The application of level 4 puncture lies in precision, in the absolute control of depth, strength, and puncture breakthrough!

The position of the organs of the general body has hardly changed.

In the process of puncture entry, in addition to understanding the important anatomical distortion between the puncture approaches and avoiding blood vessels and nerves, it is also necessary to have an extremely keen ability to explore the subtle puncture sensation of the most superficial capsule when piercing the organs of the corpse.

Otherwise, one more point will hurt more, and one point less will cause insufficient puncture depth.

The three main organs to be pierced are the heart, liver and kidneys.

However, during the cardiac puncture, this is a cardiac puncture, not a pericardial fluid puncture!

In the case of no effusion in the pericardium, it is very difficult to control the control of puncturing the capsule without injuring the heart muscle.

The liver capsule is also known as the "Glisson capsule".

It is composed of regularly arranged collagen fibers, most of which are type I collagen, a few type III collagen, as well as fibroblasts and small blood vessels. The hepatic capsule is thickest at the inferior vena cava and the first hepatic hilum and enters the blood vessels and hepatobiliary ducts around the hepatic hilum.

Therefore, the puncture of the liver capsule is the thickest part of the puncture at the moment.

There are not only liver organs, but also inferior vena cava and hepatobiliary ducts, and whether you can feel the capsule without injuring these structures requires manual and hand feeling, and you also need to have a relatively deep knowledge of anatomy.

Anatomical knowledge was originally attributed to the basic theory of medicine, but later, more and more professors discovered that anatomy could not be simply wrung out, but must be integrated with specialized knowledge.

Separate anatomy and clinical must be combined and flexibly applied, because the anatomy of patients is basically not the anatomy of a normal person, so there is such a thing as specialty and pathological anatomy......

What can be seen is that Fang Xian's expression at this moment is solemn and serious.

The operation is capable, decisive, old and spicy, and does not hesitate.

It's not like you're assessing, you're learning, it's like, you're performing, it's like, you're immersively being yourself.

Yes, just be yourself.

In order to be able to respect the teacher more, so I want to deduce my own operation to the fullest, and it has nothing to do with the simple assessment, all the attention is focused on the operation, and there is no trace of attention at all, put it elsewhere.

Because Fang Xian himself knew that maybe after today, there would never be such a complete general teacher, handed over to him for learning, even if he wanted to practice anatomy, he could only have a single organ, or a leg, a hand, an organ or a part, to have the opportunity to practice and learn for himself.

Therefore, in such a cautious situation, Fang Xian slightly slowed down the speed of his operation.

Especially in the level 4 of puncture, when comprehensively applied, it is necessary to puncture the same area many times, and five punctures, no more than 2 piercings, such a high requirement, so that Fang Xian's operation is more and more cautious!

Of course, for a total of twenty punctures, Fang Xian only took less than ten minutes.

Five times for the heart, five times for the liver, and ten times for the left and right kidneys combined.

After everything was done, Fang Xian continued to cut it.

This incision is completely different from the previous incision on the skill trainer, this time the incision is to make a full-thickness incision on all the tissues of a teacher.

Including skin, subcutaneous fat, superficial fascia, deep fascia......

Oh, this teacher has no subcutaneous fat, almost skin-covered flesh or skin-covered bone, subcutaneous fat, almost undetectable.

Therefore, the traditional basic knowledge of anatomy and the application of incision need to be changed accordingly.

And this is not difficult!

Moreover, after Fang Xian cut the superficial skin little by little, he also found that there were some small bumps under the skin of the old man, and there were also some subtle lesions on the surface of the muscles.

After seeing these lesions, Fang Xian chose to debride and excision.

Subcutaneous lesions are debrided in a slightly different way than those in the muscular layer......

This process, in fact, is relatively cruel, because it is necessary to peel off the skin, expose the subcutaneous tissue, and separate the muscle layers one by one, which is also a variant of incision, and also expose the complete shape of blood vessels and nerves, so that you can observe and learn from yourself to see their true shape.

The teacher who died did not have such a thing as blood luck, and naturally he would not bleed.

However, Fang Xian still carefully separated to avoid damage to medium or even small blood vessels, and Li Qiu connected all the blood vessels to the muscles, restoring them one by one and exposing them to the field of vision.

encountered some places, such as the existence of small aneurysms, and Fang Xian only exposed them.

Aneurysms need to be treated in the patient, but in this teacher's body, there is no need to deal with it, it is meaningless. It is excellent to know the general structure of the aneurysm as an observation.

The blood is perfused in it, and it has been naturally shaped!

