After discussion, the patient’s daughter and son-in-law agreed to the operation.
However, the patient refused the operation and made a fuss about going home. He quarreled with his daughter in the ward and threw the stainless steel cup for drinking water on the ground.
Although my daughter can't help but get angry and lose her temper occasionally, it's only occasionally. There must always be an outlet for the accumulated negative emotions.
The usual complaints are just to vent their emotions. The five old people above the couple were under great pressure and could hardly breathe.
No matter what, she took good care of her father, shaving and wiping him every day, and washing his hair every few days. The food in the hospital was not very good, so she took the time to go back and cook, and brought him to the hospital with an insulated lunch box.
The hospital gave it to my father.
My daughter is a little cotton-padded jacket, and this is the best time to show it.
Like coaxing a child, the daughter patiently explained to her father that she should cooperate with the doctor's treatment so that she could recover quickly and spend less money. If she gave up the operation and went back like this, the infection would spread throughout the body and cause sepsis, and she would have to be admitted to the ICU at that time.
Spending money is dozens of times what it is now. If you don’t spend money now, you will spend a lot of money later. Some things cannot be avoided.
The patient is clamoring not to have surgery, to go home, and to give up treatment. This is because he does not want to spend his daughter's money anymore. If the surgery fails, he will be a bottomless pit and will put a heavy financial burden on his daughter.
.
No one wants to live away from their family with a rotten leg that smells bad.
Even his grandson regards him as a monster and is unwilling to get close to him. He can only stay in the rental house every day, curled up on the bed, and has to be taken care of by his wife.
During this hospitalization, my daughter was afraid that her mother would be overworked and cause complications, so she refused to allow her to go to the hospital to take care of her father, and asked her to take care of the children at home, while she took care of her father herself, peeing and pooping.
After some persuasion from his daughter, who continued to be stubborn and would only cause more trouble for the child, the patient agreed to the operation.
As for the amputation, the patient is not much surprised, let alone unable to accept it. As long as he can bid farewell to this terrible life, amputation is nothing.
If he could really use prosthetic limbs to return to a normal life, he would be eager to share some housework with his daughter, such as helping to buy groceries and take care of the children.
Only those who have experienced loss will cherish it more. Only those who have experienced illness will know how important health is.
This surgery is not difficult at all.
The test is to be serious and pursue perfection in every detail, so as to achieve the greatest success rate.
Uric acid crystals have a very wide impact on the body. It does not only affect the joints, and joint pain is only the mildest manifestation.
Uric acid crystals can also affect blood vessels, causing hardening of blood vessels and causing problems in important organs such as the heart, kidneys, and brain.
Before the operation, Yang Ping repeatedly studied the blood supply of both lower bodies. The destruction of blood vessels by uric acid crystals led to hardening of the arteries of the lower limbs, and some arteries were narrowed. It was finally determined that the amputation plane was above the knee.
Because the blood supply of the lower legs is already very poor, there are huge gout nodules in the bilateral knee joints, the knee joints have been severely damaged, and there are serious functional impairments. Actively raising the amputation plane to the knee will not only ensure a greater chance of healing of the amputation stump, but also
At the same time, it also solves the possibility of future problems in the damaged knee joint.
Many times, surgeons tend to have beautiful fantasies about the outcome, which can make doctors more conservative when making decisions.
For example, when orthopedic trauma surgeons treat some retrograde avulsion of skin, inexperienced doctors always imagine that they can survive when they see that the skin flaps are intact, so they like to suture them in situ. However, contrary to expectations, this kind of skin flaps that have lost blood supply will slowly
Due to necrosis, the patient ultimately required a second surgery and skin grafting.
The experienced doctors never had any illusions and decisively performed reverse skin grafting on the skin flap. The operation was successful in one operation, avoiding the patient's second operation and avoiding taking skin from other parts of the body.
The same is true for this patient. Doctors tend to have fantasies about lowering the plane and preserving the knee joint, but the reality always exceeds the doctor's expectations.
Judging from the condition of blood vessels, Yang Ping felt that he should be more active, give up his illusions, and take drastic measures to amputate the entire calf from the knee, which seemed to be fine.
