godfather of surgery

Chapter 462 Sinful Uric Acid Crystals

After discussion, the patient's daughter and son-in-law agreed to the operation.

But the patient refused the operation and wanted to go home. He quarreled with his daughter in the ward and threw the stainless steel cup for drinking on the ground.

Although my daughter can't help but get angry and lose her temper occasionally, but only occasionally, the backlog of negative emotions always has an outlet to vent.

The usual complaints are nothing more than venting emotions. The five elderly people above the couple are under a lot of pressure and can hardly breathe.

In any case, she took good care of her father, helped him shave and wipe his body every day, and washed his hair every few days. The food in the hospital was not very good. The hospital gave it to my father.

The daughter is a little padded jacket, and this time is the best manifestation.

Like coaxing a child, the daughter patiently explained to her father that she needs to cooperate with the doctor for treatment, so that the recovery will be quicker and the cost will be less. If she gives up the operation and goes back like this, the infection will spread to the whole body and cause sepsis. At that time, she will be admitted to the ICU. The money spent is dozens of times that of now. If you don’t spend money now, you will spend a lot of money in the future. There are some things you can’t hide.

The patient yelled not to have the operation, clamored to go home, and gave up the treatment because he did not want to spend any more money from his daughter. If the operation failed, he would be a bottomless pit and would put a heavy financial burden on his daughter. .

Nobody wants to live away from their family with a smelly leg.

Even his grandson regarded him as a monster, and he was unwilling to get close to him, so he could only curl up on the bed in the rental house every day, and his wife took care of him.

During this hospitalization, the daughter was afraid that the mother would be overworked and cause trouble, so she refused to allow the mother to take care of the father in the hospital, and asked her to take care of the child at home, and take care of the father herself, taking care of the shit and urine.

After the daughter's persuasion, if she continues to be stubborn, it will only add trouble to the child, and the patient agrees to the operation.

As for the amputation, the patient was not surprised, let alone unacceptable, as long as he could bid farewell to this terrible life, amputation was nothing.

If he can really use the prosthesis to return to normal life, he is very eager. He is eager to share some housework for his daughter, such as helping to buy vegetables and take care of the children.

Those who have lost it will cherish it more, and those who have experienced illness will know how important health is.

This operation is not difficult at all.

The test is seriousness, and the pursuit of perfection in every detail is the only way to strive for the greatest success rate.

Uric acid crystals have a wide range of effects on the body. It does not only affect the joints. Joint pain is only the mildest manifestation.

Uric acid crystals can also affect blood vessels, leading to arteriosclerosis and problems in vital organs such as the heart, kidneys, and brain.

Before the operation, Yang Ping repeatedly studied the blood supply of the bilateral lower body. The destruction of blood vessels by uric acid crystals caused hardening of the arteries of the lower extremities, and some arteries were still narrowed. Finally, it was determined that the amputation plane was above the knee.

Because the blood supply of the calf is already poor, there are huge gouty nodules in the knee joints on both sides, the knee joints have been severely damaged, and the function is seriously impaired. Actively raising the amputation plane to the knee will not only ensure a higher probability of healing of the amputated stump, but also It also addresses the possibility of future outbreaks of damaged knee joints.

In many cases, surgeons tend to have beautiful illusions about the outcome, which will make doctors more conservative in their decisions.

For example, when a trauma orthopedic doctor treats some retrograde skin avulsions, the inexperienced doctor sees that the flaps are intact, and always fantasizes that they can survive, so they like to suture in situ. necrosis, the patient will eventually need a second surgery for skin grafting.

However, experienced doctors never have any illusions, and decisively perform anti-skin grafting on the flap. The first operation is successful, avoiding the patient's second operation, and avoiding taking skin from other parts of the body.

The same is true for this patient. The doctor is prone to illusions, the plane is lower, and the knee joint is preserved, but the facts will always exceed the doctor's expectations.

Judging from the state of the blood vessels, Yang Ping felt that he should be more active, give up illusions, and take a drastic step to amputate the entire lower leg from the knee, which looked good.

