Those years when I hung up and upgraded in the hospital

Chapter 10 True Strength (please read)

After the disinfection and draping was completed, Chen Shengwu motioned for everyone to wear sterile surgical gowns and come on stage. In fact, there were only five people.

Chen Shengwu, Dong Yunshan, Fang Yun, Peng Qingsong and bed doctor Song Wu.

Chen Shengwu smiled again and asked Dong Yunshan: "Dr. Dong, this fracture surgery is not very difficult..."

Dong Yunshan nodded and said, "Director Chen, I'm not familiar with orthopedic surgeries. Let's see him a few times first. I think Dr. Fang can do it. His training place was a large hospital and one of the top ten teaching hospitals in Hunan Province... "

The First Affiliated Hospital of Hengnan University is indeed a very good teaching hospital. All doctors recruited to the hospital must have a doctorate degree or above. Even for hospital employment, at least a master's degree is required.

Chen Shengwu no longer hesitated, and quickly drew an arc on the patient's right lower limb anterior tibial area with sterile toothed forceps: "Make an incision along this line, enter the muscle space to the broken end of the fracture, and expose it first. The fracture gap…”

Fang Yun nodded when he heard the words, and after briefly thinking about the anatomical approach to enter the broken end of this simple middle tibial fracture, he picked up the round knife and very decisively started cutting along the arc drawn by Chen Shengwu. skin operation.

Fang Yun's basic medical skill of incision is level 2. Fang Yun himself can feel that his accuracy in incision has reached a certain level. Not only can he make a complete incision along the marked line, but he can also I can incorporate some of my own insights into the incision.

For example, Fang Yun probably knows that the skin thickness of the pretibial area is about 4mm, and the superficial fascia layer under the skin is about 6mm. If the first knife goes straight to the superficial fascia layer, a large number of capillaries will be cut off. And oozing blood.

Therefore, the cutting depth of the round knife needs to be strictly controlled from the time it is inserted into the knife, when the knife is moved, to when the knife is closed.

Controlling the depth of the incision and the movement of the epidermis is also the ability that Fang Yun has figured out himself, corresponding to the level 2 incision.

When the knife went down, the skin was broken without any shock, it was clean and neat, without hesitation at all.

It was as if a cut had been made on the skin, and the blood had no time to flow out——

"Brother Dong, give me the electric knife." Dong Yunshan was six years older than Fang Yun. When Fang Yun came, Dong Yunshan had just gotten married. At that time, the age difference between everyone was not big, so he was called Brother Dong.

Dong Yunshan handed it over and said with emotion: "Xiao Fang, your level of incision is still not bad at all."

"Director Zhong has praised you before."

Fang Yun smiled back and focused on the field of surgery.

In fact, he didn't fall behind at all, but he hadn't been completely abandoned and downgraded. The current level was obtained by hanging up again. For a while, Fang Yun clearly felt that his in-depth control of the incision technique was not so easy.

The electrosurgery uses electrocoagulation to stop bleeding, and the superficial fascia layer of the subcutaneous tissue can be cut in advance to keep the surgical incision dry and facilitate the surgical process.

"Squeak squeak..."

After the electrosurgery comes into contact with the skin, the electric current generated causes the local tissue to coke, but does not produce carbonization. The protein and tissue denaturation produced by the electrocoagulation can just stop the broken ends of the blood vessels after the capillaries are cut, and prevent bleeding.

When Chen Shengwu was still nodding in approval of Fang Yun's operation, it was obvious that Fang Yun's ability did not stop there.

After breaking through the subcutaneous layer, Fang Yun continued to go deeper, and used the electrocoagulation knife to decisively cut through the fat layer again. When he reached the deep fascial layer, Fang Yun still knew that at this layer, blunt separation was the only way to achieve the goal. It is the best way to cut and expose...

All of this has already been planned in Fang Yun's mind.

Open reduction and internal fixation of fractures is a complete procedure, not a partial procedure, nor is it a simple and simple basic skill.

"Tissue scissors..." Fang Yun asked the nurse and stretched out her hand.

