[With the cooperation of your assistant, you completed an operation, causing 4 damage (1.0%) to the postoperative infection of an open fracture, and obtaining 4 skill points!] 】

[You have caused 23 damage (5%) to the skin and soft tissue surgery wound through suturing operations, and obtained 23 skill points!] 】

[Current Skill Points Remaining: 28.] 】

An operation increases the skill points by 28 points, which is not a small amount, and Fang Xian retreated happily.

But when Fang Xian retreated to the free place of the operating room and carefully considered the details of the entrainment on the panel, his brows instantly twisted into Sichuan characters.

The hand that untied the collar stopped—

There's nothing wrong with this amount of damage, but there's a problem with this damage ratio!

Fang Xian once again used the mind control panel to pull up the details of the skill points——

[You have caused 21 damage (33%) to the wound of skin and soft tissue surgery through suturing operations, and obtained 21 skill points! 】

When I was working as an assistant, the diagnosis showed that it was an infection after an open fracture!

But when I stitched it up, it didn't show the infection, what happened?

Fang Xian was not carried away by the large number of skill points obtained, but his mind was spinning rapidly, analyzing the doorway inside.

It didn't take long for him to get this thing himself!

At present, I only know that the amount of damage = skill points, as for the proportion of the back, Fang Xian generally rarely pays special attention.

Paying little attention doesn't mean that Fang Xian doesn't pay attention.

The surgery on the operating table is still going on -

After Fang Xian took off his clothes, he didn't dare to speak rashly because he couldn't analyze the results for a while, so he went out of the operating room to wash his hands first, so as to calm himself down.

Surgery is not child's play, and it is not child's play to treat and diagnose patients, and it is not child's play to report your suspicions to senior doctors, so Fang Xian must be cautious and make sure that there is evidence for advance and retreat!

Fang Xian is not stupid, IQ has never been a problem, otherwise he would not have been able to enter the Affiliated Hospital of Shonan University to become a regular training, and he had the opportunity to replace his master's degree, and finally graduated with a master's degree.

That's not right!

Even though the degree of infection and fracture of the lower limb operated by himself and Associate Professor Song Yu was lower than that of Professor Lin Jiemo's operated side, the size of the wound was basically the same.

What is serious is the internal fracture and the size of the infection range, for the surgical incision, it is reasonable to have a maximum ratio of 4:6, which is normal.

At least in terms of the length and depth of the wound.

Then, even according to the ratio of 1:9, that is to say, the degree of infection on Professor Lin Jiemo's side is higher and the nature is more severe, and after he completes the sutures, the proportion of injuries should not be less than 10%.

With the same size of traumatic surgery, why did it end up in a situation of 5%?

There are only two possibilities, either the leg handled by Associate Professor Song Yu has some hidden cavity that has not been opened, so the infection debridement is ineffective.

Either that, the left lower limb that Professor Lin Jiemo is dealing with now has a large crocodile, or even a large crocodile that has not yet been discovered! So that the proportion of damage required on this side is extremely high!

Extremely high, extremely high.

5%: 95%, which is 1 to 19.

Which is possible?

Fang Xian's braincase was a little messy, this was just a directional inference, only a direction was given and there was no detail, and this direction was twisted out by him alone.

There are two lines in the direction, and it is difficult for Fang Xian to grasp for a while.

Associate Professor Song Yu is currently a Level 3 senior associate professor certified by the Medical Association, and it is impossible for him to have a hidden cavity that is not opened during the operation, and then lead to ineffective debridement of infection.

However, in the surgical wound operated by Associate Professor Song Yu, the details of the infection were not reflected at all.

So can you speculate so boldly that the lower limb operated by Associate Professor Song Yu has only deep infection, and there is no infection on the superficial side of the skin. And under the leg operated by Professor Lin Jiemo, there is a relatively large infected cavity, but that has not been discovered?

What if you extrapolate it according to this?

The patient did not have an MRI before the operation, and even if he did, he or she may not be able to read it from the MRI.

The focus of the reading of trauma surgery is on X-rays, mainly to see fractures, and I did not specialize in learning MRI reading that focuses on soft tissues during the residency stage!

It's still not enough knowledge, otherwise, you can definitely wring out some clues.

There is no better way, so I will go to the operating table and continue to watch Professor Lin Jiemo's surgical process, and then slowly explore.

This is a problem related to diagnosis, what is needed is theoretical analysis and thoroughness, and then to find the diagnosis, at least to find a line out.

Either Associate Professor Song Yu didn't clean the abscess cavity, or there was something big in the leg that Professor Lin Jiemo was dealing with!

These two directions are focused, and Fang Xian has already found them.

This patient is still in charge of his own bed, so it must be reasonable to ask questions at the right time, after all, in the operating room, only he is most familiar with this patient.

