Dean Pan, people from the health bureau, township government, and village chief Fang all came to see Yang Ping and expressed their gratitude, condolences and apology.
Tian Yuan reported Yang Ping's injury to Director Han. Director Han reacted greatly after hearing this and ordered Tian Yuan to shorten the support time and withdraw the troops in advance. The specific withdrawal time will be notified by him.
Then he immediately called Yang Ping, anxiously asking about his injury and telling him to take a good rest.
Soon Director Tian and Song Zimo both received calls. Director Han repeatedly warned them to take good care of Yang Ping and not to get infected.
About ten minutes later, Director Han’s call came to Tianyuan’s mobile phone again.
After answering the phone, Director Tian said: "When I go back early the day after tomorrow, the hospital will send a car to pick me up. The car will arrive tomorrow. All of us in the orthopedics department will go back early."
"I told Director Han, and Xiao Su also came back." Director Tian added.
Tianyuan was very busy, and his cell phone rang again. It was Director Pan's call. He had received a notice from his superiors that because there was an emergency at Sanbo Hospital, several members of the medical team had to go back early."
"Want to go back early? The patient with chronic osteomyelitis of the femur, Xiao Xu, hasn't had the surgery yet?" Yang Ping has been thinking about this patient.
Xiao Xu's bacterial culture showed that coagulase-negative staphylococci were cultured on the exposed bone, but no bacteria were cultured on the other parts. This is consistent with the expected judgment, and surgery can be scheduled.
Director Tian said: "Just leave the operation to Director Zeng. You can clearly explain the key points of the operation."
Yang Ping was worried: "That won't work. This operation must be very thorough in removing the infected bone tissue. If even a little bit is not removed completely, the operation will fail."
"Then let him come to Sanbo in the future." Director Tian was also in a dilemma. The time for his return trip has been set. According to Director Han's temper, it is difficult to change it.
"His financial situation is not good, and now he has no money to go to the provincial capital." Yang Ping sympathized with Xiao Xu.
"Let's do it tomorrow and let Song Zimo do the surgery." Yang Ping said.
He asked Xiao Wu to call Director Zeng and instruct Director Zeng to sterilize the external fixator and supporting equipment in advance. He also told the patient to start fasting and fasting, and to have a thin-slice CT scan of the entire length of the femur tomorrow morning;
Use vascular color ultrasound to find the recipient artery in the skin defect site and the donor site artery in the latissimus dorsi muscle; then consult the internal medicine department for perioperative thyroid function management.
"For this patient, every imaging examination shows that the scope of infected bone tissue has increased. I'm afraid that if we don't do it now, then the whole femur will be infected, and then there will be no chance." Yang Ping explained.
"I've seen this patient's film. I heard that you considered local bone tissue infection in the femur. Are other imaging abnormalities caused by hyperthyroidism and bone mineral disease?" Director Tian asked.
"Yes, so we should remove the infected bone tissue as soon as possible." Yang Ping said.
"I will also go on stage tomorrow to help Song Zimo." Director Tian was very interested. After arranging the surgery, Yang Ping felt relieved.
In the evening, Yang Ping went to bed early.
After entering the system, I dissected several experimental subjects, and the anatomical image of the human body was initially established in my mind.
For doctors, especially surgeons, composition ability is very important.
Yang Ping originally had a strong composition ability, and through systematic and powerful training, the human anatomy diagram in his brain gradually became clear. With his eyes closed, the main internal organs, nerves and blood vessels were very clear, but some details needed further work.
Strengthen.
In the system, although physical energy is not consumed, mental fatigue still exists, so I didn’t stay long before I came out of the space and went to sleep.
Early the next morning, Xiao Su came to WeChat and waited outside the dormitory to accompany her to have breakfast.
Looking at the corner, Xiao Su feeds Yang Ping breakfast bite by bite.
Fatty Liang said: "The first time I saw them, I felt there was a story."
"What story?" Zhang Lin was curious. Is there any story he didn't know?
The fat man said confidently: "That night, it was the emergency diagnosis. Brother Yang was doing surgery for the first time, and Xiao Su was the instrument nurse, and the two of them looked wrong."
"No way? No wonder, we have known each other before. You said that my senior brother came to Sanbo from the People's Hospital just for Xiao Su, right?" Zhang Lin touched his chin and made bold guesses to dig up stories. He has a talent. p>
The fat man nodded affirmatively: "It's probably true that the two of us were secretive before. If Brother Yang hadn't injured his hand this time, he would have had to hide it. How deep would it be?"
Zhang Lin said: "Yes, this guy, some time ago, a few of us suspected that they were getting married, but the senior brother was adamant and refused to admit it. Now it seems that our guess was right."
Xiao Wu stood silently aside.
"Why are you mute today?" Zhang Lin asked him.
Xiaowu is also confused now and can't figure out his clues.
After the shift was over, it was not convenient for Yang Ping to conduct ward rounds, so Song Zimo took everyone to do ward rounds.
After the ward check, in the doctor's office, everyone was preparing to discuss Xiao Xu's condition. There was a lot of noise outside. I was afraid it wasn't the patients causing trouble. Director Zeng stood up and said, "I'll go out and take a look."
