medical simulator

On the operating table, Wang Yongjin, Zeng Yi, and a strange middle-aged man were busy. Of course, Li Changhong himself was the assistant.With a bunch of subordinates.

Replanted two severed fingers respectively.

On the stage, that strange middle-aged man should be the Professor Chen mentioned by Yang Yifeng.

When Zhou Cheng was still looking at other people, Yang Yifeng saw Zhou Cheng, stood up, and said, "Brother Zhou Cheng, come and take a look. This is the severed and damaged forearm of both hands, near the elbow. !"

Hearing Yang Yifeng's words, both Zeng Yi and Wang Yongjin raised their heads, and hurriedly said to Professor Chen who was working hard on the operation: "Ms. Chen, this is Xiao Zhou from our department."

"Last time, there was a patient with arterial embolism in all limbs. He also performed the limb salvage surgery. We saw it with our own eyes."

To be honest, they didn't think of Zhou Cheng at first, but after Yang Yifeng brought Zhou Cheng up, they suddenly realized.

Yang Yifeng and Zhou Cheng came to the operating table side by side. Professor Chen also temporarily stopped the operation. After looking at Zhou Cheng for a while, he was stunned.

Looking at Yang Yifeng, he smiled and said, "Yifeng, is this really the doctor Zhou you recommended to me? It's very different from what I expected."

Chen Tingye expected that no matter how young Zhou Cheng was, he would still be in his thirties, he couldn't be older, no matter how old he was, he would definitely not be able to get along with Yang Yifeng.

Originally, Chen Tingye knew that Yang Yifeng was very good at vascular surgery, so he called him as a living doctor, but he couldn't make it to the stage.

Then Zhou Cheng was recommended.

"Hello, Professor Chen, Director Wang, Director Zeng, Director Li." Zhou Cheng greeted each of the superiors on the stage one by one, while the others all passed by.

One is unfamiliarity, and the other is to avoid delaying time.

Yang Yifeng said truthfully: "Mr. Chen, I'm not lying. Brother Zhou Cheng is better than me."

This is the truth after Yang Yifeng made a comparison. During the last operation, he made a conversion in the novel, allowing readers to see the gap between the two in detail, and then replied in the comment area.

Hardcore pretense, although I can't understand it, it's really cool.

Chen Tingye didn't believe Yang Yifeng's nonsense, he just said, "Dr. Zhou, come and take a look?"

Zhou Cheng approached slightly, and immediately frowned: "The damage is so serious? It also hurt the elbow joint. If you want to save the limb, the muscles are not easy to rebuild. I guess I need to do a skin flap later."

When Zhou Chengwu was commenting on his condition, but at this moment, he hit Chen Tingye's heart.

Everyone knows the replantation of amputated limbs, but what they don't know is that the replantation of damaged and amputated limbs is more difficult than replantation of amputated limbs.

This is a combined surgery of limb salvage surgery and replantation surgery, which is a super-level IV surgery, but there are not so many of them in the surgical level.

Ordinary people may think of shortening replantation, but Chen Tingye immediately saw that this patient had the potential of amputated limb replantation + limb salvage surgery.

Inside look at the doorway.

With just this sentence, Chen Tingye at least knew that Zhou Cheng was really knowledgeable.

Immediately said without doubt: "Doctor Zhou, wash your hands and go on stage?"

Originally, I wanted to say something troublesome or difficult, but I didn't say it. It's not that I can't say it, but that it's inappropriate for Chen Tingye to say it.

Zhou Cheng glanced at Zeng Yi and Wang Yongjin, both of them nodded.

Then he said: "Professor Chen, I may have to go to the bathroom to rub my face and calm down a bit. Please wait for me for a while."

Zhou Cheng is actually a little tired at the moment, and he hasn't rested yet, so he needs to stimulate himself with temperature to wake him up, and use his utmost mental strength to deal with the operation.

After all, he is the man who underwent limb salvage + two severed palms and two severed fingers replanted today!

From outsiders' point of view, Zhou Cheng might just be waking up and dozing off, so he didn't say much.

When Zhou Cheng came to the stage and observed the surgical field for a while, he said, "Mr. Washing hands, the catheter for arterial thrombus removal!"

The handwashing nurse was puzzled. Zhou Cheng glanced at her and realized that there was a mistake. The previous operation was performed at the No.1 Civilian Hospital in Shaxian County, which is the No. [-] Hospital.

So I could only feel a little bit of emotion, and asked for a sharp knife!

Chen Tingye has already done a good job of debridement, but there are still traces of damage.

