godfather of surgery

Chapter 103 Immediate Results
Fatty Liang, Zhang Lin, and Xiao Wu went outside to smoke.

Yang Ping edited the work situation of the first day into WeChat and reported it to Director Tian.

I made a separate report on the matter of Teacher Yan. When reporting the operation plan, I deliberately did not mention the partial closure during the operation.

Director Tian replied: I agree with your opinion, the operation will be performed according to the original plan, and attention should be paid to the use of methylprednisolone to partially seal the entrapped segment of the sciatic nerve during the operation.

To be a good doctor, you need to have courage and courage.

Without courage, timid, it is difficult to become a weapon; without intelligence, courage and lack of plan, accidents will happen sooner or later.

In order to ensure the success of the operation, Yang Ping entered the system space and dissected several experimental subjects. In addition to the routine general dissection, he also paid special attention to the local anatomy around the piriformis muscle.

Now he slowly realizes the power of super-cultivation Dafa, and every anatomy training is of great help to the operation, and this improvement is a spiral.

Just like basic science and applied technology, basic science has strong strength, and applied technology can accumulate steadily. Otherwise, applied technology will become a grassroots without roots and stagnate.

After accumulating the anatomical knowledge of several experimental subjects, coupled with the foundation of master-level trauma orthopedics, this kind of sciatic nerve release is only a minor operation.

The next day, after the shift round in the morning, Yang Ping took everyone to read the films, and then went to the operating room for surgery.

Director Zeng is very enthusiastic, and now he really wants to learn something: "I will help you."

Yang Ping said: "Director Zeng, what an embarrassment, just ask Dr. Song to help me, and you have to communicate with your family members about the condition at any time later."

Yang Ping was the chief surgeon, Song Zimo was the first to assist, Director Zeng came to the stage to have a look, and he was free to move about.

The protection of the nerves during the operation is particularly important. Once the operation is inadvertent, causing accidental injury or excessive stretching, it will cause bad consequences after the operation.

It was the first time I had an operation with Director Zeng, and I was not familiar with the cooperation, and I was afraid that the operation would damage the nerves accidentally.But it's not easy to ask Director Zeng not to come on stage directly, so Yang Ping arranged it like this.

Endotracheal intubation under general anesthesia, Xiao Wu Zhang Lin has already positioned the patient in a prone position.

"Good morning, Director Yang!" Su Yixuan led a nurse from Nanqiao Hospital, who was arranging equipment, saw Yang Ping coming in, and said hello.

Yang Ping responded very seriously: "Head nurse Su, I'm sorry, I need the head nurse to arrange the stage herself."

"Director Yang's surgery should be done." Su Yixuan smiled through a mask.

Everything is ready, wash hands and dress, disinfect and spread the sheets, and open the stage.

The lower edge of the gluteus maximus and the posterior gluteal crease incision avoid the formation of scars at the ischial tuberosity. The scars at the ischial tuberosity are prone to sequelae of sedentary pain.

Open the skin to expose the gluteus maximus, the local fibrosis of the gluteus maximus, cut the fascia tissue at the lower edge of the gluteus maximus without damaging the muscle fibers, lift the gluteus maximus upwards, and protect the subcutaneous nerve of the gluteus maximus and the posterior femoral skin nerve.

The piriformis muscle was exposed, and sure enough, the lower third of the piriformis muscle had fibrosis, that is, scarring, and it was not a muscle tissue at all.

The sciatic nerve does not pass out from the lower border of the piriformis muscle, but passes through the fibrous piriformis muscle in the form of a trunk, and is entrapped by the scar at the exit.

No wonder, the symptoms of the sciatic nerve are so severe, and the symptoms are more severe when walking, because the piriformis muscle contracts and squeezes the sciatic nerve during walking, so the symptoms are more severe.

The nerve was carefully separated from the scar tissue, and the surrounding scar tissue was excised to fully expose the epineurium.

The nerve forms a dent at the compressed place, and the dent is swollen far and near.

Yang Ping picked out his nerves lightly: "Director Zeng, look!"

Sure enough, Director Zeng felt relieved about piriformis entrapment syndrome, and the preoperative judgment was correct.

"Little Five takes pictures!"

Everyone get out of the way, and Xiao Wu uses his mobile phone to focus and take pictures, carefully, to prevent pollution of the technical area.

The rubber strip gently pulls the nerve away. At this time, the sciatic nerve must not be disturbed. Once stretched too much, it will cause nerve damage. Although it can usually recover, it can be as short as a few days or as long as a few months, and the lower limbs will be numb and weak , At that time, the patient will have a misunderstanding, thinking that the operation failed, which aggravated the symptoms.

Doctor, always walk on eggshells.

"Doctor Song, protect your nerves!" Yang Ping reminded.

He wasn't worried about Song Zimo, but he was afraid that Director Zeng didn't pay much attention to nerve protection, and he would make casual movements, such as slipping the retractor, which would damage the sciatic nerve. On the operating table, being cautious would not go wrong.

Song Zimo understood, and put one hand between Director Zeng's pull hook and the nerve to protect the nerve tightly.

The nerve was retracted, and Yang Ping bluntly separated the normal muscle fibers around the piriformis scar.Entering from the gap, the fingers separate a gap, and then cut off the fibrotic piriformis muscle at the attachment points of the two ends of the muscle.With a few normal muscle fibers, the fibrotic tissue is completely removed.

In this way, the nerve will come out from the lower edge of the remaining normal piriformis muscle and the foramen sciatica, and will no longer be compressed, because the separation just now is separated from the natural muscle fiber gap, without damaging the normal muscle, and will not leave scars and adhesions in the future. No future troubles.