Yang Ping also carefully evaluated each of the more than 40 gout nodules on his body, and finally decided to remove them all.
During the amputation surgery, Yang Ping did not inflate the tourniquet. The tourniquet was just a backup.
Because during the operation, Yang Ping needs to observe the true blood supply of the limbs. His scalpel cuts through the skin, subcutaneous tissue, deep fascia, and muscles. He needs to observe the blood infiltration in each tissue section. This is the most reliable way to judge the blood supply.
This method is more reliable than any preoperative vascular imaging examination.
He tried to incise the skin on the lower leg to verify his judgment, hoping that he would make a mistake and that the skin would bleed obviously.
However, regardless of the skin, fascia or muscles, without a tourniquet, there is almost no obvious bleeding, and there is still a large amount of pus in the intermuscular space, which has spread from the ankle joint.
The preoperative judgment was correct, the leg must be amputated from the knee.
Yang Ping used a sterile medical film to seal the incised calf, changed the gloves and scalpel, and cut the skin with the scalpel again on the knee and lower thigh, and formed a standard tongue-shaped flap.
Bright red blood began to ooze from the edge of the flap. Yang Ping was not in a hurry to stop the bleeding. This was the effect he was looking forward to.
"The blood supply to the skin is relatively good, and the bleeding is more obvious." Song Zimo's tissue forceps clamped the subcutaneous tissue and gently lifted the skin flap.
Yang Ping's proactive and bold judgment of the amputation plane was very accurate.
"The choice of the amputation plane is very suitable." Yang Ping was relieved at this time.
At this time, bleeding is the hope for a successful operation. The faster and more bleeding occurs, the greater the hope.
The scalpel continues to cut through the deep fascia, severing the muscles surrounding the femur, cutting off and ligating the blood vessels, cutting off the nerves with a high-position sharp knife, and finally reaching the femur in the center.
The electric saw cuts off the femur, and the thigh is severed from the knee, leaving the patient's body and becoming a free, independent object that no longer belongs to the patient.
The separated limbs were removed from the operating table and put into a transparent plastic bag. Zhou Can put it away and sent it to the pathology department after the operation. In principle, any tissue or organ removed from the human body must undergo pathology.
Check.
After the pathological examination of the stump is completed, the final destination is to be sent to the crematorium for burning. There are procedures for handling everything and cannot be done casually.
Yang Ping used a bone file to smooth the femoral section and applied bone wax to the bone section to stop bleeding.
At this time, rinse the surgical area again and rinse repeatedly to remove some lime-like uric acid crystals. Drill holes at the bone end, sew the muscles, wrap the bone end, and use the drilled holes at the bone end to fix it to the bone end to form a good stump muscle.
pad, so that when the prosthetic limb is installed later, it will be more able to withstand impact and wear.
Finally, the deep fascia and skin were sutured, a negative pressure drainage tube was inserted, and the amputation surgery on one side was completed.
It is hard to imagine that in Europe a long time ago, when medicine was barbaric, amputation operations were extremely simple. Some even used a guillotine to cut off the limbs at once, and then pressed the limbs into boiling hot oil to cauterize them to stop the bleeding.
The severed limbs sizzled in the boiling oil, and the patients were in agony, and some died directly from the pain and shock.
Even if a person with strong physical fitness can survive the pain, subsequent infection will kill many amputees.
In Europe at that time, surgical operations were so crazy and barbaric that we in modern times cannot imagine.
Traditional Chinese medicine at the same time was much more humane. Hua Tuo's Ma Buddha Powder and surgical techniques already had the prototype of modern surgery.
After completing the amputation on one side, Yang Ping continued the amputation on the other side. After completing the bilateral amputation, the stumps of both limbs were wrapped with sterile dressings and bandages.
The huge gouty nodule at the left elbow joint was cut open, and the lime-like material inside was exposed, and a large curette was used to scrape it out in lumps.
If this kind of thing is placed in a separate place, it will definitely be considered as high-purity lime powder.
