Trauma surgery focuses on debridement and hemostasis. It's just on the heavy side.

Just because incision and suture aren't important.

Among them, the organic combination of debridement and incision can actually evolve into bone extraction and bone grafting, which is different from osteotomy as a direct specialty evolution skill of incision.

The emphasis on different basic skills is obviously not because it is important, but because these basic operations can evolve into many important components of the operation of specialized skills.

For example, in the practice room, the reason why the control requirement for debridement is to carve three-dimensional characters, the purpose of which, to a certain extent, is to prepare for bone grafting and osteotomy debridement.

Otherwise, simple debridement, you use it in fracture defects or irregular fractures, what are you doing debridement?

Need to be flexible.

Bone grafting, which is detached from the basic skills of trauma surgery, is the closest to a perfect state, which must be the number of defects after fractures here, and what kind of form the defects will become, and what kind of shape you will take the bones into.

But such morphological designs, for the most part, exist only in theory.

In clinical practice, the raw material for bone grafting is more widely used, which is bone strips.

Whether it is artificial bone or the raw material for the removal of autologous bone, most of them are designed as long strips, and then spliced or pressed for bone grafting.

Of course, are there any higher-end artificial bone materials?

Yes, that is, 3D printing, according to the absolute structure of the bone defect, printed, and then directly implanted into it. This is an advanced material variant of artificial bone, which requires the participation of 3D printing technology as well as plasticity technology of artificial bone materials.

Corresponding to the 3D printed artificial bone material, the raw material closest to the form of the bone defect can be taken out to the greatest extent according to the state of the bone defect.

The principle is simple, but the operation is very difficult.

Surgeons who can perfectly and standardly remove specially adapted human bones are generally one or two professors or associate professors at the core of a group.

More often than not, small operations such as bone retrieval are for the attending to practice.

Just like Shen Tao, now in the group, he is in the stage of bone extraction practice, and he needs to improve the subtle operation step by step, and use the human body's iliac bone and fibula as raw materials for autologous bone grafting, and carry out the exquisite design of bone extraction, and also transform the design drawings into the efforts of his hands.

It is a pity that Shen Tao is still in the preliminary stage of practice in the second practice room of the Orthopedic Department of the People's Hospital.

This also made him feel that Fang Ziye was a talent that could be created when he saw that Fang Ziye could complete the square rectangular bone extraction technique from the very beginning.

At that time, Shen Tao felt that the operation level of Fang Ziye's basic skills was still within the understandable range.

But how long has it been, why did Fang Ziye suddenly rise suddenly?

Said that he is only good at scientific research, and the clinical operation level is just average?

Who TM said that?

Who spread the rumors?

I want to kill him—

Oh, it's Zhang Mingcan, forget it first.

Shen Tao's rich inner world is incomprehensible to ordinary people.

Only Wu Guonan, who has occasionally done autologous bone extraction, is as shocked as Shen Tao at this moment, after all, he is the chief surgeon of the team, and he carried the incurable surgeries in the group.

If you are not in your position, you will not seek your own government.

The deputy chief physician like Xue Tao, when he encountered an incurable disease, he smiled directly at Director Wu Guonan without heart or lungs, but he couldn't understand the preciousness of Fang Ziye's operation at this time.

"It's pretty good." Xue Tao moved his very thick eyebrows, and his tone was full of appreciation, like a big man like a sweeping monk, unfazed.

Wang Zhongxing took the fresh and bloody bone piece taken out by Fang Ziye with his hand, and compared it towards the bone defect, only amazed: "It's about the same, although there is still a little bit of a gap, but it is also very good." ”

Fang Ziye continued to be unfazed, and after the operation, he asked the instrument nurse and said, "Bone wax." ”

Fang Ziye can actually make the operation level of the bone retrieval technique better by adding points, but there is no need for this at all!

Again, as long as the skill can be used, there is no need to pursue the ultimate, and it is good to maximize your level within the current range and be worthy of your current identity.

Knowledge points are precious and hard-won, and there are too many uses, Fang Ziye doesn't want to waste even a little.

