Cai Dongfan's position as chief surgeon remained unchanged, and Du Yanjun's position as first assistant remained unchanged, but Zhou Cheng was obviously moved from the position of secondary assistant to second assistant.
That is Cai Dongfan's lower hand side, where there is a better surgical field of vision.
Luo Yun actually doesn't care. He can also perform open reduction of tibial plateau fractures, but his level is not that good. If Cai Dongfan hadn't performed this surgery, he could have done it, but it might have taken longer, and the surgery
The quality is just not as good as Cai Dongfan.
In fact, Luo Yun was already familiar with the surgical procedure, and having followed Cai Dongfan for so many years, he also knew Cai Dongfan's surgical habits thoroughly.
What he lacks now is the heat. It is not to see how Cai Dongfan performs surgery, but to figure out how to improve the quality of his own surgery. This is the key.
See one more surgery, see one less surgery, the difference is not much.
Therefore, Luo Yun just complained in his heart.
For Zhou Cheng and Du Yanjun, two newcomers, it is very important to watch the complete surgical process and operating techniques at close range. Personally teaching Du Yanjun is also the purpose of Cai Dongfan taking over the surgery today.
Regardless of whether it is Zhou Cheng or Du Yanjun, they are only competing for a place in the hospital, and there is no competition with Luo Yun.
Even if they entered the hospital, they were not of the same generation and did not constitute competition. Luo Yun's mentality was naturally very relaxed and he looked at Du Yanjun and Zhou Cheng.
I found that Zhou Cheng was very relaxed at the moment. He was not very excited because he got the second assistant position. Instead, he looked at Du Yanjun's slightly wary eyes with helplessness.
Yes, Zhou Cheng's face was helpless, and Du Yanjun's eyes were full of vigilance, fleeting.
Of course Zhou Cheng was helpless, because in fact from the beginning of this operation, Zhou Cheng felt that he had a good grasp of the operation process from beginning to end, and with perfect skills, he could do better than Cai Dongfan
.
Just like the choice of surgical approach, at least Zhou Cheng will not choose the combined anteromedial and anterolateral approach, but will choose the LL approach.
During the operation process, Zhou Cheng would not pause like Cai Dongfan. This was just a simple tibial plateau V-shaped operation.
After watching the medial open reduction and internal fixation in the first half, Zhou Cheng knew that Cai Dongfan's level was probably at the proficiency level, not even proficient. Even after seeing Cai Dongfan's surgery, he would not get any improvement.
Instead, it made Du Yanjun wary of him, and Zhou Cheng naturally felt innocent and helpless.
But openly, Zhou Cheng still said: "Thank you, Teacher Cai, thank you, Teacher Luo."
Cai Dongfan allowed him to take the position of second assistant, and Luo Yun was grateful for this position.
Cai Dongfan remained silent and continued to choose the next operation. Cai Dongfan just felt that although Zhou Cheng was just a regular trainee, he was still his subordinate doctor and a 'named disciple'.
Too much.
Including the same will apply to Zhang Zhengquan in the future.
This is what I, as a senior physician and teacher, should do. I sent Zhang Zhengquan away today just to let Du Yanjun take the stage. It is indeed a bit unkind.
But there is no way. Du Yanjun is his student. He is determined to fight for the opportunity to stay in the hospital. As a teacher, he can only help him. If Du Yanjun can stay, he will have a closer relationship than Luo Yun.
.
It’s a true master-disciple relationship.
However, the next step is to deal with the lateral tibial plateau. The bone fractures on the lateral side do not have too many and powerful muscle insertion points like the medial side, so there is not much muscle pulling, and the displacement of the fracture is within a relatively normal range.
As the chief physician, Cai Dongfan, after exposing the broken end of the fracture, used bone peeling to apply a little pressure and reset the cracked fracture to a better position. Because pressure can be applied outward, even temporary fixation with Kirschner wires is not required.
No need to fight.
Directly drive up the outer steel plate.
