Wu Guonan and Xue Tao have already disinfected both lower limbs, Li Junfeng of the Joint Surgery Department also arranged for Xu Yanlin to complete the preoperative disinfection, and Wang Zhongxing held the patient's leg with both hands.

For this patient, the current proposed surgical plan is to amputate both lower limbs and salvage both upper limbs for amputation, but he only talked to Liu Chaodong outside about the possibility of amputation.

However, Director Wu Guonan's group couldn't do so many operations, and the patient's identity was special, so he asked a director of joint surgery to come to help, and this director of joint surgery, Li Junfeng, is also an orthopedic surgeon who is good at hand surgery, but now he is assigned to work in joint surgery.

Because the patient's body is quite strong, the weight of a pair of legs is not light.

Seeing this, Fang Ziye first put on a pair of sterile gloves and asked Huang Yu for a leg, so that Huang Yu could swap his left and right hands to make a buffer.

Xue Tao washed his hands directly with Li Junfeng, and the two were still talking about something halfway.

Xue Tao turned his head and asked Li Junfeng: "Director Li, that is to say, this patient can actually avoid amputation, but no one dares to complete this operation now?" ”

Li Junfeng glanced at Xue Tao, his eyes and tone were strange: "Xue Tao? What does this do, you ask? Don't make any extraneous branches. ”

"This patient is quite special in his own right, and his identity is also special."

Xue Tao is obviously a person from orthopedics, if he wants to mix the matter of vascular surgery, and it is still on this patient, then Li Junfeng will never allow it.

Wu Guonan also glanced at Xue Tao more.

Xue Tao hurriedly explained: "No, Director Li, I'll just ask casually if I'm curious." Naturally, I will not rush to do limb salvage surgery. ”

"I'm not a vascular surgeon myself, and since Director Peng has said that he wants to amputate his leg, it must be difficult to save his limb."

Then Xue Tao said: "Director Li, Ziye is also a senior resident, limb amputation, it is an authentic level II surgery, I let him come to the stage, I am an assistant, it's okay?" It will not delay the patient's condition. ”

"What do you think?" Xue Tao wanted to give Fang Ziye a favor.

Amputation is simple and belongs to level II surgery, which Fang Ziye can do. And amputation is actually not that difficult.

"It's okay, you can prick the artery first. The main thing now is to solve the problem of blood loss caused by blood vessel damage. Li Junfeng reminded the point.

Li Junfeng doesn't particularly know what Fang Ziye's origin is, but whoever completes the amputation is complete. It's just that Li Junfeng's rank will be higher than Wu Guonan, he is the administrative director of joint surgery, the same as Zhang Mingcan.

The situation now is.

Amputation is not difficult, limb salvage is. And Wu Guonan knew that in such a situation, even if Zhang Mingcan or the old director of Hongdu were called, it might not be as reliable as Li Junfeng to keep his upper limbs.

Nowadays, the patient's fatal place is multiple trauma, severe blood loss, hemostasis, blood transfusion, and more in than out, which is the key.

However, after stopping the bleeding for a long time, the blood in the arteries and veins will coagulate, and if the limb is not amputated, the muscles of the limbs will gradually die, and the creatine produced by muscle lysis will also be fatal.

Therefore, this amputation can actually be divided into two steps.

Tie the artery, stop the bleeding, and save your life in an emergency.

Then amputate and save your life!

Amputation can be done slowly even after six hours, and it doesn't matter, and it doesn't cause any burden on the body.

"Good!" Xue Tao nodded.

The disinfection shop was quickly over, and then Fang Ziye and Wang Zhongxing went to the sinks outside the operating room to wash their hands and disinfect.

Wang Zhongxing smiled bitterly and said, "Ziye, I encountered such an emergency, and I was lucky enough." ”

"I don't meet one for a long time."

Fang Ziye only pursed his lips and smiled, he was thinking, if he really wants to do limb salvage, is it more appropriate to add some vasotomy? Or is it more appropriate to add some vascular embolectomy, or do you add both?

I haven't met it, or I don't know, whatever.