As for the more than 40 gout nodules in his body, Yang Ping also carefully evaluated them one by one, and finally, he decided to remove them all.

During the amputation operation, Yang Ping did not inflate the tourniquet, the tourniquet was just a backup.

Because during the operation, Yang Ping needs to observe the real blood supply of the limbs. His scalpel cuts through the skin, subcutaneous tissue, deep fascia, and muscle. The method is more reliable than any preoperative vascular imaging examination.

He tried to cut the skin on the lower part of the calf to verify his judgment, hoping that he made a mistake in his judgment and hoped that the skin oozes obviously.

However, regardless of the skin, fascia or muscle, without a tourniquet, there is almost no obvious bleeding, and there is still a large amount of pus in the intermuscular space, which spreads from the ankle joint.

The preoperative judgment was correct, and the limb had to be amputated above the knee.

Yang Ping sealed the cut leg with a sterile medical film, changed gloves and a scalpel, re-cut the skin on the knee and lower thigh with the scalpel, and formed a standard tongue-shaped flap.

The edge of the skin flap began to ooze bright red blood, Yang Ping was not in a hurry to stop the bleeding, he was looking forward to this effect.

"The blood supply of the skin is better, and the bleeding is more obvious." Song Zimo's tissue forceps clamped the subcutaneous tissue, and gently lifted the flap.

Yang Ping's aggressive and bold judgment on the plane of amputation was very precise.

"The plane of amputation is very suitable." Yang Ping felt relieved at this moment.

At this time, bleeding is the hope of successful operation. The faster and more bleeding, the greater the hope.

The scalpel continued to incise the deep fascia, cut off the muscles surrounding the femur, cut off the blood vessels and ligated them, cut off the nerves with a high-level sharp knife, and finally reached the central femur.

The femur was severed with a chainsaw, and the thigh was severed from the knee, leaving the patient's body as a free, independent object that no longer belonged to the patient.

The isolated limb is removed from the operating table and put into a transparent plastic bag. Zhou Can put it away and will be sent to the pathology department after surgery. Any tissue or organ removed from the human body must be pathologically performed in principle. examine.

The pathological examination of the residual limb is completed, and the final destination is to be sent to the crematorium for incineration. Everything has a treatment process and cannot be done arbitrarily.

Yang Ping smoothed the femur section with a bone rasp, and applied bone wax to the bone section to stop bleeding.

At this time, rinse the operation area again, rinse repeatedly, remove some lime-like uric acid crystals, drill holes in the bone ends, suture the muscles, wrap the bone ends, and use the drill holes in the bone ends to fix them on the bone ends to form a good stump muscle pads so that the prosthetic is more resistant to impact and wear when installed later.

Finally, the deep fascia and skin were sutured, a negative pressure drainage tube was placed, and the amputation on one side was completed.

It's hard to imagine that in Europe a long time ago, in the barbaric age of medicine, amputation was extremely simple. Some even cut off the limbs at once with a guillotine, and then pressed the limbs into boiling hot oil and burned them to stop the bleeding. The stumps of the limbs sizzled in the boiling oil. The patients were in agony, and some died of shock directly from the pain.

Even if people with strong physical fitness survive the pain, subsequent infections will kill many amputees.

How crazy and barbarous surgery was in Europe at that time, we can't imagine it in modern times.

Contemporary Chinese medicine requires a lot of humanization. Hua Tuo's Mafo Powder and surgical techniques already have the embryonic form of modern surgery.

After completing the amputation on one side, Yang Ping continued to amputate on the other side. After the amputation was completed on both sides, the stumps of both limbs were wrapped with sterile dressings and bandages.

The huge gouty nodule on the left elbow was cut open, revealing the lime-like substance inside, which was scraped out in lumps with a large curette.

If this kind of thing is placed alone in one place, it will definitely be regarded as high-purity lime powder.