After bone retrieval, bone defects will occur in the original bone, but the position is not critical and there is no force effect.

However, hemostasis is still needed.

Xue Tao and Wang Zhongxing didn't understand something very much, and the instrument nurse naturally didn't think there was anything subtle, so she directly handed over the bone wax, her eyebrows tightened, and her tone was sweet: "Doctor Fang, it's okay to deduct a little." ”

Looking at the three innocent people like Teletubbies, Shen Tao's mood was also a little melancholy.

Sometimes, the more you really know, the more you feel that the world is big, and the more ignorant you are, so the less afraid you are, the less shocked you feel.

But Shen Tao didn't know what to say, and looked at Wu Guonan, who had a similar reaction to himself: "Director Wu, let's start bone grafting, this autologous material is good, so there is no need to suppress bone grafting." ”

"Hmm!" Wu Guonan nodded.

And Wu Guonan actually knows more than Xue Tao, because Wu Guonan tends to focus on hand surgery in the department.

In the field of hand surgery, there is a relatively high-end specialized operation, which is bone flap transplantation.

Bone flap transplantation, in fact, is a more sophisticated variant of bone removal, which is most suitable for the treatment of bone defects and osteonecrosis.

"Next time, I can let Ziye try to make a pedicle bone flap, presumably as long as I understand vasotomy, I can still do it." Wu Guonan smiled softly, looked in the direction of Fang Ziye, and couldn't help but feel a little more positive.

Bone flaps, which are slightly different from autologous bone grafts.

Autologous bone graft is a bone graft material, a pure piece of bone.

Bone flap, take out a piece of bone, but this bone should also have blood vessels or muscles, the bone flap with blood vessels is a vascular bone flap, and the bone flap with muscles is a musculoskeletal flap, its function is to fill the bone defect, as a bone graft, to promote fracture healing or bone growth, for example, the femoral neck fracture surgery is implanted into the fracture fracture flap, which can play a role in promoting fracture healing.

The pedicle bone flap mentioned by Wu Guonan is actually the abbreviation of the pedicled vascular bone flap, which can be divided into pedicle periosteal bone flap and anastomotic periosteal bone flap in great detail!

Professional, and quite professional, are actually two different concepts.

Wu Guonan's words directly made Xue Tao's face and expression, which was originally like a Teletubbies, begin to stiffen slowly.

Xue Tao is the deputy chief physician who follows Wu Guonan, no matter how ignorant he is, he still knows that Wu Guonan dares to let Fang Ziye operate the meaning and gold content of the pedicle bone flap.

Wang Zhongxing also had a similar expression at the moment, and looked sideways at Fang Ziye.

However, this time, Fang Ziye himself was a little confused.

Because Fang Ziye didn't quite understand the difficulty of designing with pedicle flaps. After all, Fang Ziye is a master's student in trauma surgery, and he only has some understanding of hand surgery, but the depth of understanding is definitely not as good as that of practitioners.

Orthopedics is much more than just fractures.

Hand surgery is also much more than just muscle and tendon suturing and amputated limb replantation.

Next, the surgery continues.

It's just that Wu Guonan and the others all glanced at Fang Ziye intentionally or unintentionally, and they had a lot of questions in their hearts, but they didn't ask them directly.

Because it's not time to ask questions yet.

Let's operate first, on the operating table, surgery and treatment of the patient, is the first priority.

Even if you want to ask questions, at most they can only be teaching or joking driving, formal clinical Q&A or gossip, and generally people with a little surgical cultivation will put it in the audience.

Instead of asking east and west on the operating table, asking south and north like neuropathy.

The operation continued methodically.

In the case of pelvic fracture with bone defect, a small titanium mesh is also required for fixation and bone grafting. Because the material of the bone graft is dynamic, if you don't tie it up, then the result of waiting for it is a free piece of bone, not a repair of the bone defect.

But this is a harmless operation, there are cognitive barriers, but there is not much gold content in the operation, it is a customized placement operation.

If it is handed over to Fang Ziye, with Fang Ziye's level 3 orthopedic instrument operation experience, it can also be done, but the adaptability may not be as good as Wu Guonan.