The various uses of [Incision] were vividly interpreted by Fang Xian.

The usage of [debridement] was used just right by Fang Xian.

And after the incision was completed, when Fang Xian confirmed the corresponding intra-articular manifestations one by one, he did not see the damage to the cartilage surface of the joint.

There is no cartilage, and there is no needle-eye structure on the bone surface.

This means that Fang Xian's previous puncture surgery only reached the joint, and there was no other superficial damage.

Time passes slowly.

Fang Xian was like an uninterrupted learning machine and an anatomical machine, one by one, and began to dissect step by step.

The old professors who were watching, and those who couldn't stand it, left the scene in silence one after another, leaving only some people to continue to watch the operation of Fang Xian, and there was no need for everyone to guard.

But not many people left.

On the 24th, there were no competitions and tasks, and the old professors did not need to go to work. Even if I am on the job, I was arranged a vacation by the hospital because of the task of the competition, so I am not afraid that I will not have a good rest tomorrow.

And some of the elderly had a shallow sleep, so they found a rest room nearby in the medical association to lie down, and in the early hours of the morning, they returned to the on-site examiner seat in the skill assessment room.

Around one o'clock in the morning.

On Fang Xian's operation table, such a scene appeared.

On the tabletop, the following organs are placed in a humanoid pattern.

The heart is centered in the middle and top. The lungs encircle the heart with the large arteries and veins that are cut.

The liver, one, is divided into two lobes, left and right, and is placed on the right side, level with the gallbladder.

The bile duct system also corresponds to it one by one.

The spleen, stomach, and pancreas are juxtaposed with the liver.

The small intestine and large intestine are sewn into two blind ends, which are arranged in a row and are several meters long!

The bladder, high pill and epididymis, YJ, prostate, vas deferens and high pill sheath are located at the bottom.

In addition, some small organs were also removed one by one.

Lymph nodes, thyroids, larynx, trachea, glands, etc., are all listed one by one.

In addition, the lesions that have been cleaned up on these organs are also corresponding.

It looks like an accident scene, but it is more vivid and orderly than the accident scene.

Moreover, Fang Xian only had a knife, and he was slowly deboning at the moment.

The human skeletal system consists of about 206 bones!

These bones make up the skeleton of the entire body. But there are some bones that are not separated, even in the course of teaching anatomy, namely the skull.

There are about 22 pieces.

The quilt is isolated in one place, waiting for the incision to observe tissues such as the cerebellum and medulla oblongata.

Other vertebral bones: including cervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacrum and coccyx, a total of 33 vertebrae, Fang Xian directly took the intervertebral discs, and arranged them in a stack in order.

Then there are the sternum and the ribs that have been cut off from the cartilage!

One sternum and 12 pairs of ribs! A total of 24 pieces.

The upper limb bones include the scapula, clavicle, upper arm bone (humerus), ulna, radius, metacarpal bones, and finger bones, a total of about 64 pieces, which are listed in order.

The lower limb bones include hip bones, femurs, tibia, fibula, talus, ankle bones and toe bones, a total of about 62 pieces, and the same is true for Fang Xian, and Fang Xian also mischievously spliced the foot bones together to form a slightly less white bony patchwork structure.

It's all about showing off your skills, and it's also about learning in depth.

In addition, Fang Xian was now carefully handling the muscles, separating the muscles and vascular sheaths one by one, exposing the perfect shape except for the heart, Fang Xian sutured the heart and the major blood vessels and so on, connecting them into a human-like ultra-long blood vessel shape.

Such an anatomy, when viewed, brings people a shocking power that is incomparable.

In the middle of the night, a group of old men and old ladies around were whispering there as if they had been beaten with chicken blood.

"Have you ever seen or heard of this kind of anatomy before?"

"I've heard it, but I've never seen it."

"Hardly anyone dared to do that, and they never did. The maximum extent of preservation of all organs, including the outer layer of skin, is peeled off, which is not unusual. ”

"Human skin is no better than cowhide! It's not easy to peel off like this. ”

"Especially when peeling off the organs, if it is not inferior, it will break, but Xiaofang peels off the envelope of the organs. This incision is the work. ”

"Tsk!"

"Huh?"

"Professor Guang, how many of them are? Gone? When did you go. Suddenly, an old man looked over there and found that none of these people were sitting on the scene anymore.

Because Fang Xian's dissection was really good, they really didn't look in the direction of those people.

What's the point of looking at old faces, is there a young man's face that looks good?

Is there a genius show operation that looks good?

This is the younger generation, and it is the future of Huaguo.

When people are old, they don't like to see much.

