Chapter 31 Kung Fu in the audience
"Senior Brother Yang also did such a good job in his fracture surgery."
"Broken collarbone, it's very simple, I can do it too."
"Can you do it in 6 minutes?"
“-——”
Song Zimo sat aside silently.
How many clavicles does this guy have to do to make it like this? I thought he would just cut off his fingers and replant them.
Even the chain epithelial nerves are protected. Many doctors don't pay attention to this at all. Especially when using transverse incisions, they cut the cutaneous nerves with one knife. The skin around the surgical site is left numb after the operation. Numbness means numbness. It is a small problem and inappropriate. Something happened.
The hemostasis was very good and there was almost no bleeding visible on the gauze. The periosteal dissection is kept to a minimum and the blood supply of the fracture is protected to the maximum extent.
The second one is a comminuted fracture of the clavicle. Don’t underestimate any fracture operation, because there will never be exactly the same fracture, so orthopedics in trauma tests a person’s adaptability.
The clavicle is not only broken into several segments, but each segment is also divided into several front and back flaps. This kind of fracture reduction sometimes makes doctors very embarrassed. Some doctors had to end the operation hastily and reluctantly completed the operation.
There are two different things between completing a surgery and doing it well. A high-quality surgery has fewer complications and good postoperative functional recovery.
"This is difficult to do!"
Looking at the fragmented bones, even the attending physician with some experience expressed concern.
Lao Han looked at the X-ray film on the reading lamp - it was really not easy to do.
The fracture has been restored during surgery. Everyone cheered up, and Song Zimo also concentrated.
See how he copes with this kind of fracture, or how he handles it perfectly.
Based on Song Zimo's experience, seeing how Yang Ping handled his first clavicle surgery, it was not something that could be accumulated through several dozens of surgeries. He believed that Yang Ping could handle it, but was curious about how he could handle it perfectly.
1.2mm K-wire, this time the steel needle used is thinner.
The vascular forceps carefully clamp the bone fragments and are very stable, just like clamping an egg firmly. It is firmly clamped in the forceps without using excessive force to crush the bone fragments. Even a little bit of the soft tissue on the upper band is gently preserved,
Big ones first, then small ones.
Horizontally, vertically, obliquely, almost every bone piece has thin steel needles.
The bone pieces were put back together and their shape returned to their original shape.
"How are you going to put the steel plates on later? These will interfere with the placement of the steel plates."
Someone frowned.
Shape the steel plate and put it on, this time in the front. Most of the steel needles avoid the steel plate. There are two that cannot be avoided, but they just pass through the holes of the steel plate without affecting the placement of the steel plate at all.
The insertion position of each steel needle was planned in advance, and the placement of the steel plate had been taken into consideration. Everyone suddenly realized.
When inserting screws, the direction of the screws in each hole is different, and a bone block will be controlled. Each time a screw is inserted, at least one pin is pulled out, and with the last screw inserted, the pin is completely pulled out.
The fracture was well reduced and fixed very firmly.
Lao Han smiled slightly, this is a tricky thing to handle. In order to solve the problem of temporary fixation interfering with the ultimate fixation, I have spent a lot of research on it. It seems that this kid has also spent a lot of effort on research.
Song Zimo was satisfied. Simple things often require a lot of effort.
In other words: one minute on stage, ten years of hard work off stage.
The entire process embodies the concept of protecting blood supply at all times. Even if some bones and soft tissues may be broken by a slight movement, they are still protected.
Only bones with soft tissue attached have blood supply and are living bones; while bones without soft tissue attachment and completely separated from the body are actually dead bones. Only living bones have the ability to heal, dead bones do not, and living bones can only be extended and grown to replace them.
Fifteen minutes after the operating room was cleaned and disinfected, the third unit was ready to start.
This operation involves the exploration of blood vessels and nerves under the clavicle, and is considered a level 4 operation.
This kind of exploration is a high-risk operation.
On Channel 3, Lao Han was a little worried.
When it comes to vascular and nerve exploration, it is no longer a simple clavicle fracture surgery. These stubborn old men on the expert panel are not soft-hearted at all when judging, and they will pick out the bones in your eggs.
"The tip of the fracture has penetrated the blood vessels and nerves under the clavicle. Be careful when exploring later, especially the bone fragments. Do not move them easily. Exploring clearly and making preparations to stop the bleeding, then remove the bone fragments. It is very likely that once the bone fragments are removed, the blood vessels The severed end will retract, and the chest will need to be opened to stop the bleeding, which is troublesome," Lao Han reminded Yang Ping.
Lao Han is rich in experience. He doesn't actually need to sit here all the time. Sitting here, in addition to seeing what Yang Ping's orthopedic surgery skills are, I also want to give Yang Ping timely guidance and ensure the safety of the patient.
The exposure is step-by-step, with a conventional transverse incision to facilitate exploration of the subclavian blood vessels and nerves.