There must be no scarring around the loosened nerve, otherwise the operation will fail and the entrapment of the nerve will re-form.

Blunt separation and sharp separation, blunt separation is used for separation with natural gaps, sharp separation is used for separation without natural gaps, the former follows the existing road, and the latter must open up a road because there is no road.

The operative area was flushed and the bleeding was again thoroughly stopped.

"80mg methylprednisolone with 20ml saline, syringe!"

Methylprednisolone is a glucocorticoid with anti-inflammatory and edema-reducing effects.

Gently slant the needle of the syringe into the nerve sheath, inject methylprednisolone into the nerve sheath, and then sprinkle some on the epineurium to partially seal the nerve, and wait for about 5 minutes.

Then use 20mg of ropivacaine, dilute it with normal saline one to one, infiltrate the part where the muscle scar has just been cut, and then infiltrate the incision edge in layers, which can reduce postoperative pain.

Checked again, the release was very thorough, and the hemostasis was also perfect. The whole operation was pleasing to the eye, with almost no bleeding, and no gauze was used.

Several orthopedic surgeons who were watching privately discussed that the big hospitals are different.

The rubber strip is withdrawn and the nerve is put back in place.

Put the drainage tube, suture in layers, and the operation is over.

Immediately after the operation, the sterile drape was lifted, and the patient woke up. Fatty Liang used a straw to remove the secretions from the patient's throat and trachea.

After recovering from anesthesia, the patient was sent out of the operating room. The nurse called the family members, and his son came up immediately.

Yang Ping took out his mobile phone and showed him the pictures taken during the operation: "Mr. Yan, look, this is the sciatic nerve. The legs are useless."

When he arrived at the ward, the patient was fully awake and could speak normally.

Under general anesthesia, once awake, there is no problem with limb movement.

The patient moved his right lower limb, hey, no more pain, maybe the anesthetic is working, no matter what, the pain is relieved now.

Pain has a very large negative impact on patients, seriously affecting their lives, such as inescapable nightmares, and some are tortured by pain to the point of committing suicide.

The mountain was moved away, even temporarily, the patient felt very comfortable, a feeling of being reborn.

"It doesn't hurt anymore!" Teacher Yan's first words came back to the ward.

"Go and say thank you to the doctor!" Teacher Yan told his son.

The son said, "Don't worry, I know."

After this kind of nerve release, some will rebound, and the symptoms will be more serious than before. In order to avoid this phenomenon, Yang Ping uses the hormone methylprednisolone to partially seal the nerve, eliminate inflammation, reduce nerve edema, and avoid possible rebound after surgery. , to improve the patient's postoperative experience, this experience is very important, the patient does not know whether the operation is beautiful or not, his intuitive experience is whether the problem has been solved, and how much has been solved.

For Teacher Yan, pain relief is success, and saying it [-] times cannot match his own experience.

More than ten years, ushered in the first pain-free day.

Teacher Yan was so excited that his hands trembled, and he held his son: "Remember, you must remember, thank you to Director Yang."

Although the whole process went smoothly, Yang Ping did not relax for the time being. It is not too early to draw conclusions. After all, partial sealing was used during the operation. It still depends on whether there will be rebound symptoms in the next few days, although the probability is very low.

Yang Ping instructed the doctor in charge of the bed to pay attention to protecting the stomach, and to use some drugs that nourish the nerves. When changing the wound dressing, he told Xiao Wu to do it himself. When changing the dressing, he asked him to go with him.

After the operation, Yang Ping and Director Zeng rested in the office.

Teacher Yan's son came over, this time with a normal expression on his face, not gloomy.

"Thank you, Director Yang!" He took the initiative to shake hands with Yang Ping.

Yang Ping said: "It should be. Doctors and patients are comrades-in-arms, and the common enemy is disease."

"Director Zeng, thank you too." Seeing Director Zeng beside him, the old man's son expressed his gratitude.

I just finished the operation, and although I saw immediate results, I don't know if it can be maintained like this. Therefore, the old man's son can't talk too much, and can't turn too fast, just observe and see.

Dean Pan took Director Tian to the department, and just happened to arrive at the Department of Orthopedics. He heard Dean Pan's voice from a distance. Because he was missing a front tooth, his pronunciation was leaky, so his speech was very distinctive.

"Director Yang, you've worked hard! I heard that an operation has just been completed." Dean Pan shook hands with Yang Ping.

Director Zeng said: "The one who just had the operation is Mr. Yan who has been entangled with us for a year. After the operation, the pain is relieved now. The patient's family just thanked us here."

Director Tian had already reported the matter to Dean Pan last night. This kind of patient is a special patient, and the surgery cannot be done quietly.

Dean Pan: "Oh, it's too embarrassing to ask you to wipe your buttocks just after you settle down. You're ugly, you're ugly."

Yang Ping said: "Dean Pan is serious. Director Zeng figured out the illness. Because the misunderstanding between the two parties was deep, so I just asked me to come forward, not to mention helping."

Dean Pan turned to look at Director Zeng: "Director Zeng, learn more from the professors in the provincial capital and dig deeper."

Director Zeng was very happy in his heart. Although he knew that Yang Ping was telling lies, but the lies were not obvious, so he said: "No, I pester Director Yang every day, trying to squeeze out more real things. This illness is also true. Thanks to Director Yang's guidance, I figured it out."

Chat a few words, then ask about any difficulties in work, accommodation and living habits, and then recommend a few more interesting places in Southbridge.

Dean Pan and Director Tian left and went to other departments.

"The one with osteomyelitis of the left femoral shaft?" Director Zeng offered.

During the rounds yesterday, he felt that Director Yang had something to say.

(End of this chapter)