Since I have encountered it, and I still have a lot of knowledge points in balance, I will temporarily add some to use.

Isn't that the meaning of having some knowledge on your own?

So, simply, Fang Ziye directly found the basic skills of the corresponding specialty in vascular surgery.

Angiotomy, thrombectomy, vascular suture......

More than a thousand points of knowledge disappeared.

This is Fang Ziye's largest consumption so far.

When he walked in again, Fang Ziye found that the patient's condition was really very bad, but at the same time, it was very lucky-

A knife in the upper right abdomen is estimated to have been directly pierced into the liver. The edges of the opening are neat, and it should be quite easy to repair.

The edges of the jejunum and ileum are also neat, and it seems that the injured person did not stir it after stabbing the knife very cruelly.

If you really do this, then I'm afraid it's really hard to save the immortals-

But even so, there is an extremely pungent smell in the abdominal cavity.

The intestinal tube is broken, and the smell is immortal.

Fang Ziye couldn't help frowning......

When Fang Ziye and Wang Zhongxing washed their hands and walked in, they saw that Li Junfeng had already cooperated with an unknown brother in the joint surgery department to peel off the brachial artery of one upper limb.

Wu Guonan and Xue Tao temporarily formed a team and operated on one side of the lower limb.

After Wang Zhongxing and Fang Ziye came in, Wang Zhongxing immediately took over Xue Tao's position, and the four of them divided into two teams and began to find arteries and stop bleeding.

Because the limb is to be amputated, the brachial artery and femoral artery can be found directly and then temporarily punctured.

Fang Ziye changed into a sterile surgical gown and swayed around Xue Tao.

Wu Guonan turned around and said: "Xue Tao, you take Ziye to do the other side first, femoral artery exploration ligation is just a simple level II operation, it is part of the amputation, you should not be difficult to complete, right?" ”

This is actually an exposure surgery, also known as an incision.

But actually, vascular exposure surgery and vascular wall canalotomy are two different surgeries. Vascular exposure is the basic skill of vascular specialty under incision, while angiotomy is a specialty skill of vascular surgery.

One is the foundation, and the other is the content of the specialties that really need to be operated by the specialists.

Fang Ziye nodded, Xue Tao smiled, and stood in the assistant position.

The exploration of the femoral artery is only a level II operation, and it is also a part of amputation, which is naturally not difficult.

It's much easier to ligate the artery, just prick it with a silk thread.

Blood vessels are similar to water pipes, but they are not exactly the same as water pipes, and they can pass through liquids.

The difference is that water pipes can be on the surface of the body, and blood vessels are generally buried deep in the body, especially large arteries, which rarely run superficially.

If there is a hole in the water pipe, you can stop the water first, and then slowly find the opening, but the blood vessels can't do it, the main switch of blood in the blood vessels is the heart, and if you stop beating, you will be gone.

Therefore, it is necessary to quickly locate the proximal end of the blood vessel and then press it down to control the bleeding.

Xue Tao said: "Ziye, you help with compression to stop the bleeding first, I will expose the femoral sheath first, and after it is exposed, I will hand it over to you." ”

Fang Ziye nodded.

Then while Fang Ziye's right hand slowly tore the gauze, his left hand went to his abdomen, and after touching it flat for a while, he pressed it tightly and deeply!

This is on the surface of the body, according to the blood vessel shape to stop the bleeding!

It is natural to have anatomical knowledge, and it is not too advanced skill.

The application of bare hand pressure hemostasis in surgery is another level and is not the same.

However, by pressing the more proximal end of the artery rupture, the amount of bleeding can be greatly reduced.

Because the patient's blood pressure is not high, coupled with Fang Ziye's compression, after Fang Ziye uncovered the gauze, there was not a lot of bleeding!

At the same time, Fang Ziye temporarily consumed about 500 knowledge points, and added the downstream skills of the hemostasis technique, the pressure hemostasis technique, to level 4.

Knowledge points are used for use, and Fang Ziye can't manage so much now.

Then the result was that Fang Ziye actually grabbed the proximal end of the femoral artery before Wang Zhongxing.