Below the clavicle, on the outside are blood vessels and nerves, extending to the upper limbs; on the inside is the apex of the pleura, which is the tip of the chest and lungs.
If the pleura is punctured, it may cause hemopneumothorax, which requires thoracic surgery to come to the rescue.
Exposure in orthopedic surgery is very important. Many surgeries have to go through many blood vessels and nerves, and some also go through the internal organs. These blood vessels, nerves and internal organs are like minefields. To reach the destination of the surgery, you must bypass or cross these minefields.
Therefore, our ancestors spent a lot of effort to design various approaches to avoid or cross these minefields. The muscles were peeled off and opened from under the collarbone, and inside, blood vessels as thick as a little finger were seen, as well as yellow nerves. The blood vessels pulsed rhythmically, and there was a living life under the hand.
Once these are damaged, it can range from disability to death.
Slow down, Yang Ping holds Xiao Wu's retractor. Only by respecting life can one become an excellent doctor.
A sharp piece of bone penetrated between the blood vessels and nerves, and was surrounded by blood clots. There are many more blood clots than normal fractures, covering the blood vessels and nerve areas. Meaning blood vessels may rupture, veins more likely.
"Be careful, the subclavian vein ruptures. Once it retracts, the incision must be enlarged and the thoracotomy must be performed." Lao Han reminded again.
Prepare ice saline and blood vessel clamps.
Yang Ping stopped moving his hands. Although he was not nervous, he could not be rash.
I have practiced countless clavicle fracture operations in the system, but no trauma can be replicated. Everyone's physique is different, the direction of the force is different, the posture of the body at the time is different, and other influencing factors are different. .
Therefore, systematic training only gives you an opportunity to acquire abilities. In real surgery, you need to adapt to changes.
Ice salt water can constrict blood vessels, minimizing risk.
A metal basin was delivered with ice salt water. Yang Ping soaked it with gauze, took it out, and poured some on it.
With so many blood clots, the process of removing the blood clots can easily involve the blood vessels, causing them to retract, resulting in catastrophic consequences.
Lao Han regretted a little. He shouldn't have chosen such a case. If there was an accident during the operation, he would be rejected by one vote.
Although coming on stage at this time can give those old men a bad impression, the patient's safety is the most important thing.
"I'm going to wash my hands." Old Han went to wash his hands.
Yang Ping waited for the ice saline to take effect. He held the tissue scissors in his left hand and the vascular forceps in his right hand to gently separate the blood clot from the outside to the inside.
The place where the subclavian vein comes out to form the axillary vein is clearly separated, and the vascular clip is clamped in time. Don't be careless about this, it only blocks possible bleeding, and there is still the possibility of retraction at the proximal end.
Once it shrinks, it is equivalent to the water pipe breaking in the wall. Only by tearing down the wall can it be repaired, otherwise you can only watch it leak.
This is beyond the ability of an attending physician. Even a genius like Song Zimo would lack experience.
For doctors, especially surgeons, surgical experience is very important, so a platform is very important for surgeons.
For example, two classmates, one of whom was smart, had good grades and was clever, went to the county hospital. One frequently failed and was clumsy and went to a top tertiary teaching hospital. Ten years later, the county hospital will not be able to compare with that of the top tertiary hospital. Because people perform surgeries every day, you may not encounter one a year. This is the gap.
The number of cases is the reason why doctors, especially surgeons, widen the gap.
So even if you are a genius, if you have not reached a certain level, you do not have the authority for this type of surgery and cannot accumulate and improve.
"We encountered one last time. The blood vessels retracted. We opened the chest and found the blood vessels to stop the bleeding."
"I've seen blood spurting from the arteries here, to the ceiling."
Those who have seen it have lingering fears and discuss it carefully.
The blood clot is lifted bit by bit, then clamped with a vascular forceps, picked up, and placed in a curved plate.
Song Zimo moved forward and used a blood vessel clamp to clamp the blood clot. He practiced for a long time before he could clamp it firmly. Because blood clots are fragile and will break apart with a little force, you usually use a curette to remove blood clots, scrape them off, and then push them out in piles.
At this time, if you use a curette, it is easy to break and retract the blood vessel due to excessive force or pulling.
Vascular forceps can clamp accurately, but this is a technical job that not everyone can imitate.
The blood clot was removed, and the blood vessel break was exposed. It had been blocked by the blood clot, and only a little bit of the connecting blood vessel wall remained.
The proximal end was also placed with a vascular clamp.
Ligation is the safest and simplest treatment, but Yang Ping still chose suturing.
Cut off the broken ends and sew easily. Checked the arteries, no problem.
The outer membrane of the nerve was cut open, and Yang Ping opened the outer membrane to reveal the perineurium inside. There was no problem.
Rinse and sew.
Lao Han came in after washing his hands.
The third operation was completed.
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(End of chapter)