on Monday.

Ling Ran came to Yunhua Hospital in high spirits with his thesis.

At five o'clock in the morning, the hospital was slowly waking up. Dozens of breakfast carts occupied several pedestrian passages of Yun Hospital. On the way to the parking lot, the security guards also started to collect fees. The most active ones were scalpers.

They sell famous expert numbers, whether they are director numbers or deputy director numbers, all based on fame and fairness, so much so that doctors occasionally make fun of them at this price.

Long queues began to form in front of the outpatient clinic fee counters. The specialist outpatient clinics costing 13 yuan or 17 yuan were their first choice. Only when all the specialist numbers were registered, would anyone choose the general outpatient clinics costing 5 yuan or 7 yuan.

The scalpers among them can raise the price of an expert account worth 17 yuan to 60 yuan, and then sell it for 80 yuan or even 180 yuan.

In the month when Pan Hua came back with the "Japanese expert", the price of the expert account was as high as 500 yuan, which was also rare in Yunhua Hospital.

Compared with scalped tickets for celebrity concerts and the like, hospital scalped tickets are even more profitable. Experts visit every week, so they don’t have to worry about selling, the supply is very stable, and transactions are mainly in cash...

The emergency building is actually more peaceful.

The patients for the night have been settled, but the patients for the day have not yet arrived, and the nurses in the reception area are a little drowsy.

"I brought you some fruits." Ling Ran placed a bag of fruits from home on the waiting table.

The two young nurses said in surprise: "Doctor Ling is so polite."

"It should be." Ling Ran has a pretty good understanding of courtesy. Now he often receives gifts from nurses, doctors, patients, family members, eldest sisters and others. After all, he wants to repay something.

Second. Fortunately, Ling Ran's mother Tao Ping has been preparing gifts in return for Ling Ran, so there is sufficient material supply.

"Wow, the grapes are so fresh..."

"And apples, I like to eat apples the most..."

Regardless of whether it was true or not, the two nurses expressed their fondness for Ling Ran's gift.

"Grapes and apples are grown by relatives and friends in the neighborhood. My family orders some in advance every year, and they can be delivered to our house at any time during the picking season." Ling Ran specifically explained, and added: "Although chemical fertilizers and pesticides are still used,

Everything is within the standard and easy to clean.”

The two young nurses nodded excitedly and said in unison: "Doctor Ling is the best."

Ling Ran entered with a smile, placed the written paper on Huo Congjun's desk, changed into a white coat, and headed to the operating area.

In the operating area, I changed into hand clothes and entered the lounge. Unsurprisingly, I smelled the smell of braised pork.

Ling Ran entered with a smile, and was surprised to find a flat plate with more than a dozen pig's trotters piled on it. There was also a small sign on the lower right with a QR code, and a description beside it: In order to balance the income and expenditure, pig's trotters are 19.9 each.

Yuan, please pay by yourself.

When I looked up again, I saw Lu Wenbin standing next to the table with a smile on his face. His white coat looked more and more like a chef's.

"Are you ready for the operation?" Ling Ran's focus was always on the operating room, pig's trotters and so on... Of course they are delicious but also useful.

While Ling Ran was talking, he took out his cell phone and scanned the code for a pig's trotter.

Lu Wenbin fished out a big one from the bottom, handed it to Ling Ran with both hands, and said with a smile: "The operating room is ready. The anesthesiologist is Su Jiafu, and the MRI films are also placed inside. The 38-year-old air conditioner,

My hand got stuck while installing the air conditioner, and my index finger was rotated and avulsed. The skin was severely damaged, and the tendons and blood vessels were detached."

Compared with cutting injuries, rotational avulsion disconnections are much more serious.

For doctors, the survival rate of replantation will also be reduced.

Ling Ran nodded slowly and asked, "What are the expectations of the patient and family for the surgery? They know that the possibility of complete recovery is close to zero."

"The family understands." Lu Wenbin said: "I informed them that skin grafting and blood vessel transplantation will be carried out, and the shortening of the fingers is inevitable. The family members said they can accept it. However, the patient hopes to restore the hand function as well as possible and recover quickly.

Some, can get back to work sooner."

Lu Wenbin paused as he spoke, and then added: "The patient's family conditions are not very good, and he is also more concerned about medical expenses."

Ling Ran nodded slightly, these were considered normal requirements for replanting a severed finger.