"Here, here!" Teacher Yan came in with a cane.
His son and daughter-in-law carried a big banner with several gold characters on it: Cure the disease at your fingertips!
"Director Yang, what's wrong with you?" Teacher Yan exclaimed when he saw Yang Ping's hand.
Yang Ping smiled and said: "It's not a problem if you accidentally scratch it."
Teacher Yan nodded: "That's good, there won't be anything wrong with your hands."
The old man directed his son and daughter-in-law to carry the banner in. This banner was big enough, at least three times the usual size.
"Director Yang, I have nothing to thank you for. I just want to send you a banner to express my feelings. I originally wanted to write a poem, but I held it in for two days and couldn't come up with it. So it's more appropriate to send these words."
It was lively for a while, everyone continued to discuss Xiao Xu's condition, and Director Tian also came to the orthopedics department.
Xiao Xu returned to the ward after the CT scan. The bedside doctor came up with his CT film, and Director Zeng hung the film on the reading light.
"For this patient, there are three main surgical steps. First, remove the intramedullary nail and replace it with an external fixator; second, remove all the diseased bone tissue and fill the bone defect with calcium sulfate containing vancomycin; third, use
The free latissimus dorsi myocutaneous flap repairs the defective part. The most difficult part is to remove the infected bone tissue. It must be precise and thorough. Every imaging examination shows that the scope of the infected bone tissue is expanding, so we have to re-do it before surgery.
Do a thin-section CT scan to determine the scope of infection."
Yang Ping briefly explained the steps of the operation, then carefully read the film under the reading light, and said: "In the extended position, ten centimeters from the upper edge of the patella, make a rectangular bone flap, eight centimeters long and three centimeters wide. The midline of the rectangle is this
The midline of the femur. Only in this way can the infected bone tissue be completely removed. Give me a piece of paper."
Someone pulled out a piece of A4 paper from the printer. Yang Ping held the pen through the gauze bandage and started to draw on the paper: "This is the shape of infected bone tissue, and this is the shape of a cuboid."
Draw an irregular three-dimensional figure on the paper, surrounded by regular cuboids.
"How did you calculate it?" Song Zimo looked at the drawing.
Yang Ping said: "It is constructed based on the CT scan pattern, and 20% of normal bone tissue is added around it to create a safe zone."
Song Zimo thought, this requires strong composition ability. If he were to draw it himself, he would probably need to measure and try out the drawing repeatedly before he could draw it. He looked at the film like this and drew it by visual inspection. What kind of brain composition imaging is this?
Ability.
Director Tian adjusted his glasses: "How sure are you of success?"
"Theoretically, it should not fail." Yang Ping was sure, after all, the range was calculated from CT scans.
"The skin and muscle defect is trimmed into an oval shape, twelve centimeters long and five centimeters wide. The latissimus dorsi myocutaneous flap is routinely increased by 20% on this basis. The latissimus dorsi muscle can just repair the vastus lateralis muscle defect.
."
The person from the color ultrasound room is here, the doctor in charge of the bed is notifying.
Yang Ping and the doctors in the color ultrasound room searched for the arteries in the defect area and the latissimus dorsi muscle together, and marked all the available arteries one by one.
A skin flap is to take a piece of skin from one place to replace the missing skin in another part. If the distance is short, the blood vessels can be transferred to the location to fill it. If the distance is far, the blood vessels can be cut off and then connected to the blood vessels of the defective part.
Myocutaneous flap is taken together with the muscle and skin, which can not only replenish the skin, but also replenish the muscle.
It’s all a job of tearing down the east wall to make up for the west wall.
Yang Ping asked Song Zimo to draw the shape of the defective part and the shape of the latissimus dorsi flap with surgical scribing pens.
"Doctor, when you're done, I'll go join the army."
Xiao Xu still remembers being a soldier.
Yang Ping looked at him wearing glasses: "You are short-sighted, and you are still a soldier?"
Xiao Xu took it off: "Flat mirror, wear it for fun."
You can't become a soldier. The young man will know in the future that sometimes there are conflicts between dreams and reality, and some are irreconcilable conflicts.
The internist looked at the thyroid function data and found that it would not affect the operation for the time being. He would recheck the thyroid function after the operation and control it with medication. During the operation, he went to the operating room to follow up and be alert to thyroid storm.
Song Zimo was the surgeon, with Director Tian as the first assistant and Director Zeng as the second assistant. This operation was not difficult for Song Zimo.
During the process, Yang Ping patiently guided Song Zimo about the precise positioning of infected bone tissue. Song Zimo also had certain composition skills and was easy to understand.
Yang Ping repeatedly confirmed that the infected bone tissue had been completely removed, with a ring of normal bone tissue surrounding it. This is the most ideal situation.
Chronic osteomyelitis is the most troublesome problem in orthopedics and what orthopedic surgeons are most afraid of. Because the bacteria are hidden in the bone tissue, antibiotics cannot reach them and are beyond the reach of the bacteria. Therefore, once you suffer from chronic osteomyelitis, it will recur again and again and cannot be cured for many years. If there are no accidents, Xiao Xu should be able to recover this time.