Being able to debride the damaged limbs to have the potential and vitality of replanting the severed limbs, this basic skill is enough to make Zhou Cheng feel very good.

The reason why it's just very good is that he can do it too, and it's not good to talk nonsense in his heart, using the word "look up".

In addition to debridement, Chen Tingye also performed anastomosis of blood vessels, and he only performed anastomosis of blood vessels first.

That's right, for severed finger replantation, the order of surgery will vary according to the time of the patient's injury.

The former Tan Yuanwu was immediately pushed into the operating room because he was injured on the spot.

As for this patient, when Chen Tingye rushed over, it had been more than two hours. It took time to debride the wound. If the blood vessels were not anastomosed unobstructed, other operations would be meaningless.

It was also after the anastomosis that no distal blood supply was found, at least unsatisfactory, which allowed Zhou Cheng to remove the thrombus.

When I called Huang Shinan from the 'vascular surgery department', this brother was terrified, and he came to the operating room to take a look and then yo-yoed.Then Yang Yifeng was called, and Yang Yifeng called Zhou Cheng to the operating room.

However, Zhou Cheng didn't keep Chen Tingye and the others waiting for long. After touching the blood vessel for a while with his hand, he made an incision in the patient's distal skin.

The blood supply is not smooth, so no blood flows out.

But this didn't seem to affect Zhou Cheng's operation at all, he quickly pulled out the small blood vessel and cut it on the spot.As soon as the thrombus was peeled back, fresh blood gushed out immediately. Chen Tingye had been prepared for a long time!

It was a man, also a surgeon, who got excited when he saw blood.

"Bleeding, bleeding!"

It's late at night, but fortunately, it's in the operating room, otherwise I'm afraid it will cause some misunderstanding...

Chapter 156 If you can't speak, can you not speak? !

Unobstructed blood supply is the guarantee for the success of severed finger replantation!

Blood is the source of life.

However, although Chen Tingye was very excited after seeing the blood, Zhou Cheng didn't let the blood flow for too long, but immediately clipped the artery near the heart with an artery clip after seeing the blood.

The remaining blood still flowed for a while, and the tiny blood pools formed were sucked up one by one by Zhou Cheng with the suction device.

Turning to look at the patient's blood pressure, it was still stable, and then he let out a sigh of relief.

Only then did Chen Tingye and Zeng Yi realize their gaffe.

This is a replantation of a severed limb. Although as a hand surgeon, he should be excited instinctively after seeing blood, he shouldn't be looking at it for so long.Let the blood flow and ignore it.

"Vascular sutures." Zhou Cheng directly asked the handwashing nurse to open the prepared sutures.

In fact, the best way to remove thrombus is to have a professional thrombus removal tool from vascular surgery. No matter how bad it is, a catheter can be used at any rate, which will save more time.

Thrombectomy, although cheap, does not require catheter money!

But in fact, the time wasted and the cost of anesthesia are not less than the money for the catheter.

However, Huang Shinan of the Eighth Hospital did not get the catheter into the operating room.

Purchasing new devices, even syringes, must go through the formal approval process of the hospital, and the hospital will purchase them uniformly!The procedure is trivial, although it is also for quality assurance and other corruption, but there will also be a certain degree of restriction.

Temporary purchases need to be signed by Huang Shinan, who is in charge of vascular surgery. Maybe Zeng Yi, as the chief director of the orthopedics department, can get Huang Shinan to sign, but Zhou Cheng will definitely not be able to do that.

Seeing that Zhou Cheng still had to suture the blood vessel to continue to remove the distal thrombus after incision and removal of the thrombus, Yang Yifeng frowned slightly.

Shaking his head slightly.

Now we are racing against time, but because of the equipment, we have to prolong the operation time.

But fortunately, Yang Yifeng saw that Zhou Cheng stitched up the blood vessels extremely fast, and within a short while, the artery he had just cut was stitched up by him.

Because it is not completely cut off, only part of the tubular vessel wall is sutured.

After finishing the beating, Zhou Cheng stuffed the blood vessel into the muscle tissue, but ignored it, and then opened the proximal arterial clamp again——

Finger along the shape of the artery, continue to touch the pulse of the artery with the pulp of the index finger (the index finger is the index finger, the index finger is the official term, because the index finger is mostly used to refer to objects).

The naked eye is neither CT nor X-ray, and has no penetrating ability.

Therefore, the specific location of the thrombus cannot be seen.

In fact, speaking of it, the reason why arteriotomy and thrombectomy is classified as a Class II operation is not that thrombectomy is so difficult, but it is very simple, as long as there is a CTA showing intravascular thrombus Location.

It can be done by a senior resident who is very familiar with surgical anatomy.