The other party was just stunned for a moment, then passed the tissue cut back to Fang Yun.

Fang Yun used toothed forceps to lift the deep fascia layer on the outer layer of the muscle. After breaking the opening, he put down the scissors and used a vascular forceps as a blunt breaker to open the deep fascia layer as well.

At this point in the surgery, it has already reached the muscle level.

Logically speaking, at this time, Fang Yun should hand over the authority of the surgeon to Chen Shengwu.

However, when Chen Shengwu saw that Fang Yun's early operations were so smooth, he couldn't help but start to love talents and see what Fang Yun's specific strength was.

"You go on, and I'll take another look. So far, they're doing extremely well." Chen Shengwu continued to delegate power.He is the chief surgeon. Although Fang Yun is currently in the chief surgeon's position, he is the one who controls and controls the overall operation. Fang Yun asked him out of respect.He continued to delegate power in a procedural and orderly manner.

Fang Yun is not a troublemaker. In many aspects, he is very rule-abiding and sticks to the point.

Fang Yun continued the operation, not incompetently, not overstepping the rules, and not reluctantly.My strength has reached this point, so I have the confidence to continue.

After Director Chen delegated power, Fang Yun continued to do it!

Dong Yunshan and others were even more silent.

Fang Yun is not only able to help, but may also do everything...

Fang Yun still chose the vascular forceps to penetrate the muscle gap. After simply opening it, he used an S-curved retractor to further expand the muscle gap and expose the lowermost periosteum layer.

However, after this exposure, it can be seen that the periosteum layer is not complete, and there are dark black blood groups in the bloody chaos. This is the bleeding after fracture and the blood clot formed after long-term coagulation.

Fang Yun was not in a hurry and continued to glance at Chen Shengwu, but the other party had no intention of taking over.

Fang Yun put down the vascular forceps, took the sterile aspirator from Peng Qingsong's hand on the opposite side, and began to aspirate the blood clots. Blood clots are waste soft tissue and must be cleaned. This is part of the debridement... …

Only by removing the blood clot can better exposure be achieved. This step needs to be cleared and is part of the incision.

There is a saying in surgical practice.

Three years of studying surgery means a lifetime of studying exposure.

The better the surgical field and the better the vision, the easier and simplified the operation will be.

After the blood clot is removed, a relatively clear fracture 'broken end model' is obtained——

The oblique fracture in the middle section is displaced laterally to the left and right, and the displacement distance is about three centimeters. Moreover, the middle section of the fracture has sluggish muscles at the rear, so it is not suitable for manual reduction of the fracture.

As for the surgery, all that needs to be done is the reduction of the fracture, which is not difficult for a fracture that has been exposed to this extent. What's more, the displacement of this fracture is left and right, not shortening displacement.

Therefore, it is only necessary to eliminate the irregularities, debridement, and after the fracture fragments are dealt with, Kirschner wires can be temporarily fixed.

After temporary fixation, internal fixation with plates and screws is performed under visible eyes, and the surgical instrument operation is standardized -

Therefore, the real significance of this operation is to relieve the trapped muscles, and there are no other difficulties, so it is a simple operation.

However, unknowingly, while Fang Yun was looking at Chen Shengwu again and again, the operation came to the suturing part...

At this time, everyone, including Chen Shengwu, looked at Fang Yun in a different way. Their eyes were full of disbelief and thoughtfulness.

The incredible people are Dong Yunshan, Peng Qingsong and Song Wu.

The thoughtful person is Chen Shengwu.

Fang Yun still looked at Chen Shengwu this time. Although Chen Shengwu didn't speak, Fang Yun still took the initiative to speak: "Director Chen, thank you for finishing the work and correcting the mistakes!"

I've done most of the surgery myself, but I can't do it all.

Chen Shengwu is the chief surgeon and does nothing. This is procedurally wrong.You have to do something, you can't just watch from the sidelines.

Chen Shengwu nodded when he heard this: "Okay~"

But in my heart, I felt that Fang Yun had another label: he was a young man who didn't have the upper hand, and rushed forward without tasting the benefits.

(End of this chapter)