Normally, if the bones of the two toes do not grow together, they have a separate and intact bone structure, and they are only surgically separated from the middle.

Because it is a malformation, it is prone to various unexpected situations during the actual operation.

For example, the blood vessels of the two toes are intertwined, or only one artery supplies blood to them at the same time. In this case, the surgery is a bit more complicated. An arterial vessel is reconstructed by artificial bypass grafting.

In fact, the anterior tibial and dorsalis pedis arteries are the main blood supply to the toes.

As for venous return, the great saphenous vein and the small saphenous vein are the sources.

The posterior tibial artery is one of the two terminal branches of the popliteal artery and can also be used as a source of blood for bypass reconstruction. It generally supplies blood to the plantar of the foot and is rarely used intraoperatively.

The specific operation of this patient is not clear to Zhou Can.

One thing is for sure, the surgery should not be too difficult. Otherwise, it will be performed by him or the doctor himself.

After the gauze is untied, the sutured wound can be seen.

The sutures are relatively neat, there is no skin grafting, but pull-up sutures.

Patients who are able to do so will receive a period of water filling and skin expansion before surgery. However, because it is only a minor operation and the patients come from all over the province, the preparation is often not exhaustive.

Requiring patients to travel back and forth to the hospital multiple times is also unrealistic.

Doctors definitely want the surgery to be as perfect as possible, but it is often difficult for patients to accept it due to their affordability and time cost.

Postoperative pull sutures are common.

The skin itself has a strong ability to be resilient and extensible. After a period of rest, it will grow on its own and cover all the wounds.

The only thing to take care of during this time is to prevent infection.

In addition, the postoperative hospitalization observation time is often only about one to two days. The rest of the time, I dispense medicine to patients and take care of them at home.

Especially in a large hospital like Tuya, there is a shortage of beds, and it is difficult to spend limited bed resources on patients undergoing minor surgery.

This patient chose to have surgery in Tuya's emergency department, mainly because of Zhou Can's fame.

Originally, this kind of parallel toyed surgery is usually done by general surgery.

The emergency department operating room is now a general operating room, except for the fourth-level surgery, obstetric surgery, almost all surgeries dare to be performed.

There are two main technical parts to do surgery.

The first is the basic skills of surgery, which is incision, suture, hemostasis, anastomosis and so on. The second is surgical experience.

Under normal circumstances, as long as it is not a particularly difficult operation, the surgeon can turn into an all-round warrior.

Of course, in practice, this kind of all-round surgeon is very rare.

You ask a surgeon who usually only performs general surgery to open the chest and perform heart surgery on the patient, basically treating one person and one death.

This is why cardiac surgery and neurosurgery have always been called the two ceilings of surgery.

Because both fields are highly sophisticated surgeries.

Only those who have a high level of surgery and have extensive surgical experience in this field can be competent.

The training cycle of extracardiac and extraneurological surgeons is at least 11 years.

That is to say, it takes at least 11 years to train from an ordinary novice doctor to be able to complete an extracardiac surgery independently. In fact, this culture cycle will be longer, and without fifteen to twenty years of surgical experience, senior doctors simply do not dare to let you preside over the operation alone.

Human lives matter.

This patient's parallel toe splitting surgery, judging from the suture technique and neatness, should be performed by a more experienced surgeon.

Because it's pretty well handled in terms of some details.

"Is this toe numb?"

Zhou Can took a sterile cotton swab and touched the patient's right toe. To be precise, this toe is the third toe.

Typically, the second to fifth toes are most susceptible to malformed syndacty.

The first toe is located on the inside, the thickest one.

It is the eldest of the toes, and the probability of deformity with the second toe is very small.

This female patient is predominantly deformed with the third and fourth toes of the left foot.

"yes, that's it."

The girl nodded.

Family members are at the bedside.

Judging by the appearance and age, the escort should be the girl's mother. However, the woman was very shy and simple, and did not speak much, just stood by with a smiling face and watched Zhou Can examine her daughter.

The patient's father only appeared on the day of the operation, and it is estimated that after seeing the baby after the operation, he went home to work and earn money.

Basically, the men in most families are the breadwinners of the family.

It is also the backbone of the economy.

"You close your eyes first."

Zhou Can said to the patient.