At this time, the reduction and fixation of the fracture treatment principles have been completed, but this is not over yet.
The entire operating room must have surgical procedures and rigorous thinking.
Next, we naturally have to return to the tibial plateau classification itself.
Tibial plateau fracture, type V of Schatzker classification: bicondylar fracture involving medial and lateral plateau splitting, combined with vascular and nerve damage, this type accounts for 12.0% of tibial plateau fractures!
This is a classification in a strict sense, as the definition says, but in fact whether the blood vessels and nerves have actually been damaged must be explored during surgery.
The most easily injured nerve is the common peroneal nerve. The fibula is on the outside of the tibia, so the necessary places to explore are the common peroneal nerve and blood vessels on the outside of the tibial plateau and near the fibular head.
This is basic operation!
Common fractures are caused by violent trauma. Exploring tendons, nerves, and blood vessels during surgery is part of the basic operation. If it is an open fracture, it is even more necessary to explore.
In the simulator, Zhou Cheng once failed to systematically master the exploration techniques, which resulted in the damage to blood vessels not being discovered, the broken end of the fracture not healing after surgery, and avascular necrosis of the bone occurring.
This kind of operation is nothing more than an extremely simple matter for Cai Dongfan.
After reviewing the chief physician, if he can't even do a good examination, then the chief physician's praise is too high.
The operation ended without incident, and Zhou Cheng did not have too many outstanding performances after the treatment of the medial platform was completed. Moreover, Cai Dongfan and Luo Yun did not deliberately require Zhou Cheng to have outstanding performances.
However, after the operational surgery is completed, there is still one step.
That's suturing.
As Cai Dongfan was taking off his clothes and getting ready to step off the stage, he said, "Luo Yun, don't step off the stage yet. Later, Zhou Cheng and Du Yanjun will stitch up the wounds on one side. Just keep an eye on it."
"After internal fixation of this kind of tibial plateau fracture, because of the intervention of the steel plate, the suturing still needs to be more rigorous."
After saying that, Cai Dongfan took off his clothes completely, then picked up the mobile phone on the shelf, stepped on the sensor door of the operating room with his foot, and walked outside, probably to the rest room or smoking room of the operating room.
.
This is the right of Cai Dongfan as the chief physician and the most senior doctor in his team.
Afterwards, Luo Yun looked at the two little ones, Zhou Cheng and Du Yanjun, and said, "Du Yanjun, you sew the inside, and Zhou Cheng, you sew the outside."
"Tour, open two tubes of 2-0 and 1-0 antibacterial microfibers."
Antibacterial micro suture is a common name for sutures with needles.
2-0 and 1-0 are the diameters of the sutures, also called models. The inside of the skin needs to be stronger, so 1-0 sutures are used to suture the subcutaneous tissue. The surface of the skin needs smaller scars, so use
2-0 to sew.
Because the steel plate is added, the tension on the skin is greater, and sutures below 3-0 can easily break after surgery and burst the wound. Of course, if the subcutaneous sutures are done well, you can also choose cosmetic sutures.
However, cosmetic suture threads are not cheap and are not covered by medical insurance reimbursement.
Except for children and girls who love beauty, most people will not deliberately ask patients if they need cosmetic sutures, unless the patient himself requests it.
Soon, the circulating nurse put the sutures on the table.
If you are suturing the skin, one 2-0 suture on one side is definitely enough, but if you are subcutaneously suturing the periosteum, muscle layer and subcutaneous layer, one suture is probably not enough.
Zhou Cheng and Du Yanjun each held a pair of tweezers and a needle holder, waiting for the sutures to come.
Du Yanjun looked at Zhou Cheng, with a smile on his lips, but his eyes were closed. The reason why he dared to smile was because he was blocked by the mask, and the reason why his eyes were closed was because he didn't want to show it too obviously.
For surgeons, suturing is the foundation of the basics, and there are levels of suturing skills. Although Zhou Cheng came to the department before him, he has one more year of experience, so his suturing skills may not be better than his own.
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