godfather of surgery

Chapter 31 Kung Fu Under the Stage

"Senior Brother Yang's fracture surgery has also been done so well."

"Fractured collarbone, very simple, I can do it too."

"You do a look in 6 minutes?"

"---"

Song Zimo sat silently on the side.

This guy, how many collarbones do he need to make this, he thought he would only replant his broken fingers.

As far as the interlocking epithelial nerves are concerned, the protection is avoided. Many doctors do not pay attention to this point at all. Especially when a transverse incision is used, the cutaneous nerve is cut with a single stroke, and the skin around the surgical site is left numb after surgery. matter.

The hemostasis was done very well, and there was almost no bleeding on the gauze.The periosteal dissection is controlled to a minimum, and the blood supply of the fracture is protected to the greatest extent.

The second one, comminuted fracture of the clavicle, do not underestimate any fracture operation, because there will never be an exact same fracture, so trauma orthopedics is a test of people's ability to adapt.

The clavicle is not only broken into several segments, but each segment is also divided into several front and rear flaps.The reduction of this kind of fracture sometimes makes doctors very embarrassed.Some doctors had to wind down and barely complete the operation.

Completing the operation and doing it well are two different things. A high-quality operation has fewer complications and better postoperative functional recovery.

"This is hard to do!"

Looking at the broken bones, even some experienced attending physicians expressed concern.

Lao Han looked at the X-film on the reading light - it's really not easy to get.

The fracture had already been reduced during the operation, everyone cheered up, and Song Zimo also focused his attention.

See how he coped with this fracture, or how he managed it perfectly.

Based on Song Zimo's experience, seeing Yang Ping handle the first clavicle surgery, it was not something that could be accumulated by a few or dozens of them. He believed that Yang Ping could handle it, but was curious about how he handled it perfectly.

The 1.2 mm Kirschner wire, the steel needle used this time is thinner.

The vascular forceps carefully clamps the bone block, which is very stable, just like firmly clamping an egg, which is firmly clamped in the forceps, and will not crush the bone block with too much force.The soft tissue on top, even a little, is gently preserved,

Big ones first, then small ones.

Horizontal, vertical, oblique, almost every bone has fine steel needles.

The bone pieces were pieced together and the shape returned to its original shape.

"Wait, how do you put the steel plate on? These will interfere with the placement of the steel plate."

Someone frowned.

The steel plate is shaped, and then placed on it. This time, it is placed in front. Most of the steel needles avoid the steel plate. Two of them cannot be avoided, but they just pass through the holes of the steel plate, which does not affect the placement of the steel plate at all.

The insertion position of each steel needle is pre-planned, and the placement of the steel plate has been considered, and everyone suddenly realized.

When the screw is placed, the screw direction of each hole is different, and it will hold a bone block.Every time a screw is implanted, at least one needle is pulled out, and the last screw is implanted and the needle is completely pulled out.

The fracture was well reduced and the fixation was very firm.

Lao Han smiled slightly, this is the old man.In order to solve the problem of the interference between temporary fixation and final fixation, I spent a lot of thought and research. It seems that this kid also spent a lot of effort and research.

Song Zimo was satisfied, and a lot of effort was often spent behind simple things.

In other words: 1 minute on stage, ten years off stage.

The whole process reflects the concept of protecting blood supply all the time. Even if some bone fragments are a little bit of soft tissue, they may be torn off with a little movement, but they are still protected.

Bone blocks with soft tissue attachments have blood supply and are living bones; while those without soft tissue attachments are completely separated from the body and are actually dead bones.Living bone has the ability to heal, dead bone does not, and can only rely on living bone to extend and grow to replace it.

After 15 minutes of cleaning and disinfection in the operating room, the third unit is ready to start.

This operation involves the exploration of blood vessels and nerves below the clavicle, and it is already considered a fourth-level operation.

This exploration is a high-risk operation.

On the third channel, Lao Han was a little worried.

When it comes to vascular and nerve exploration, it is no longer a simple clavicle fracture surgery.The stubborn old men of the expert group are not soft at all in the evaluation, and they will pick out bones for you in the eggs.

"The tip of the fracture has penetrated the blood vessels and nerves under the clavicle. Be careful when exploring, especially the bone fragments. Don't move easily. The exploration is clear, and the bleeding is ready, and then the bone fragments are taken. It is very likely that once the bone fragments are taken, the blood vessels will The broken end will be retracted, and the chest will be opened to stop the bleeding, which is troublesome." Lao Han reminded Yang Ping.

Lao Han has a lot of experience, and he doesn't actually need to sit here all the time.Sitting here, in addition to seeing how Yang Ping's orthopedic surgery technique is, the main reason is to give Yang Ping timely guidance and to ensure the safety of the patient.

