"Senior Brother Yang also did such a good job in his fracture surgery."
"A broken clavicle is very simple and I can do it too."
"Can you do it in 6 minutes?"
"---"
Song Zimo sat aside silently.
How many collarbones does this guy have to do to make it like this? I thought he could 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's a small problem and inappropriate.
What's going on.
The hemostatic treatment was in place, with almost no bleeding visible on the gauze. The periosteal stripping was kept to a minimum, protecting the blood supply of the fracture 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. The reduction of this kind of fracture sometimes makes doctors very embarrassed. Some doctors have to end the operation hastily and barely complete 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 hard 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 reduced during surgery. Everyone cheered up, and Song Zimo also concentrated.
Let’s see how he copes with this kind of fracture, or how he handles it perfectly.
Based on Song Zimo's experience, seeing Yang Ping handle the first clavicle surgery, it cannot be accumulated by several dozens of surgeries. He believed that Yang Ping could handle it, but was curious about how he handled it perfectly.
1.2mm K-wire, this time the steel needle used is thinner.
The vascular forceps carefully clamp the bone fragments, which is very stable, just like clamping an egg firmly. It is firmly clamped in the forceps without using too much force to crush the bone fragments. Even a little bit of the soft tissue on it is
, also gently retained,
Big pieces first, then small pieces.
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 install the steel plate later? These will interfere with the placement of the steel plate."
Someone frowned.
Shape the steel plate and put it on, this time in 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 and do not affect the placement of the steel plate at all. p>
The driving position of each steel needle was planned in advance, and the placement of the steel plate was 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 held. Every time a screw is implanted, at least one steel pin will be pulled out. When the last screw is implanted, the steel needle will be completely pulled out.<
/p>
The fracture was well reduced and the fixation was very firm.
Lao Han smiled slightly, this is a tricky thing to handle. He had spent a lot of time researching in order to solve the problem of temporary fixation interfering with the final fixation. It seems that this kid also spent a lot of effort in research.
Song Zimo was satisfied. Simple things often require a lot of effort.
In other words: one minute on stage, ten years 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; 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 have the ability to heal and can only rely on living bones.
The bone extends and grows to replace it.
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, which is considered a level 4 operation.
This kind of exploration is a high-risk operation.
Channel 3, Lao Han is a little worried.
When it comes to blood vessel and nerve exploration, it is no longer a simple clavicle fracture operation. These stubborn old men on the expert team are not soft at all during the review, and they will pick out the bones for you.
"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 possible 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, so 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 like, the main reason is to give Yang Ping timely guidance and ensure the safety of the patient.
The exposure is step-by-step, with conventional transverse incisions to facilitate the exploration of the blood vessels and nerves under the clavicle.
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 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 from under the clavicle and opened, and inside you saw blood vessels as thick as your little finger, as well as yellow nerves. The blood vessels were beating rhythmically, and there was a living life under your hands.
Once these are damaged, it can range from disability to death.
Slow down, Yang Ping holds on to Xiao Wu’s retractor. Only by respecting life can one become an excellent doctor.
A sharp piece of bone penetrated between blood vessels and nerves, and was surrounded by blood clots. There were many more blood clots than normal fractures, covering the blood vessel and nerve areas. This means that blood vessels may rupture, and veins are more likely to rupture.
.
"Be careful, the subclavian vein ruptures. Once it retracts, the incision needs to be enlarged and the thoracotomy needs to be done." Lao Han reminded again.
Prepare ice saline and blood vessel clamps.
Yang Ping stopped and moved 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 there are other influencing factors.
.
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 and minimize risks.
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 regrets 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 safety of the patients is the most important.
"I'm going to wash my hands." Lao Han went to wash his hands.
Yang Ping waited for the ice-cold 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 emerges to form the axillary vein is clearly separated, and the vascular clamp is clamped in time. This should not be careless, as it only blocks possible bleeding, and the proximal end may retract.
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 will lack experience.
For doctors, especially surgeons, surgical experience is very important, so a platform is very important for surgeons.
For example, two classmates, one is smart, has good grades, and is ingenious, so he went to the county hospital. The other one often failed, was clumsy, and went to a top tertiary teaching hospital. Ten years later, the county hospital will not be able to compare with the top tertiary hospital. Because
Of the surgeries that people do every day, you may not get one in 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, but 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 arteries here spurting blood, spurting to the ceiling."
Those who have seen it have lingering fears and discuss it carefully.
The blood clot was 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 steadily. Because blood clots are fragile and will break with a little force, usually a curette is used to remove blood clots and scrape them off.
, and then poke them out pile by pile.
At this time, if you use a curette, it is easy to break the blood vessel and retract it 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.
A blood vessel clamp was also placed on the proximal end.
Ligation is the safest and simplest treatment, but Yang Ping still chose suturing.
Cut off the broken end and sew easily. Check the artery, no problem.
The outer membrane of the nerve was cut open. Yang Ping opened the outer membrane and exposed the perineurium inside. There was no problem.
Rinse and sew.
Lao Han came in after washing his hands.
The third operation was completed.
***The author has something to say***
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