"Silk thread!"

The right hand turned into a loach grabbing style, and a section of the femoral artery was neatly pulled out from the inside. Pinch your thumb and forefinger tightly.

Then switch to the thumb and forefinger of the left hand that is pressing on the groin position!

Lift it out slightly, and then immediately take the two silk threads prepared in advance and quickly go around the blood vessels, and tie them tightly into a half-dead knot (refer to tying shoelaces, which are tighter than shoelaces).

That's when the femoral artery was put down! I flicked the stump of the blood vessel a little, and I didn't see the bleeding, so I breathed a sigh of relief.

Xue Tao didn't even have a scalpel and other instruments ready here.

When I turned around, I saw that Fang Ziye had finished tying, just waiting for him to cut the thread.

Xue Taocai said: "You release the pressure first, and I'll see if there is any bleeding elsewhere." ”

Wang Zhongxing, who was on the other side, raised his eyebrows suddenly, and after discovering that Fang Ziye had actually done surgery to get in front of him, the movements in his hands couldn't help but speed up slightly.

But it was just such a frizzy point, but Wu Guonan didn't have time to catch the arterial stump!

Suddenly, the arteries began to bleed!

Crash high!

Then it sprayed down, and some of it was shot directly onto the eye lenses of Li Junfeng, the director of joint surgery.

Of course, Li Junfeng didn't move at all, but said seriously: "Tour, wipe the blood, let me step down......"

did not blame Wang Zhongxing.

No one wants to have an accident during the operation, but there are some diseases that cause blood.

Xue Tao, who was cooperating with Fang Ziye, was still looking for other blood vessels, and when he saw this scene, he immediately reached over the operating table and directly grabbed the femoral artery stump on the opposite side with his thumb, index finger and middle finger.

It can be said that it is stable, accurate and ruthless!

The bloodshed stopped immediately.

The blood that could be spurted out kept falling at this moment, falling on the floor of the operating room and on everyone's heads and shoulders.

Even so, everyone just glanced in Wang Zhongxing's direction and saw that there was no more bleeding.

He didn't walk away, but continued to operate without hesitating the scene.

They were not affected by the bloodstains, and they did not have to step down like Li Junfeng.

What are you afraid of when you are sprayed with blood during the operation? As long as the scalpel is not on the neck, the patient does not have any infectious diseases, and the surgery must be performed.

This is the regular concentration of a surgeon.

Wu Guonan immediately pressed it, stopped the heavy bleeding, and asked Wang Zhongxing to take over the pressure position, and comforted softly: "Don't panic, the operation should be done slowly." ”

At the tense moment of the operation, Wu Guonan was not even willing to waste time scolding his mother.

It's just that the three-person press and continue operation is not so tacitly completed.

……

On Fang Ziye's side, after Xue Tao completed the thread cutting, he gave up the position of the main knife to Fang Ziye.

The tone is short: "Sub-industry, functional transposition." ”

Intelligent transposition is the exchange of the main tool and the assistant, but not the position.

Fang Ziye nodded and said yes, then took the scalpel and toothed forceps handed over by Xue Tao, and began the operation.

Xue Tao took the opportunity to flash his eyelids, then raised his neck, eased his posture, and when he moved his gaze to the surgical field again, the whole person was not very good.

It's just that after a while, I saw that after Fang Ziye opened the wound at this moment, he was still 'playing' with the femoral nerve next to him and the accompanying femoral vein after exposing the wound of the femoral artery......

In fact, it is to check whether these two things are injured.

It's just that this skillful technique made Xue Tao instantly become a second monk.

MLGB, I'm having surgery right now, you're flipping around.

No, when did I grow taller but not have enough hands?

Xue Tao was puzzled and didn't dare to touch it.

At this time, Xue Tao saw again that the vascular forceps in Fang Ziye's hand seemed to be like a sperm, and he didn't know where to pry it from, and it seemed that he had taken out the saphenous vein on the inside from the wound, and after the pressure of the wound was lifted, blood was gurgling out.