"I always have to ask for face, what suspicions do I still suspect now, how to apologize, how to apologize, how to deal with things in hospitals and schools, how to report and how to report."

"With Fang Xian's kung fu, do you still want to be suspicious?"

"It's really shameless? Grasping the mistakes made by the master, a lifetime and a string of people can't turn over? ”

"The feudal rule has been overthrown for more than a hundred years, is there still a saying about even sitting?" Someone rolled their eyes.

Others were yin and yang: "A few of them, none of them can repeat such a gross anatomy, what are they doing here, are they being mascots?" ”

"I left early, a little after eleven o'clock. Now what remains is Xiao Fang's solo show. ”

"I didn't lose my face completely, and I look forward to Xiao Fang's Waterloo in hemostasis or other basic operations."

"Don't say it, don't say it, there is also a professor of local anatomy here who will give a live lecture on the spot, so put on your headphones and listen. The doll in it is very interesting......"

"Can you still go to the operating table?" An old man sneered.

"Can't you get too much of it? Can't you learn? ”

"Are you going to change the slogan that you live to learn?"

However, whether it was the whispers of these people or the departure of Professor Guang Puyuan and others, it did not affect Fang Xian's operation.

Fang Xian only felt a little tired, but other than that, everything was fine.

He worked hard to identify and manipulate each step.

This is an old man who used his body to be a teacher for himself, and it cannot be repeated, such an opportunity needs to be cherished.

Even if you stay up late, you must finish their studies, and you can't give up halfway.

Moreover, Fang Xian is not a selfish person, these organs are obtained well, and they can also be used as specimens for the younger brothers and sisters to see.

What I have to do is to learn what I can learn to the extreme.

What can be operated is also used to the extreme!

Maybe it will delay the overall length of the assessment, but that's okay.

The learning at this moment is no less than the learning in the operating room of the trauma center, and it is more precious than the learning opportunity there, because no patient can open his whole body so unscrupulously, show himself, learn for himself, and give himself a general view of all the shapes of the real human body.

For example, this string of blood vessels, from the abdominal aorta, is divided into the left and right common iliac and the left and right internal and external iliac......

For example, this string of blood vessels is divided into other genera and branches, and then they are intertwined again.

For example, these nerves go directly into a certain muscle, and the nerve root that comes out of the spinal canal is the root from there, and continues to the palm and fingers.

This kind of series is the wonder of the human body and the mystery of life.

How can I see such a comprehensive view of the dissection that I did in the past in terms of anatomy, and what kind of mess is it?

And the preciousness of the corpse is basically not allowed for individuals or mature doctors to go through the whole local dissection on one side, which is for students and for those who are just starting out.

It can be said that no one has ever had such an opportunity except for undergraduates in local anatomy!

The Hubei Provincial Medical Association can give itself a reward for genius.

The operation continues.

The nerve should be severed, otherwise it will affect the integrity of the muscle layer.

The ligament should also be cut, otherwise you will not be able to fully see the shape, direction, and size of the muscle.

The local surgical area of a living patient is only the tip of the iceberg, and the field of vision that can be seen is really limited.

For example, the skin that Fang Xian saw now seemed to be unobstructed under the skin area measured by the machine.

Although there is a slight difference from the commonly used calculation formula based on the BSA formula proposed by Du Bois and Du Bois: BSA = 0.007184× height (cm)^0.725× weight (kg)^0.425, Fang Xian has never seen such a general view.

Because, almost no one chooses to peel off the skin as a whole in terms of anatomy, and it can't be peeled so well.

Moreover, in the process, Fang Xian almost reshaped an unprecedented spectacle!

According to the study, the total length of large and medium-sized blood vessels is connected one by one after incision and disconnection.

This includes major arteries and veins such as aorta, pulmonary artery, vena cava, common carotid artery, etc. It is estimated that the total length of the large and medium-sized blood vessels is about 60,000 to 10,000 kilometers, which is twisted into a string, and it is estimated that it is not so long, but if it is broken and stretches for one or two thousand kilometers, it should not be a problem......

The total length of the peripheral greater and median nerves is approximately between 20,000 and 400,000 km.

This range includes various major and middle nerves, such as sciatic nerve, femoral nerve, ulnar nerve, radial nerve, median nerve, etc.

Fang Xian's is not so perfect, but if everything is broken and connected, it will stretch for one or two thousand kilometers, and it will be no problem.

And at the moment, they are just a bunch, lying there like a mess instead of a mess!

At the scene, there was silence!

Note: The total length of capillaries and neural networks in the human body is much longer than this.