But the reason why limb salvage is quite difficult is how to recanalize the blood vessels without CTA. This is an urgent matter for vascular surgery.

Post-traumatic arteries have multiple embolisms, and the position of the thrombus is not fixed. It is basically unrealistic to search for the thrombus throughout the entire process of penetrating the artery.

At present, the blind extraction of thrombus is limited to one or two sites. If a catheter is used to remove the thrombus at a distance, it is life if it can be removed. If it cannot be removed, the limb must be amputated.

How much work can be done depends entirely on the level of the surgeon and the luck of the patient himself!

In other words, positioning is difficult.

In modern medicine, the most difficult thing is not the operation, but the diagnosis, which includes positioning and qualitative.

Sometimes it is difficult to locate, and sometimes it is difficult to identify.

Therefore, when Chen Tingye saw Zhou Cheng pull out the radial artery again as if he was catching a loach, he and Yang Yifeng finally saw something wrong with Zhou Cheng.

Chen Tingye himself is a giant in hand surgery, and has a deep connection with vascular surgery, so he knows a little bit about it.And Yang Yifeng's talent in vascular surgery is excellent, and he has made the professor of vascular surgery at the Affiliated Hospital of Shonan University sigh more than once.

Yang Yifeng entered the wrong line.

Seeing Zhou Cheng's technique, Yang Yifeng's mind was moved.

It seems that Zhou Cheng's arteriotomy and thrombectomy is no longer just a skill, but a skill.

Skills, skills are skills, ability is ability, know this skill.

Skill is art.

He can feel the location of the thrombus and the pulsation of the artery with his fingertips. He is the most clear about the difficulty and extent of this.

The reason why Yang Yifeng dare not go to the operating table anymore is because of his nervousness, and the trembling of his hands caused by his nervousness.

For a good surgeon, hands are extremely important!

To a certain extent, cognition determines the upper limit of surgery, and the volume of surgery, or the honed surgical skills, is another guarantee for the quality of surgery.

If he could have Zhou Cheng's hands, wouldn't it be possible that his parents wouldn't die?

……

Another thrombus was pulled out by Zhou Cheng. When the dark red long blood clot was pulled out of the blood vessel, there was a sense of stagnation. It seemed quite decompressed. The whole long strip was unbroken and pleasing to the eye. .

Great for relaxing your mind.

Perhaps Li Changhong had seen Zhou Cheng take thrombus before, so he was not surprised, but the faces of Zeng Yi and the others were quite strange.

This almost showed Zhou Cheng's kung fu to the extreme.

Although they have not had much experience with thrombectomy in vascular surgery, they have all eaten hot pot. The duck blood in the hot pot is often ordered.

Dried duck blood is very hard, and it may rot if you pick it up, let alone wet duck blood that has solidified?

PS: (If it is difficult to understand, use chopsticks to pick up duck blood or pig blood when you are in the hot pot!)

Zhou Cheng was busy but not chaotic, concentrating on it.Did not pay attention to other people's eyes and expressions.

Although arteriotomy and thrombectomy is only a simple level II skill, in order to practice this skill well, he spent a lifetime immersed in the simulated copy before reaching the perfect level. Naturally, there are reasons and ways.

And it's not the time to teach.

After sewing again.

Zhou Chengcheng also took out a thrombus in a communicating artery!

After releasing the proximal arterial clamp, blood was seen.

After suturing, continue to test the blood supply of the distal limb.

simple.

Then he called up a syringe and poked the pulps of five fingers with the needle.

It wasn't torture, and the patient was already anesthetized. By the time he regained his senses, the punctured needle hole had already healed.

I saw that the blood vessels of the thumb, middle finger, ring finger and little finger were all unblocked, and a little bit of blood slowly seeped out.But the pad of the index finger is still peaceful, no blood is seen.

At this point, Zhou Cheng immediately said: "Professor Chen, the proper artery of the index finger is probably thrombused, let's ignore it for now, you deal with this hand first, and I will go to the opposite side to get the thrombus!"

"The blood coagulation status of this patient is probably not very good. The incisions I made to remove the thrombus will not be closed for the time being, shall we keep them?" This is a suggestion.

Chen Tingye nodded immediately, before he had time to sigh with emotion, and said, "Okay, thank you for your hard work, Doctor Zhou."

"I'll start suturing part of the vascular bed right away. If this patient is fixed, then use external fixation." Chen Tingye said rather excitedly.

For amputated limbs with long-term ischemia, the vascular bed is sutured afterward. The vascular bed is another name for the muscle. In fact, it can also be called the nerve bed, whichever it is.