Fang Ziye said: "Are there sutures in vascular surgery?" Open a few. ”

"Yes!" The two itinerant nurses replied immediately, although they didn't know which department asked for it, she just wanted to listen to orders now, and she didn't bother to care about it at all.

The situation was urgent, even if the intern doctor asked him to prescribe something, she would not hesitate to ask.

Ask what to save a second of time is a second, which is a quality in the rescue and first aid process.

When Li Junfeng and the others heard this, they immediately glanced at Fang Ziye.

This patient is preparing for amputation, what are you doing with vascular sutures?

Of course, it also includes Wu Guonan of the first bone department.

Fang Ziye said to Wu Guonan: "Director Wu, I think the plane of the amputation can be slightly lower and closer, so that it is easier to pretend to be a prosthetic limb in the future, and the arteriovenous break here is not big, so it can be sutured and repaired." ”

Although it is an amputation, how much is left and how much is amputated, that is completely different.

Amputation from the root of the thigh is amputation, and amputation from the ankle is also amputation, and the degree of functional preservation is completely different.

Wu Guonan said: "You have full authority to deal with it, you don't need to ask me, you don't care if I look at you or not." ”

Don't use suspicious people, don't suspect people.

It's just an amputation, no matter how much Fang Ziye tosses, the result is just an amputation.

Wu Guonan then didn't say much!

Xue Tao secretly gave Fang Ziye a thumbs up.

With this awareness, Fang Zi's growth height in the future will not be too low.

Amputation, although cruel, but if you can stay as long as you can, this is also for the good of the patient, and I am afraid that this is all that can be done now.

Orthopedic people are not very proficient in vascular surgery, and vascular surgery cannot solve the problem of blood vessels, so orthopedics can only try to leave as many stumps as possible to make up for it.

After Fang Ziye got the vascular sutures, he quickly sutured the saphenous vein first, and the saphenous vein had only a small opening, and there was no need for the three-point vascular suture method of amputated limb replantation, so he quickly filled the saphenous vein.

The same goes for the femoral artery......

After listening to Fang Ziye's words, Wu Guonan secretly felt astringent in his heart, if Fang Ziye didn't say this, then he really planned to amputate his leg from the injured place, simple and rude, but Fang Ziye said this.

As the director, Wu Guonan was embarrassed to say that the scope of the amputation here was shorter than Fang Ziye's, so he also asked for vascular sutures, and then began to stitch them.

It's not that I deliberately compare it with Fang Ziye, it's just that I do it to make the patient better.

It's just that when Wu Guonan finished stitching, he was about to see what Fang Ziye was doing.

Suddenly I found something not quite right-

Because Fang Ziye is now moving the knife on the back of the patient's calf!

And the movements are skillful -

What is he doing?

After Fang Ziye took care of himself, he used a round knife to break the skin, and then did not use a sharp knife to go deep, but used a vascular forceps, as if entering his own door, bluntly broke the muscle layer, and went straight to the posterior tibial artery......

A minute later, the sharp knife broke through the wall of the posterior tibial artery, and pulled out a strip of thrombus the size of a little finger from the lumen of the blood vessel, like a radish plucked, like a black loach......

Obviously, this is the arterial embolus that Fang Ziye found from the arterial branch downstream of the femoral artery!

He's doing an arteriotomy and thrombectomy!

Seeing this, Wu Guonan's expression was the same as that of Xue Tao, who was Fang Ziye's assistant, and he immediately changed suddenly!

And not at once.

Fang Ziye is doing an arteriotomy and thrombectomy, how does he know where the thrombus is?

That's the first point.

The second point is that if Fang Ziye now makes the scope of limb salvage below the knee joint, what will they do?

Can a limb be amputated above the knee and above the elbow?

Doesn't this mean that he and others are inferior to Fang Ziye?

But what can you do if you don't amputate your leg here? Will they be what Fang Ziye is doing now?

No!

Fang Ziye didn't notice that anyone was looking at him, he had already put his heart and soul into it.

Probably, in general, it is difficult to find a vascular emboli. However, the basic medical physical examination, after the point is level 4, it is fine.

At this time, Fang Ziye had already emptied all his knowledge points to below 200 points.