The next morning, at 7:30 a.m.

Fang Xian ended all the dissection operations.

Looking at the various organs on the display table, which were listed and lined up one by one, Fang Xian's mood was a little serious.

Stop, take the handle of the scalpel that has been changed at least fifteen or sixteen times, and put it down.

He pinched his stiff fingers slightly, then took two steps back and bowed to them one by one.

After getting up again, Fang Xian also found that there was some undried blood dripping on the display panel.

Looking around, Fang Xian found that Professor Guang Puyuan and others had left, including many people who watched his operation.

There were only seven or eight staff members, sitting far away, yawning one by one.

showed Fang Xian the sequelae after staying up late.

Fang Xian felt that it was okay, he was relatively young, and it had become a habit to stay up late when he was on duty before, and he didn't feel particularly tired, it was these hands, if they could be massaged a few times, it would be comfortable.

But it's impossible.

"Teacher, can I finish my current operation?" Fang Xian looked at the fact that there were not many onlookers, and he didn't know whether his previous operation had passed the assessment.

And seeing that Fang Xian finally stopped his operation and began to speak, several staff members, who were also old men, straightened up one after another.

"You're done?"

"It's done, and there is no need to continue the subsequent assessment. It doesn't make sense anymore. ”

"We'll take care of these things." Said one of the staff members.

The medical association, in addition to being a place for skill training, the practice of human anatomy, and the resources of general teachers, in addition to colleges and universities, is the only place that can be legally owned, that is, the major medical associations.

Dealing with the aftermath is also something they must do.

"Okay, thank you, teacher."

After Fang Xian finished saying this, he was still a little uneasy: "Teacher, can I really go?" You won't be called back again, will you? ”

Fang Xian asked again in order to be sure.

If he goes to Kyoto again, some people suspect that he didn't finish the operation, and he is called back, so tossed, Fang Xian is not happy, where is there such a toss?

I'm not a tool.

"Don't worry, this time our Hubei Provincial Medical Association will give you a guarantee, and if there is any doubt, we will directly contact the unit and the medical association where the questioner is located, and let them deal with it themselves."

"Where is there such a toss-up?" The staff also said.

After saying that, I couldn't help but yawn again.

People don't take their muscles and bones as their ability, Fang Xian's anatomy operation is good-looking, but it can't stand watching all the time, most of the staff of the medical association are retired old professors, at least sixty years old.

I can't stand it.

Fang Xian was relieved!

Now that the Hubei Provincial Medical Association has come forward to guarantee it, there should be no more mistakes and moths.

I can also set off with confidence, and it should still be in time.

Professor Gui passed away yesterday, so he didn't end the memorial service today, maybe it just started today, it's about the same, after all, I also have to notify my relatives and friends.

Fang Xian began to undress, and after taking off his gloves, he found that his hands were already slightly white.

Under the invasion of sweat stains, there are many folds.

and dry.

And Fang Xian's bladder was constantly fighting at the moment, as if it was about to burst.

However, compared to these efforts, Fang Xian's harvest is unimaginable, and there is no comparison at all.

"Wait a minute, come and fill in the card number."

"Shall we give you a small gift?" The staff said this after seeing that Fang Xian had finished arranging the surgical gown and gloves.

"Teacher, I'll wash my hands first, it's convenient, it's a little uncomfortable." Fang Xian took the initiative to make a request.

People have three urgencies.

Although money is a good thing, these are also unavoidable.

"No problem, you'll come back later, it's because I didn't think it through." The old man said so again, and at the same time began to turn his head to the other people to ask about something.

Fang Xian went out of the skill assessment room first, and after putting water first, he found his mobile phone, keys, wallet and other personal belongings on the shelf.

After making sure that his ID card and bank card are all there, Fang Xian is relieved.

It's just that the power of the mobile phone is not very much, Fang Xian thought that after going out for a while, he must borrow a power bank as soon as possible, so he called Senior Brother Bu Su and invited him to rush to Kyoto together.

There is no need to carry out the subsequent assessment, so Fang Xian does not need to go to the trauma center anymore.

It's just that Fang Xian slid on the screen of his mobile phone.

I saw that there was an unread message on WeChat.

From Uncle Fang Yun.

Edited from 8:45 p.m. last night.

A photo.

Two sentences.

"Remember the name of Teacher Gui Yuanping!"

Well!

Fang Xian's consciousness was slightly confused, and he nodded autonomously.

And then.

Well?

After Fang Xian carefully compared the photos, he suddenly felt very familiar inexplicably-

Isn't this old man the teacher he dissected last night?

(End of chapter)