This is what you have to do if your superiors trust you and let you manage the bed!

Next to the operating table, Fan Chengpeng and his senior brother Wu Xiong were whispering about the difference between Associate Professor Song Yu's current level of debridement and Professor Lin Jiemo's level of debridement.

Liang Longqi and Zhou Xiaosheng, two residents in the same grade as Wu Xiong, were wondering with each other about the next step of debridement, what operation details should be paid attention to, and the direction of control.

There is also a doctor's brother, who is constantly touching his chin, occasionally making a sudden realization, occasionally frowning, obviously reading the operation very carefully.

Fang Xian was also paying careful attention to the operation of Lin Jiemo and the other two doctors, and then he also saw that Associate Professor Song Yu and Attending Physician Xue Li were also seriously observing something on the stage.

Almost all of them are focusing on the debridement done by Professor Lin Jiemo at this moment, because the debridement done by Professor Lin Jiemo is not only the debridement of soft tissues, but also the debridement of fracture sections, bone courtyards, bone cavities, and periosteums.

Finally, about twenty minutes later, Fang Xian really discovered the strange point in it.

This patient's left lower limb, the posterior aspect of the gastrocnemius muscle on the side of the limb with deep vein thrombosis, has more severe signs of edema!

Previously, Fang Xian and everyone in the department considered that due to the obstruction of venous return, the outflow of fluid in the vein led to edema on the back of the calf, and most of the patient's injury was in the front of the calf, and there was a certain degree of skin defect!

But as a trauma surgeon, Fang Xian knows!

Each person has four compartments in the lower leg, which is the anatomical basis for the occurrence of compartment syndrome.

Including anterior chamber, lateral chamber, posterior deep chamber, posterior shallow chamber!

What is more troublesome is that the incision made by the patient is the anterolateral incision, and the anterolateral incision generally corresponds to the anterior fascial compartment and the lateral fascial compartment, and there are no special signs that can be seen.

To open the posterior deep fascial compartment and the superficial fascial compartment, it is usually through the posteromedial incision.

In addition, because the patient's tibia is fractured, and the tibia is an important part of the posterior deep fascial compartment, if there is a large number of infections in the posterior deep fascia compartment, it must have been manifested by now.

The only blind spot is the posterior superficial fascial compartment.

To mention or not to mention?

If you mention it, you have to make more openings, what if you don't have it?

If you don't mention it, then this operation may be done in vain, and the subsequent processing will have to be carried out for the third time in the operating room. Thorough debridement is a prerequisite for infection healing, and if there are bacteria left, a large number of flora can be formed in a short period of time, and reinfection can occur.

After hesitating, Fang Xian still moved to the side of Associate Professor Song Yu and whispered, "Teacher Song, this patient has edema during hospitalization, especially the left lower limb, can you see how the pressure in the superficial fascia compartment at the back is?" ”

Generally speaking, if the infection occurs in a closed chamber, the internal hydraulic pressure will increase because the bacteria will secrete a large amount of fluid and emulsify the normal tissue.

"This patient did not go to the posterior superficial fascia during the first operation, and the fascia compartments were relatively separated from each other." Associate Professor Song Yu knew Fang Xian's worries, so he asked in a low voice.

"But this is a comminuted fracture, and the fact that the first open fracture surgery did not enter the superficial fascia compartment does not mean that the fracture fragments did not enter!" Fang Xian said this.

Associate Professor Song Yu was thoughtful when he heard this, returned to the operating table, and then probed the back of the patient's left lower limb slightly, and after a slight pinch, his face instantly changed!

When the patient came to the hospital, there was an external fixation device and gauze entangled, which was inconvenient for physical examination.

In the process of disinfection, Associate Professor Song Yu and Professor Lin Jiemo were not involved in the disinfection sheet, so they did not have the opportunity to conduct a comprehensive physical examination at all.

Even if Fang Xian is a bed manager, it is impossible to do a grinding examination on the back of the calf after applying the external fixation brace!

Song Yu's physical examination was very deep, and after a moment of effort, he asked in a soft voice: "Professor Lin, there is a problem with the posterior superficial fascia compartment of the left lower limb. ”

Lin Jiemo focused most of the operations on the debridement of the tibia surface at the moment, and had no time to deal with it.

"If there is a problem, explore it, there is a gap between the posterior superficial fascial compartment and the current fracture end, and the probability is not large." Obviously, Lin Jiemo also thinks that the probability of such a occurrence is very small!

Song Yu did so immediately, and after squeezing out a position, he just made a very small incision on the posteromedial side of the left lower limb from the direction where the right lower limb was, and after breaking the deep fascia of the lower leg, pale white purulent mucus immediately oozed out of it, like milk droplets.

And Lin Jiemo, who noticed this scene, stopped all operations in an instant!