It is hard to imagine that this substance is produced by the human body itself. It is this "lime" - uric acid crystals that make patients miserable and suffering.

This gouty nodule, dug out "lime", filled a large metal basin. Even a surgeon, who is used to seeing all kinds of strange diseases, is very uncomfortable at this time.

Fatty Liang was one meter away from the operating table, staring at this basin of evil "lime". He had to remember this kind of thing to make his determination to fight gout even more rock-solid.

An intern leaned against the corner, his face was pale, his forehead was sweating, and he said weakly, "Teacher, I can't do it."

Then he leaned against the wall and slowly slid down. He tried hard to hold on, but his strength didn't allow it.

"Help him to lie down!" Zhou Can, the itinerant nurse with sharp eyes and quick hands, threw a surgical gown on the ground, and ordered another intern to support him and let him lie flat on the spot.

Nima, who is undergoing surgery and has to rescue interns. I have seen people who fainted from blood and needles, but I have never seen people who fainted from uric acid crystals.

Zhang Lin did not come to the stage. Seeing this scene, he immediately participated in the rescue organization, lying flat, opening the airway, auscultating the heart and lungs, inhaling oxygen, and performing ECG monitoring. A series of operations were performed quickly and clearly.

The operation here did not stop, and Yang Ping continued with Song Zimo and Xu Zhiliang.

"Are you okay?" Yang Ping asked while doing it.

They have all seen big scenes and still care about this.

"It's okay, my heartbeat and breathing are both, and my blood pressure is relatively low." Zhang Lin took off his stethoscope.

"Replenish the fluid, check the blood sugar on your fingertips." Song Zimo helped cut the thread.

"2.4!" Zhou Can's blood glucose meter measured blood glucose at his fingertips.

"Low blood sugar, don't eat breakfast, push a 50% high sugar." Zhang Lin called Zhou Can.

Now that the diagnosis has been confirmed, there will be no further intervention in the intern's rescue, and the operation will continue, while Zhang Lin will continue to direct the rescue in an orderly manner.

They are all veterans who have experienced many battles, and they don't blink their eyes when they rescue such things.

"I don't eat breakfast, and I still value taste surgery. Is there anyone who hasn't eaten breakfast? Those who haven't eaten breakfast, and those who can't stand the stimulation, all go out." Zhang Lin yelled.

Slowly, the intern came to his senses. Hypoglycemia can sometimes be fatal.

Fatty Liang was at the side, ready to intubate the trachea at any time. The intern survived the danger and woke up. He put away his intubation equipment.

"Is the operation done?" The intern's first words when he woke up.

"Enough!" Zhang Lin auscultated the heart and lungs again.

"How much have you dug out?" the intern asked again.

Still want to see? The guy who doesn't know how to live or die.

"Close your eyes, lie down and rest for a while, and test your blood sugar again." Zhang Lin stood up.

Xiaosu has already covered the stage with "lime" -- uric acid crystals -- with a sterile sheet. The number of metal basins holding them has increased to five, and the sixth one will be filled soon.

After the gouty nodules in several large joints were removed, Yang Ping handed over the operation to Song Zimo and Xu Zhiliang to continue.

The blood sugar of the intern lying on the ground rose to 6.2 in the retest, and he was out of danger. He stood up by himself.

"Wow, there are so many, teacher, I still want to see." He stared at the several metal basins covered by sterile sheets on the stage, holding back the sweat from his forehead, and said curiously.

"Do you have self-abuse obsessive-compulsive disorder? Do you think there is not much to do?" Zhang Lin said in a stern tone.

Song Zimo said while performing the operation: "Let him take a look, as a desensitization treatment, so many people are here, nothing will happen."

The sterile sheet was slowly lifted, revealing pure white "lime" piled high in metal basins.

"Teacher, I still can't do it."

The intern quickly looked away, and the people next to him immediately supported him, his face turned pale again, and the first desensitization treatment failed.

"Take your time and desensitize a few more times." Yang Ping had already taken off his surgical gown and rested aside.

(End of this chapter)