After fixation, it is the fluoroscopy review of the quality of the operation.

The direct vision is seen by the doctor himself, and the results of the perspective can be shown to patients and peers to a certain extent, so it is very necessary to leave a bottom.

Because the patient is generally not shown the results of the operation, so as to avoid his fear.

Making the patient relatively ignorant and not having a particularly clear understanding of the whole process is actually a kind of protection to eliminate fear.

The operation finally came to an end.

It was 12:37 p.m.

There was also a relatively small operation in the afternoon, and the operation was not expected to take a particularly long time, so Wu Guonan and the others all stepped down sequentially and went to the mistaken dining room downstairs to start cooking.

Of course, Wang Zhongxing, the patient's bed-keeper, had to send the patient back to the ward and give the doctor's order before he could come down to cook again.

Walking halfway, the corners of Shen Taocai's mouth squirmed seventeen times, and after more than thirty times of entanglement in his heart, he asked: "Ziye, when you were in Zhongnan Hospital, how many bones did Professor Deng Yong and your master let you knock?" ”

Traditionally, modern medicine is a gradual accumulation process.

Operation too.

The longer you learn, the more dexterous and sophisticated you become.

All the skills are either learned from the practice room or knocked out on the operating table.

Fang Ziye, this guy, how old is this, he actually has such a deep attainment in bone extraction, this is not Professor Deng Yong's deliberate feeding, Shen Tao has to close himself on the spot.

"I don't remember the exact number." Fang Ziye is not clever.

The operation must have been operated, since it was favored by Professor Deng Yong, Fang Ziye also has the opportunity to practice occasionally for small operations like bone retrieval, but the number of operations is not so much.

Of course, it is impossible for Shen Tao to make specific statistics, because Fang Ziye himself has not counted them.

Hearing this, Xue Tao swallowed a mouthful of saliva and asked, "Teacher Shen, is this bone extraction technique of Ziye a little something?" ”

Later on stage, Xue Tao noticed that the expressions of Shen Tao and Wu Guonan were slightly wrong.

Shen Tao didn't answer directly, but jokingly said, "Director Xue, I may only have the north and the south left." ”

"Mom. Target! Shen Tao directly began to rub Fang Ziye's hat, obviously very indignant.

"You are the god of Zhenshan sent to me by God."

Xue Tao's hands clenched into fists a little nervously, and he was also indignant in his heart.

Why is Fang Ziye's scientific research talent good, but also clinical talent? Which window did God close for Fang Ziye?

He began to look Fang Ziye up and down, trying to find a balance.

Appearance, not a closed window.

Neither is the figure.

Could it be said?

Yes, it must be!

Xue Tao began to comfort himself.

Wu Guonan only smiled at this moment, and asked, "Doctor Fang, do the people in the hand surgery department of your hospital know anything about you?" ”

After listening to this, Fang Ziye glanced at Wu Guonan.

"Director Wu, I am a student of trauma surgery, so I am not very familiar with the teachers of hand surgery."

Wu Guonan is also very discerning.

After a few words, everyone went to the locker room, and then staggered the topic.

The main thing is that Wu Guonan and Shen Tao are discussing how to improve the quality of surgery and how to design a surgical plan if they encounter such a pelvic fracture next time.

This is feedback and reflection on the surgery.

As for Fang Ziye, he is cleaning up the harvest of his operation, which is not small.

"+29 Knowledge! ~”

The improvement is very sharp, and one operation has increased by nearly thirty points.

This has already exceeded, and the lesions that Fang Ziye had removed under Yuan Weihong's feeding before.

In other words, although the basic skill of bone retrieval is only a specialty, it has penetrated into the specialty, and its contribution to the operation is very large.

Compared with just doing an internal fixation instrument before, it is much stronger to do intraoperative manual reduction!

Naturally, if it is a contraindication to conventional surgery, manual reduction is not within the scope of comparison, and the nature of the two operations is different.

Fang Ziye knows that the focus of improvement in the future will still have to shift more to specialist skills, after all, specialties are the charm of clinical practice, not simple basic skills.