"Do you feel it?"

He touched the third toe of the patient's left foot again with a cotton swab.

"It's a little bit, it's not obvious."

"Which toe am I touching? Left or right? ”

"Right!"

"Which one is it touching now?"

"Left!"

"Is there a difference between the touch of the left toe and the right one?"

"Yes! It was so clear that I could tell you were touching my toes on the end of the swab. ”

The girl's answer was precise.

This also facilitates Zhou Can's accurate diagnosis.

The most feared thing is to ask three questions, answer questions ambiguously, and squeak the kind of patient.

It's really maddening.

It is now almost certain that the patient has a problem with the third toe of the left foot.

Zhou Can's expression became serious.

"You can open your eyes, thank you for your cooperation."

Now that the surgery has been completed, nothing can be seen from the outside with the naked eye.

The patient's two toes are more ruddy, indicating that the blood flow is smooth.

It seems likely that there is a problem with the nerves in the toes.

"Have you touched these two toes with your hand before?"

"I've touched it!"

"Do you feel the right toe when it touches it?"

"Yes! In the past, when I cut my nails and scratched my itch, my perception was very clear. Dr. Chow, is there something wrong with this toe? ”

No matter how stupid she was at this time, she understood that the third toe was not a good anesthetic.

Most likely, something went wrong.

"It's hard to say for the time being, but there must be a problem with the tactile feeling of the third toe. Because the surgery has just been completed, it can be observed for another day or two. I'll arrange for you to do further testing at that time. ”

Zhou Can didn't jump to conclusions right away.

Because of the presence of local hematoma and wound pain after surgery, it is really difficult to make a conclusion immediately.

In fact, there are few definitive conclusions in medicine, and the answers given to patients are often vague and flexible.

Even if the doctor knows that the patient's tumor is cancer, even if he sees the pathological biopsy results supporting the malignant tumor, he still will not say to the patient, "You must be such and such cancer." Instead, try to be conservative.

Of course, when a patient is found to have a malignant disease such as a malignant tumor or uremia, the patient is often not informed of the results of the examination because of the patient's ability to bear it.

Instead, inform the family.

"I have surgery this time to be able to dance ballet better in the future, if there is a real problem with this toe, will it affect my dancing?"

The girl looked a little nervous at this point.

This is also a normal reaction in most patients.

When they learn that something is wrong with their body after surgery, they tend to feel anxious and nervous.

"Don't worry too much just yet, take a good rest. If something goes wrong, we'll definitely find a way to help you solve it. ”

Zhou Can didn't know much about ballet, only knew that dancing this kind of dance required landing on the ground with his toes and rotating his whole body like a spinning top. There are high demands on toe tolerance, as well as dexterity.

Patients do this surgery, both for aesthetics and for better dancing.

Each toe has its own unique role.

Theoretically, the main function of the toes is to stabilize the body.

In the course of human evolution, apes needed to run barefoot in the woods, mountains, jump, and even climb trees to avoid predators when they encountered danger.

This requires a certain degree of grip on the foot.

The toes are used to grip the ground, grasp the trunk of the tree, and stabilize the body.

Modern humans have evolved to the point where they are more civilized, basically walking in shoes most of the time, and the function of the toes has further deteriorated. Even if you lose a toe, you can adapt quickly, and it will not affect your walking too much.

But for jumping and dancing, there will definitely be shadows.

……

After checking the room, Zhou Can found that there were really a lot of small problems.

There is a certain reason why patients are afraid to let young doctors do surgery and see patients.

The proportion of these inpatients in the emergency department is very low, accounting for only about 30% of the total number of inpatients in emergency surgery. Most patients undergoing primary and secondary surgery are treated as they go.

At most, I can come to the outpatient clinic to change the medicine once a day, or go to the hospital to remove the stitches and recheck within a week.

The third-level surgery and the second-level complex surgery are basically presided over by Zhou Can and Dr. Xu in person, and the quality is not perfect, but at least it has reached a high level.

But other people's surgeries are a bit more difficult to explain.

In particular, in the past two years, new surgeons have been introduced to the emergency department, and all of them are young doctors, inexperienced and poorly skilled.

In this case, the quality of the surgery can be imagined.

The hospital has always been very tolerant of the training of newcomers.