The patients who encounter the most severe finger replantation are industrial workers. Industrial workers care less about appearance and are more concerned about survival ability and medical burden.

"Come in." Ling Ran threw away the pig's trotter bones, wiped his mouth clean, washed his hands, and entered the operating room. With the help of the nurse, he put on the surgical clothes that covered his whole body.

At this time, the operating room is in an almost sterile state.

However, the sterility standards of emergency department operating rooms have always been low, and the same is true for hand surgery. After all, it is impossible to thoroughly clean the operating room every time a patient enters.

The operating room of neurosurgery can do cranial surgery, and the operating room of cardiothoracic surgery can also better eliminate foreign contaminants. The emergency department does not have such conditions, and the same does not exist for hand surgery.

There are also no high-cleanliness operating rooms, including general surgery. When a bag of feces is sprayed on the roof, any high-cleanliness operating room will be blinded.

Ling Ran read the MRI film as usual. Lu Wenbin and Ma Yanlin unwrapped the towel on the patient's hand together and tried to clean the oil stains on the patient's non-surgical site.

After Ling Ran finished reading the film and came back, he would proceed with the debridement.

I saw that his waist and neck were kept straight, his legs were spread apart, his elbows and wrists were firmly supported, and he was highly concentrated...

Lu Wenbin and Ma Yanlin both watched and learned.

Among surgeons, the one who pays the most attention to surgical posture (surgical posture) is microsurgery. Because microsurgery is a typical physical surgery, it requires long-term concentration and the burden on the body is also extremely serious.

Without a good surgical posture, microsurgery doctors will have to go to the operating table before they become famous and have a family.

"Lower the light." Ling Ran ordered, and the circulating nurse immediately came over and lowered the light on the affected hand.

The main function of lighting is to maintain temperature.

A key point in replanting a severed finger is the temperature of the hand. Once the blood temperature drops too much, it will be very difficult for the replanted severed finger to survive.

At the same time, anesthetist Su Jiafu also kept his spirits up and kept an eye on the monitor, always ready to deal with the problems of vasospasm and blood coagulation.

In the operating room, in addition to heparin, doctors can also use several tubes of papaverine. The latter has a more prominent anticoagulant effect and is a super effective special drug. It will probably not be eliminated for a long time.

"We will use the retrograde method today." Ling Ran finished the debridement and made a decision.

Anterograde and retrograde are relative to the order of suturing.

The so-called antegrade method is to fix the bone and joint first, then sew the extensor tendon, then the tendon of the dorsum of the finger, the skin of the dorsum of the finger, then sew the flexor tendon, artery and nerve, and finally sew the skin of the palm side of the finger. It can be seen as easy first and then difficult.

Retrograde is basically the opposite, suturing the most difficult arteries, nerves, and flexor tendons, and then doing the joints, extensor tendons, etc.

Newcomers generally perform anterograde surgery, which allows them to complete more steps step by step and build confidence step by step. Retrograde surgery is a relatively high-end operation, and only a few doctors will use it.

If Ling Ran had only master-level replantation of severed fingers, he might only have mastered the forward method, which is the current perfect level, allowing him to skillfully use the retrograde method.

There is not much difference in the results between antegrade and retrograde. The main difference lies in the doctor's habits, the patient's condition, and the ability to control risks.

For avulsion wounds, fixation of bones and joints is relatively easy, and replantation of arteries and tendons is the top priority.

Ling Ran and Ma Yanlin were each on one side of the binocular microscope, while Lu Wenbin used a high-power microscope to cut out the patient's autologous blood vessels from the upper reaches of his right arm for transplantation.

Arteries need to be transplanted, veins need to be transplanted, and skin flaps need to be transplanted in large areas.

It took the three of them 2 hours to complete the most difficult part of this finger.

"Put on another 10-0." Ling Ran was a little tired, but his eyes did not leave the microscope for fear of losing his field of vision.

laugh.

The operating room door was opened, and Nurse Liu came in with a smile: "When you come out, remember to get eggs. Each person has a box of free-range eggs, a box of salted duck eggs, and a box of 4 potatoes for those above the deputy director level."

After a pause, Nurse Liu added: "Dr. Ling, Director Huo asked you to take his share."

"Oh." Ling Ran still didn't look up.

The same is true for Lu Wenbin and Ma Yanlin.
Chapter completed!