Exposure step by step, conventional transverse incision, in order to facilitate the exploration of the blood vessels and nerves under the clavicle.

Below the clavicle, outside are the blood vessels and nerves, extending to the upper limbs; inside is the top of the pleura, the tip of the thoracic cavity and the lungs.

If the pleura is punctured, it may cause a hemopneumothorax, which requires a thoracic surgery to save the Taiwan.

The exposure of orthopedic surgery is very important. Many operations go through many blood vessels and nerves, and some also go through internal organs. These blood vessels, nerves and internal organs are like minefields. To reach the destination of the operation, you must bypass or pass through these minefields.

Therefore, the ancestors spent a lot of effort and designed various ways to avoid or pass through these minefields.

The muscles were peeled off from under the collarbone and opened. Inside, the thick blood vessels of the little finger and the yellow nerves were seen. The blood vessels were pulsating rhythmically, and there was a fresh life under them.

Once these are damaged, ranging from disability to death.

Slow down, Yang Ping supported Xiao Wu's hook.To be a good doctor is to fear life.

A sharp piece of bone pierced between the blood vessels and nerves, surrounded by blood clots.The blood clot is much larger than a normal fracture, covering the area of ​​blood vessels and nerves.Means a blood vessel may rupture, and a vein is more likely.

"Be careful, the subclavian vein is ruptured. Once it retracts, the incision should be enlarged and the chest should be opened." Lao Han reminded again.

Prepare iced saline and vascular clamps.

Yang Ping stopped the movement in his hand. Although he was not nervous, he could not be rash.

I have practiced countless operations on clavicle fractures in the system, but none of the traumas can be replicated. Everyone has different physiques, different directions of force, different postures of the body at that time, and other influencing factors. .

Therefore, systematic training only gives you an opportunity to acquire abilities, and real surgery requires adaptability.

Ice salt water constricts blood vessels, minimizing the risk.

The metal basin was delivered with ice salt water, Yang Ping soaked it with gauze, took it out, and drizzled some.

With so many blood clots, blood vessels can easily be involved in the process of removing blood clots, leading to retraction and catastrophic consequences.

Lao Han regretted that he should not choose such a case. If there is an accident during the operation, he will be rejected by one vote.

Although playing at this time is good to give those old men a bad impression, the safety of the patients is the most important.

"I'm going to wash my hands." Old Han went to wash his hands.

Yang Ping waited for the ice saline solution to work. He held the tissue scissors in his left hand and the vascular forceps in his right hand to gently separate the blood clots from the outside to the inside.

The place where the subclavian vein came out to form the axillary vein was clearly separated, and the vascular clip was clamped in time.This can't be careless, it just blocks its possible bleeding, and the proximal end has the possibility of retraction.

Once retracted, it is equivalent to the broken place of the water pipe in the wall. Only by dismantling the wall can it be repaired. Otherwise, you can only watch it leak.

This was beyond the ability of an attending physician. Even a genius like Song Zimo would be inexperienced.

Doctors, especially surgeons, have very important surgical experience, so a platform is very important for surgeons.

For example, two classmates, one smart with good grades and ingenious, went to the county hospital.One often failed, was clumsy, and went to a top tertiary teaching hospital.Ten years later, the county hospital is no match for that top tertiary hospital.Because of the surgeries that people do every day, you may not see one a year.This is the gap.

The number of cases is what makes the gap between doctors, especially surgeons.

So even if you are a genius, you don't have the authority to perform this type of surgery without reaching a certain level, so you can't accumulate and improve.

"We encountered one last time, the blood vessel was retracted, the chest was opened, and the blood vessel was found to stop the bleeding."

"I've seen blood spurting from arteries here, onto the ceiling."

I have seen lingering fears, careful discussion.

The blood clot was lifted little by little, then clamped with a vascular clamp, picked up, and placed in the curved plate.

Song Zimo moved forward, using a blood vessel clamp to clamp the blood clot. He practiced for a long time before he could clamp it firmly.Because the blood clot is fragile, it will break with a little force. Generally, a curette is used to remove the blood clot, scrape it off, and then fiddle it out in a pile.

At this time, if a curette is used, it is easy to break and retract the blood vessel due to excessive force or pulling.

The vascular clamp can clamp accurately, but this is a technical job that not everyone can imitate.

The blood clot was removed, and the blood vessel ruptured, which had been blocked by the blood clot, leaving only a little bit of the connected blood vessel wall.

The proximal end was also delivered with vascular clips.

Ligation is the safest and easiest treatment, but Yang Ping still chose suture.

Cut off the ends and sew easily.Checked arteries, no problems.

The epineurium of the nerve was cut open, and Yang Ping opened the epineurium to reveal the perineurium inside. There was no problem.

Rinse, suture.

Lao Han came in after washing his hands.

The third operation was completed.

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(End of this chapter)