After Xue Tao took a deep breath, he asked, "Will you have an arterial tomy and a thrombectomy?" ”

It's not asking, it's affirming.

Fang Ziye was suturing the incision site of the posterior tibial artery where the thrombus was removed, nodded, and replied naturally: "Yes, Teacher Xue, I have encountered a similar one before, and I thought it was useful, so I learned a little." ”

Fang Ziye's words, although he said it very bluntly, were also very direct, and even reasonable.

When Fang Ziye spoke, he obviously heard several screeching sounds made by rubber slippers rubbing against the ground!

The voices were made by Peng Yuanming of the Department of Hepatobiliary and Pancreatic Surgery and Li Junfeng, director of the Department of Joint Surgery.

They couldn't help but turn their heads.

After all, Peng Yuanming had a fierce quarrel with his family outside, why, it was because such a thrombosis removal operation could not be done.

At present, such a fine-level extensive thrombectomy, all he knows can do is Wu Xuanqi and Nie Mingxian, Wu Xuanqi has his own task, and Nie Mingxian is now anesthetized.

I didn't expect Fang Ziye to be able to do it, isn't this TM?

Of course, this is the operating room, it is on the operating table, and the operation is in progress.

All doubts that have nothing to do with surgery are asked by the audience, which is the basic principle of surgery and the basic quality.

……

The muscles at the corners of Li Junfeng and Wu Guonan's mouths on both sides were like heart muscles, which became monolithic, and they began to twitch at the same time.

Either twitch or not, very neatly aligned.

Xue Tao took a step back slightly, didn't stand too firmly, and stumbled his outer ankle, there was pain, but it was not obvious.

He also saw that Li Junfeng and Wu Guonan glanced at Peng Yuanming intentionally or unintentionally, their eyes full of weirdness and complexity......

Big brother, why don't you come and see if this is your surgery?

Peng Yuanming felt that today must be his end, and first a lot of unlucky things fell from the sky like money.

Peng Yuanming had to take the time to come over and take a look.

……

Fang Ziye continued to the next step, he first stitched up the opening of the artery!

Then he let go of the banded silk thread, and he saw that the posterior tibial artery began to fill and there was no blood seeping.

Feel the beating of the artery from top to bottom with both hands immediately following the shape of the posterior tibial artery!

The femoral artery runs from the lateral to the medial, and the posterior tibial artery pulses from the posterior to the lateral malleolus.

Therefore, Fang Ziye's hand went down to the dorsalis pedis artery, and he was immediately slightly startled.

Then, after retracting his hand in disbelief, he switched to his left hand and tried again.

I also felt the pulse of the dorsalis pedis artery!

At this time, Ziye began to get entangled, and whispered to Xue Tao: "That, Brother Tao, it seems that if I don't feel wrong, we may not have to amputate my leg here, I actually just want to stay longer." ”

"But now the dorsalis pedis arteries are pulsating."

"Can this still be amputated?" Fang Ziye was really asking Xue Tao.

But when Xue Tao heard this, his eyes almost rolled over his head, and his vital signs were gone......

NMB！

Although Fang Ziye's voice was small, the operating room was quiet enough at the moment.

It's almost like a needle dropping, because you can hear other people's breath sounds very clearly.

However, in this case, Fang Ziye said that he might not need to have an amputation.

But in fact, Wu Guonan, who is next door, is already carrying out the amputation, and even Li Junfeng of the joint surgery department originally planned to do limb salvage, however, at this moment, Li Junfeng, after seeing that the condition of the upper limb artery is not good, thought that the patient was talking about amputation anyway.

has also gone from limb salvage to amputation-

But at this time, Fang Ziye told them that Fang Ziye would not do amputation over there, and would change limb salvage.

Xue Tao didn't speak, Wu Guonan, as the director, scolded in a low voice at the moment: "I'm ...... Olympics"

The 2000 monthly ticket has been sent, don't be in a hurry to vote for the monthly ticket, and then vote when it doubles at the end of the month, if you have more guaranteed monthly tickets, you can also vote.

(End of chapter)