read xie!"

Zhou Cheng didn't return, he continued to sink into the operation...

After Fu Qiangxue came back from the conversation, he also brought back a new informed consent form for surgical risks.After putting it in the medical record book, he washed his hands again before coming to the stage, and stood opposite Zhou Cheng seriously, watching the operation field carefully.

Time goes by slowly...

It was past six o'clock, and Zhou Chengcai finished rebuilding the arteries of more than a dozen muscles.

After this, Zhou Cheng himself felt that his hands were a little sore, and when he stepped off the stage, his steps were a little wobbly.

Li Xuande, who stepped off the stage with him, hurriedly stepped forward, put his shoulder against Zhou Cheng's back, and asked with flickering eyes, "Xiao Zhou, would you like a bottle of sugar water?"

At the same time, he began to wink at the anesthesiologist. The high-intensity operation, which lasted three hours without any slack and interruption, even steel must be soft.

"No, thank you, Professor Li. I'll just go out and cook a bowl of noodles later." Zhou Cheng replied.

Li Xuande didn't understand Zhou Cheng's meaning for a while, and after a while, he said: "Yes, I forgot that you are from Hunan Province, Xiao Zhou. Rice noodles are more popular in Shashi, but I don't know where you can find them in Shanghai. Authentic rice noodles."

"Round noodles are quite rare, but there are a lot of pasta, let's go out and eat some."

Zhou Cheng didn't pretend to be polite either. He needed to eat very much at this moment. At this point, after being tired for half the night, he was already hungry.

Li Xuande didn't bring Zhou Cheng to meet the family members, he just brought such good news to the family members at the door, and he could see that a couple who seemed to be from a fairly good family at the door almost knelt down.

I would like to thank Li Xuande a thousand times, but fortunately, Li Xuande had quick eyesight and quick hands, and helped them up.Said: "We should do our best, we still have to see the recovery situation later, and this is the first operation, and there are still many tough battles to fight."

However, even though Li Xuande said so, they already knew that their son's legs were so rotten that it was unimaginable before. It was beyond their thinking to keep such legs.

In fact, the same is true.

Li Xuande didn't stay long, just walked in, met Zhou Cheng again, and said, "Xiao Zhou, I didn't take you out to meet the family just now, and I listened to their thank you words, you don't blame me, do you?"