It is to allow doctors to make some small mistakes, small problems in the process of learning evolution. As long as there is no accident, the hospital will turn a blind eye.

It is unrealistic to expect every novice surgeon to be able to perform surgery to a high level like Dr. Zhou Can and Dr. Xu.

"Which doctor did the one-bed surgery?"

Zhou Can asked Dr. Jiang Shuangshuang, who was in charge of the bed.

Because she was a doctor in the endocrinology department, after she was transferred to the emergency department, she happened to have an inpatient ward in the emergency department, so she was transferred to the inpatient ward as a bed doctor.

At present, there are more than 100 beds in the emergency department, and her status here has also increased significantly.

If nothing else, I should be able to get a chance to study this year and then come back as a resident general in preparation for my promotion to the attending department.

That's basically how every resident grows.

When there are few doctors in the department, each doctor will be forced to take turns in the total hospitalization for a year.

If there are many doctors, it is difficult to say.

Hospitalization always requires a whole year of hospitalization, which can be said to be on duty 24 hours a day.

It is very unfriendly for married people or young doctors who are in a relationship.

Wanting to go home and live a normal married life with your lover is a luxury.

Many doctors have a love-hate relationship with the position of total hospitalizer.

Because after the total hospitalization, all aspects of ability, including ward management ability, will be greatly improved and exercised. Next, as long as you can pass the exam, it is basically a certainty.

Actually, the exams for the attending physician are not particularly difficult.

More than eighty percent of doctors can pass.

It's really not good, you can take the test again the next year.

Therefore, the key to promotion to attending physician is not in the attending physician examination, but in the exercise of a one-year total hospitalization.

Those doctoral students, who were not hospitalized, worked for one year, and were directly promoted to attending departments.

There will certainly be some clinical deficiencies.

Maybe the ability to manage and solve the sudden illness and deterioration of the patient's condition is not as good as this kind of attending physician who has been promoted step by step. Hospital leaders are not stupid, and when appointing important management positions in clinical departments, they usually do not directly give such untrained doctoral students.

Besides, the development path of others is completely different.

Doctoral students pay more attention to scientific research and work hard to write high-quality papers to prepare for the impact of the deputy high school and the high school as soon as possible.

It is precisely this kind of talent promotion system that is a bit out of touch with reality that leads to many master's and master's degree students who have studied for eight years may not be able to do anything after working in the hospital.

Many well-known doctors don't even necessarily treat diseases.

This is also a big strange phenomenon in the current medical circle, and the relevant competent authorities have discovered this problem and are formulating a more scientific and reasonable talent training mechanism.

Lao Mei's medical student exam uses a living person.

It is very difficult to get a doctor's license in a foreign country. It often takes a very wealthy family to train a doctor or nurse. Lao Mei's doctors belong to the high-paid class.

There is currently no shortage of medical students in China, but there is a shortage of medical students who can see a doctor.

The last time Tuya Hospital recruited people in the emergency department, there were only two positions, and they were relatively poor technical positions, and as a result, more than 300 graduate students submitted resumes. Including a small number of doctoral students, they also submitted resumes.

It can be seen to what extent medical students are now looking for jobs.

There is also a very strange phenomenon, everyone squeezes their heads and wants to enter the big hospital. However, it is difficult for those small and medium-sized hospitals to recruit high-level talents.

The more top hospitals like Tuya, the more sought-after they are.

Zhou Can participated in the recruitment of general practice training that time, and the initial quota given by the hospital was only ten to twelve people, and as a result, thousands of people participated in the recruitment.

In the past few years, Tuya's comprehensive strength and ranking have improved a lot, and it will only be more volatile when recruiting.

Jiang Shuangshuang has always had special respect for Zhou Can.

When Zhou Can was on patrol, as long as she was on duty, she would basically wait for Zhou Can to arrive early.

Because of the ward rounds with Zhou Can, I can learn a lot of things.

Zhou Can often gives her some guidance, which benefits her a lot.

"The parallel dactydly in the first bed was performed by Dr. Fu. Do you need to see your surgery records? ”

Jiang Shuangshuang asked.

"You can help me adjust the operation records, I have to find Dr. Fu to understand the situation, this patient is likely to have a problem with his toes."

(End of chapter)