It is hard to imagine that this substance is produced by the human body itself. It is this "lime"-uric acid crystals that makes patients miserable and tormented.
The "lime" dug out of this gouty nodule filled a large metal basin. Even a surgeon who is used to seeing all kinds of strange diseases is not used to it at this time.
Fatty Liang was one meter away from the operating table, staring at this sinful "lime". He wanted to remember this kind of thing to make his determination to fight gout even more solid.
An intern was leaning against the corner, his face pale, sweat dripping from his forehead, and he said in a weak voice: "Teacher, I can't do it anymore."
Then he leaned against the wall and slowly slid down. He tried hard to hold on, but his strength did not allow it.
"Help him lie down!" Zhou Can, a circulating nurse with sharp eyes and quick hands, threw a surgical gown on the ground and ordered another intern to hold him and let him lie down on the spot.
Damn, we are undergoing surgery and we have to rescue the interns. I have seen people fainting from blood and needles, but I have never seen people fainting from uric acid crystals.
Zhang Lin did not go on stage. When he saw this scene, he immediately participated in organizing the rescue. He lay down, opened the airway, auscultated the heart and lungs, inhaled oxygen, and put on ECG monitoring. A series of operations were performed quickly and clearly.
The operation here did not stop, Yang Ping took Song Zimo and Xu Zhiliang to continue.
"Are you okay?" Yang Ping asked while doing it.
They have all seen big events and still care about this little thing.
"It's okay, my heartbeat and breathing are fine, and my blood pressure is relatively low." Zhang Lin took off his stethoscope.
"Replenish fluids and check your fingertip blood sugar." Song Zimo helped cut the thread.
"2.4!" Zhou Can's blood glucose meter measured fingertip blood sugar.
"Low blood sugar, you didn't eat breakfast, I'll give you a 50% high sugar drink." Zhang Lin called Zhou Can.
Now that the diagnosis has been made clear, there will no longer be any intervention in the intern’s rescue. The operation will continue, while Zhang Lin will continue to direct the rescue in an orderly manner.
They are all veterans who have experienced hundreds of battles, and they don’t even blink when it comes to rescuing people.
"If you don't eat breakfast, you still need to pay attention to taste surgery. Are there any people who haven't eaten breakfast? Those who haven't eaten breakfast and can't stand the stimulation should all go out." Zhang Lin yelled.
Slowly, the intern regained consciousness. Hypoglycemia can sometimes be fatal.
Fatty Liang was at the side, ready for tracheal intubation at any time. The intern survived the danger and regained consciousness. He put away his intubation equipment.
"Are you done with the operation?" is the first thing the intern says when he wakes up.
"It's not over!" Zhang Lin started auscultating the heart and lungs again.
"How much have you dug out?" the intern asked again.
Still want to watch? The guy who doesn’t know whether to live or die.
"Close your eyes, lie down and rest for a while, and test your blood sugar again." Zhang Lin stood up.
Xiao Su has covered the "lime" - uric acid crystals on the table with a sterile sheet. The number of metal basins containing them has been increased to five, and the sixth one was quickly filled.
After removing the gout nodules in several large joints, Yang Ping handed over the operation to Song Zimo and Xu Zhiliang to continue.
The blood sugar of the intern lying on the ground rose to 6.2 when re-tested. He was out of danger and stood up on his own.
"Wow, there are so many, teacher, I still want to see." He stared at the several metal basins covered with sterile sheets on the stage, holding back the sweat on his forehead, and said curiously.
"You have self-abuse obsessive-compulsive disorder, right? Don't you think it's too much?" Zhang Lin said in a stern tone.
Song Zimo said while performing the operation: "Let him take a look. It's a desensitization treatment. With so many people here, nothing will happen."
The sterile sheets were slowly lifted, revealing a pile of pure white "lime" in a metal basin.
"Teacher, I still can't do it."
The intern quickly looked away, and the person next to him immediately supported him. His face began to turn pale again, and the first desensitization treatment failed.
"Take your time and desensitize a few more times." Yang Ping had already taken off his surgical gown and was resting aside.