Naturally, it is also important to have a high level of operation of the basic foundation.

If your debridement level is not enough, you may not be able to do it as handy as you are now in the shape design of bone extraction, even if your level of bone retrieval reaches level 3 200/500 proficiency.

During the meal, we do not discuss the process of the operation, but only give feedback on the details.

But it won't be particularly deep, after all, it's in the cafeteria.

After eating, when he entered the locker room again, Shen Tao still asked very uneasily: "Ziye, if you don't give me a thorough explanation, how many bones have you knocked?" ”

There is no way, among the skills that Fang Ziye showed before, except for the manual reduction technique, which is a bit close to a specialty, the others are all decent in Shen Tao's opinion.

Fang Ziye is a little better than him in manual reduction and suturing, but trauma surgery does not pay attention to suturing, and manual reduction has the top point of understanding.

Debridement and hemostasis, Shen Tao was sure to beat Fang Ziye to death, but Shen Tao would never dare to show off in front of Fang Ziye.

A thirty-five-year-old superior, the same age as Fang Ziye's teacher, is it more shameful to compare basic skills with Fang Ziye?

But the problem is that he doesn't bully Fang Ziye, but Fang Ziye knocks out a piece of his bones in his most important promotion task at present.

Even if Fang Ziye can get in touch with the bone extraction technique, it is Professor Deng Yong's love.

But Fang Ziye's bone extraction technique is even better than his own, is this TM still unreasonable?

Although it is only a detailed operation, the basic operation of osteotrieval is an important skill component of many large-scale surgeries in the future, and it will be used in many surgeries.

Of course, the operation of bone retrieval is a basic skill of the specialty because it is also very plastic, and it can not only develop and derive in the direction of bone defect treatment, but also in the direction of bone flap treatment.

It is similar to basic operations such as incision and debridement.

"Teacher Shen, it's really not much. I don't remember either. Fang Ziye replied with a smile.

"Well, forget it." Shen Tao immediately covered his face.

So as the old saying goes, people have to die more than people, and goods have to be thrown away.

Although Shen Tao said forget it, his expression at the moment was also a little solemn, he turned his head to look at Fang Ziye, and asked with some evil taste: "Do you want to cut some big brothers under the horse in the youth skills competition?" ”

"Huh?" Fang Ziye tilted his head slightly, slightly puzzled.

Shen Tao immediately puffed up his chest and was slightly arrogant: "I, in last year's competition, was only two places lower than your master, and the difference in score was only about 3 points." ”

After hearing this, Fang Ziye immediately became interested: "Teacher Shen, why don't we divide the bonus?" Can you point me out? ”

Fang Ziye was very much looking forward to Shen Tao being able to point him out something, preferably a new direction, something new that broke through the existing barriers of understanding.

"Fuck off, look down on people, don't you?" Shen Tao rubbed Fang Ziye's hat again, and scolded a little unceremoniously, like a real teacher.

"Then thank you, uncle." Fang Ziye also sold a good job.

……

Hearing the conversation between Shen Tao and Fang Ziye, Wang Zhongxing, who was going to participate in the skills competition, immediately frowned and became solemn.

If Shen Tao wants to interfere with Fang Ziye's competition, then Fang Ziye is very likely to run in front of him, and if there is one more person in front, the odds of getting results will be a few points smaller.

It's a lot of pressure.

But Wang Zhongxing didn't dare to mention the matter of asking Shen Tao not to point out Fang Ziye.

Wu Guonan didn't care about these petty fights at all, but proposed: "Ziye, why don't you perform a manual reduction technique today, let's do a quick one, get off the stage early, and then go out for a little drink?" ”

Fang Ziye looked at Shen Tao.

Shen Tao also narrowed his eyes and nodded in agreement: "Drink less pleasant." ”

For ordinary small fractures in which Fang Ziye participated, the operation time could be saved by at least 20 minutes or even half an hour. It's just that in normal times, Xue Tao, Wang Zhongxing and others all need the opportunity to operate minor surgeries, so they didn't let Fang Ziye violently do manual reduction, leaving no chance.

(End of chapter)