After discussion, the patient's daughter and son-in-law agreed to the operation.

But the patient refused the operation, clamored to go home, quarreled with his daughter in the hospital room, and threw the stainless steel cup for drinking water on the ground.

Although my daughter can't help but lose her temper occasionally, only occasionally, the backlog of negative emotions always has an outlet for catharsis.

The usual complaints are just emotional venting, and there are five old people in the family, and the pressure is so great that they are almost out of breath.

In any case, she took care of her father cleanly, helped him shave and wipe his body every day, and washed his hair every few days.

The daughter is a small padded jacket, which is the best embodiment at this time.

The daughter is like coaxing a child, patiently explaining to her father that she must cooperate with the doctor's treatment, so that the recovery is fast and the cost is less, if you give up the operation, go back like this, the infection will spread to the whole body in the future, causing sepsis, and then you will have to stay in the ICU, and the cost is dozens of times that of now, and it will not cost money at this time, and it will cost a lot of money in the future, and some things cannot be avoided.

The patient shouted that he would not have surgery, and that he wanted to go home and give up the treatment, because he was unwilling to spend his daughter's money again, and if this operation failed, he would be a bottomless pit and would put a heavy financial burden on his daughter.

No one wants to live away from their families with foul-smelling wounds.

Even his grandson treats him as a monster and doesn't want to get close, so he can only curl up in bed in the rental house every day, and his wife has to take care of him.

In this hospitalization, the daughter was afraid that her mother would be overworked, so she refused her mother to go to the hospital to take care of her father, and asked her to take care of the child at home, and take care of her father herself.

After the persuasion of the daughter, if she continues to be stubborn, it will only add trouble to the child, and the patient agrees to the operation.

As for amputation, the patient was not much surprised, let alone unacceptable, as long as he could say goodbye to this bad life, the amputation was nothing.

If he could really use a prosthetic leg to return to his normal life, he longed to be able to share some household chores for his daughter, such as helping with groceries and taking care of the children.

Those who have lost will cherish it more, and those who have experienced illness will know how important health is.

There is no difficulty in this operation.

The test is seriousness, the pursuit of perfection in every detail, in order to strive for the greatest success rate.

Uric acid crystals have a wide range of effects on the body, and they do not only affect the joints, but joint pain is only the mildest manifestation.

Uric acid crystals can also affect blood vessels, which can lead to hardening of blood vessels and cause problems in vital organs such as the heart, kidneys, and brain.

Before the operation, Yang Ping repeatedly studied the blood vascularization of the bilateral lower body, and the destruction of blood vessels by uric acid crystals led to the hardening of the arteries of the lower limbs, and some arteries were narrowed, and finally determined that the amputation plane was on the knee.

Because the blood circulation of the lower leg is already very poor, there are huge gout nodules in the bilateral knee joints, the knee joint has been seriously damaged, and there are serious impairments in function.

Many times, surgeons are prone to fantasies about the good ending, which can make doctors more conservative in their decisions.

For example, when trauma orthopedic surgeons treat some retrograde skin avulsions, inexperienced doctors see that the flaps are intact and always fantasize that they can survive, so they like to suture in situ, but it backfires, and the flaps that lose blood vessels will slowly die, and the patient will finally need a second surgery for skin grafting.

The experienced doctor never had illusions, and decisively performed anti-skin grafting treatment on the flap, which was successful in one operation, avoiding the patient's second operation, and avoiding taking skin from other parts of the body.

The same is true for this patient, the doctor is prone to the illusion that the plane is lower, and the knee joint is preserved, but the reality will always exceed the doctor's expectations.

Judging from the state of the blood vessels, Yang Ping felt that he should be more active, give up his illusions, and make a bold move to amputate the entire calf that looked fine from his knee.

Yang Ping also carefully evaluated more than 40 gout nodules all over the body, and finally, he decided to remove them all.

When the amputation was done, Yang Ping did not inflate the tourniquet, and the tourniquet was just a backup.

Because during the operation, Yang Ping has to observe the real blood vascularity of the limbs, his scalpel cuts through the skin, subcutaneous, deep fascia, and muscles, and he observes the oozing blood of each layer of tissue section, which is the most reliable way to judge blood vascularity, which is more reliable than any vascular imaging examination before surgery.

He tried to make an incision in the lower calf to test his judgment, hoping that he had misjudged and that the skin was bleeding significantly.

However, in the absence of a tourniquet, there is almost no significant bleeding from the skin, fascia, or muscle, and there is a large amount of pus in the intermuscular space, which spreads from the ankle joint.

The preoperative judgment was correct, and the limb had to be amputated from the knee.

Yang Ping closed the incised calf with a sterile medical membrane, replaced gloves and scalpel, re-cut the skin on the knee and lower thigh, and the scalpel was formed, and the standard tongue-shaped flap was formed.

Bright red blood began to ooze from the edges of the flap, and Yang Ping was not in a hurry to stop the bleeding, this was the effect he was hoping for.

"The blood circulation of the skin is better, and the bleeding is more obvious." Song Zimo's tissue forceps clamped the subcutaneous tissue and gently lifted the flap.

Yang Ping's active and bold amputation plane judgment is very accurate.

"The amputation plane selection is suitable." Yang Ping was relieved at this time.

At this point, bleeding is the hope for a successful operation, and the faster and more bleeding there is, the greater the hope.

The scalpel proceeds to cut through the deep fascia, severing the muscles that surround the femur, the blood vessels are cut and ligated, the nerves are cut by a high sharp knife, and finally the femur in the center is reached.

The femur was severed by a chainsaw, and the thigh was severed from the knee, leaving the patient's body and becoming a free, independent object that no longer belonged to the patient.

The detached limb was removed from the operating table and put into a transparent plastic bag, which Zhou Can put away, and was sent to the pathology department after surgery, and any tissue or organ removed by the human body must be subjected to pathological examination in principle.

After the stump completes the pathological examination, the final destination is to send it to the crematorium for incineration, and everything has a process of treatment, which cannot be done arbitrarily.

Yang Ping smoothed the femur section with a bone file, and applied bone wax to the bone section to stop bleeding.

At this time, the surgical area is flushed again, repeatedly irrigated, some lime-like uric acid crystals are removed, holes are drilled at the bone end, the muscle is sutured, the bone end is wrapped, and the bone end is fixed at the bone end by using the drilling hole at the bone end to form a good stump muscle pad, so that the prosthesis can withstand impact and wear and tear stronger.

Finally, the deep fascia and skin were sutured, a negative pressure drainage tube was placed, and the amputation on one side was completed.

It is hard to imagine that in Europe a long time ago, in the era of medical barbarism, amputation surgery was extremely simple, and some even directly cut off the limbs with a guillotine, and then pressed the limbs into the boiling hot oil to cauterize to achieve the purpose of stopping bleeding.

Even if the physical fitness is strong, after surviving the pain, the subsequent infection will cause many amputees to die.

At that time, Europe was crazy and barbaric in terms of surgery, which we cannot imagine in modern times.

At the same time, Chinese medicine was much more humanized, and Hua Tuo's Ma Fo San and surgical techniques already had the rudiments of modern surgery.

After completing one amputation, Yang Ping continued with the amputation on the other side, and the bilateral amputation was completed, and the stumps of both limbs were bandaged with sterile dressings and bandages.

A large gourd nodule at the left elbow joint was cut open, revealing the lime-like material inside, and a large curette scraped it out one by one.

If this kind of thing were kept in one place alone, it would definitely be considered a high-purity lime powder.

It is hard to imagine that this substance is produced in the human body itself, and it is this "lime" uric acid crystals that make patients miserable and tormented.

This gouty nodule, dug out of the "lime", filled with a large metal basin, even the surgeon, accustomed to all kinds of strange diseases, is very uncomfortable at this time.

Liang Fatzi was one meter away from the operating table, staring at this pot of sinful "lime", he wanted to remember this kind of thing, so that his determination to fight gout was as solid as a rock.

An intern doctor leaned against the corner, his face pale, sweating on his forehead, and a weak voice: "Teacher, I can't do it anymore." ”

Then leaning against the wall, he slowly slid down, he tried to persevere, but his strength did not allow it.

"Help him lie down!" Zhou Can, a roving nurse, threw a surgical gown on the ground and instructed another intern to hold him up and let him lie flat on the spot.

Nima, who is undergoing surgery and has to rescue interns, has seen fainting blood and fainting needles, but has never seen fainting uric acid crystals.

Zhang Lin did not come to the stage, but when he saw this scene, he immediately participated in the organization of rescue, lying down, opening the airway, auscultating the heart and lungs, inhaling oxygen, and monitoring the ECG, and a series of operations were fast and clear.

The operation here did not stop, and Yang Ping took Song Zimo and Xu Zhiliang to continue.

"Are you alright?" Yang Ping asked as he did it.

I've seen big scenes, and I still care about this.

"It's okay, my heart is beating and breathing, and my blood pressure is relatively low." Zhang Lin took off his stethoscope.

"Rehydrate, check your fingerstick blood sugar." Song Zimo helped cut the thread.

“2.4！” Zhou Can's blood glucose meter measured fingertip blood sugar.

"Low blood sugar, skip breakfast, push a 50% high sugar." Zhang Lin's name is Zhou Can.

Now that the diagnosis has been clear, this side will no longer interfere with the intern's rescue, the operation continues, and Zhang Lin over there continues to direct the rescue in an orderly manner.

They are all veterans who have been through a hundred battles, and they don't blink their eyes when they rescue this kind of thing.

"If you don't eat breakfast, you still value the taste of surgery, and if you don't eat breakfast, if you don't eat breakfast, if you can't stand the stimulation, you go out." Zhang Lin shouted.

Slowly, the intern woke up to low blood sugar that could sometimes be fatal.

Liang Fatzi was on the side, ready for tracheal intubation at any time, and the intern survived the danger and woke up, and he put away his intubation equipment.

"Is the surgery done?" The intern woke up with the first words.

"It's not over!" Zhang Lin re-auscultated his heart and lungs.

"How much have you dug up?" The intern said again.

Still want to see it? I don't know if I'm alive or dead.

"Close your eyes, lie down and rest for a while, and take your blood sugar again." Zhang Lin stood up.

Xiao Su's sterile sheet has been covered with "lime" uric acid crystals on the table, and the metal basin containing them has increased to five, and the sixth one is also quickly filled.

After the gout nodules in several large joints were cut, Yang Ping handed over the operation to Song Zimo and Xu Zhiliang to continue.

The intern, who was lying on the ground, had his blood sugar retested to 6.2 and was out of danger, and he stood up on his own.

"Wow, that's so much, teacher, I still want to see it." He stared at the several metal basins on the table that were covered by sterile sheets, held back the sweat on his forehead, and said curiously.

"You have masochistic obsessive-compulsive disorder, right? Not a lot of work?" Zhang Lin's stern tone.

Song Zimo said while doing the operation: "Let him take a look, as a desensitization treatment, there are so many people, nothing can happen." ”

The sterile sheet was slowly lifted, revealing a pure white "lime" piled up with metal basins.

"Teacher, I still can't."

The intern quickly looked away, and the person next to him immediately supported him, his face began to turn pale again, and the first desensitization treatment failed.

"Take your time and desensitize a few more times." Yang Ping had already taken off his surgical gown and rested on the side.

The first is the latest.