The process of ward rounds did not slow down or pause just because Zhou Cheng was new here today.
Only Zhou Chengyin was new to the hospital and was not familiar with the patient's past and current conditions. He could only conduct an analysis based on the report of the doctor in charge, which was equivalent to a superficial glance.
Although I roughly remembered the general condition of the patient, there were some detailed issues. Even if the junior doctor made a report, it was impossible to restore all the details at once.
Because the doctor in charge of the bed tacitly knew some details for Yu Qiuhua and others, naturally he would not report more things just because Zhou Cheng was a newcomer.
If there is only one variable factor, then there will be a very small number of variable factors adapting to the majority of stable factors.
Even Zhou Cheng couldn't make up for the lack of overall control over the patient's condition so easily.
Of course, Zhou Cheng did not have the opportunity to understand the other patients, but Zhou Cheng was deeply impressed by the two patients who were going to be operated on today. Because he deliberately spent an extra ten minutes,
I looked at the medical records of two beds.
After reading it, I felt a little worried.
Zhou Cheng had just arrived. Although the lower-level doctors could ignore him, Professor Xue Xiude was still very considerate to Zhou Cheng. After he left the operating room, he asked Mao Yuxuan to accompany Zhou Cheng and arrange things in the department first.
Mao Yuxuan also almost figured out Zhou Cheng's current state. He felt pity for Zhou Cheng and said: "Xiao Zhou, according to your statement, it's not profitable for you to do this general hospitalization now."
Mao Yuxuan initially thought that Zhou Cheng was an employee of the hospital who came by air. Because of his relationship with Academician Zeng, he served as a general resident for a few months as a token, and then was promoted to attending physician.
He wanted to make way for Zhou Cheng, so he moved his position.
But now that I think about it, things are not what I imagined. Zhou Chengdu has not yet worked, so the work of being the general hospital resident is equivalent to doing it in vain. Both he and Zhou Cheng are losing blood.
Naturally, Zhou Cheng would not tell Mao Yuxuan the main purpose of his visit. This had to penetrate slowly, otherwise he would be regarded as a fool.
"It's okay. It's mainly because Mr. Zeng wants to exercise properly. I also feel that I need more clinical polishing at the moment."
Then Zhou Chenggong brought the topic back to the topic: "Brother Xuan, these two surgeries today are not easy to perform."
Zhou Cheng said while flipping through the medical records.
The first patient to be operated on was a tuberculosis patient on bed 5. The patient had sinus tracts on the skin of his lower limbs, and the sinus tracts had pus, which was extremely difficult to treat.
What is the concept of sinus pus discharge? It is because Mycobacterium tuberculosis has eroded and broken open the bone marrow cavity, bone cortex, and even the soft tissue layer outside the bone, eroding a channel.
Then the pus inside slowly seeped out.
Originally, according to logic, patients with special infections like tuberculosis should definitely be placed in the last surgery in an operating room, so as not to increase the risk of infection for patients undergoing surgery in the latter surgery.
However, the other 8-bed situation is even more dangerous than the 5-bed one. In addition to Mycobacterium tuberculosis, the infection bacteria also include bacteria. It is equivalent to a mixed infection, which is terrible...
Bacteria and conjugative bacilli are not the same thing. So we arranged the 5 beds to the first station and the 8 beds to the second station.
The situation is roughly like this.
The skills Zhou Cheng knows now are all simple skills written in textbooks. These skills are definitely the foundation. With so many level I-IV skills, he can basically deal with all orthopedic diseases.
Especially when faced with textbook fractures or diseases that require surgery, these perfect-level skills are extremely lethal.
But there is also a very critical problem that the patients you encounter may not get sick according to the textbook, so you need to slowly dismantle and analyze the mechanism of the disease.
The grades of surgeries are strictly graded I-IV. However, in Zhou Cheng's understanding, some surgeries should not be grade IV surgeries, but should be super grade IV surgeries, or even be classified as grade V surgeries...
Zhou Cheng's own experience is limited. Even when using the simulator, he only practiced his skills one by one according to the orthopedic surgery grading list published by the country.
Zhou Cheng definitely has the ability to perform treatment and surgery, but it seems that it is difficult to treat the patients in Professor Yu Qiuhua's group by simply using one or two simple surgeries.
More detailed analysis of its pathogenesis is needed to achieve better therapeutic effects.
Mao Yuxuan smiled and asked: "Xiao Zhou, didn't you say before that you are a professional in trauma surgery? Have you never seen such a patient before?"
Mao Yuxuan has been trying to figure out Zhou Cheng's origins, and finally determined that it should not be the inheritance of the Nine Courtyards of the Demon City, but might be from the Demon City. But now seeing Zhou Cheng's unseen appearance, it seems that he is not the inheritance of the Demon City.
.
Of course, Mao Yuxuan didn't mean to look down on Zhou Cheng by asking this.
If the unit Zhou Cheng stayed in before was on the same level as the current No. 9 Hospital in the Demon City, patients like this should not be uncommon.
How many hospitals are there in the country?
Even if a hospital has an average of two difficult patients a year, the number of patients that cannot be dealt with will be thousands or even tens of thousands when they are finally gathered in Shanghai, Kyoto, Guangdong and other places.
China is too big.
Both Zhou Cheng and Mao Yuxuan felt that it would be a bit too ostentatious for Mao Yuxuan to call Zhou Cheng, Teacher Zhou or Teacher Xiao Zhou. In the end, Mao Yuxuan would definitely call Zhou Cheng Xiaozhou, and Zhou Cheng would call Mao Yuxuan Brother Xuan.
In the friendship between young people, Mao Yuxuan also didn't like Zhou Cheng calling him teacher.
"I've never seen it before. Patients with simple infections after surgery are rare." Zhou Cheng didn't care. Anyway, he was young. Even if he admitted that he was short-sighted, what would he do?
At most, you will be teased a little. If you pretend to know everything, if you are told, since you have more experience, then you should stop studying. How can Zhou Cheng get started and gain trust?
Mao Yuxuan roughly understood that Zhou Cheng's previous unit was the kind of unit that only dealt with patients with simple fractures and trauma that he encountered.
Don't solve problems for others, don't solve problems that others have solved but can't solve.
It cannot be said that their technology is not good, but that the positioning of each place is different.
This also just shows that Zhou Cheng's previous unit had many patients with simple fractures, and there was enough patient base to support him in practicing his amazing closed reduction and external fixation technique for fractures.
"Then you can see more from now on." Mao Yuxuan's mentality improved a bit.
Because I saw Zhou Cheng's shortcomings, I felt that Zhou Cheng was more real. Although Zhou Cheng has such great skills, he also has his own shortcomings. This is normal and like a human being.
"We won't have to worry about other things for now. We mainly focus on taking care of lower-level doctors and reviewing their medical orders."
"But these things are now done by the general resident, and these doctors also have something to do..."
"What we have to do now is review the surgery scheduled for tomorrow, if..."
After Mao Yuxuan told Zhou Cheng some common sense questions, he took Zhou Cheng towards the operating room.
Before that, Professor Xue Xiude, Gu Zhongliang and others had already gone down.
In addition to the chief resident, there are three attending doctors and above, plus two attendant chiefs. Therefore, the operation can be carried out normally regardless of whether the chief doctor on duty is in the hospital or in the operating room.
The chief resident can complete his own duties before entering the operating room and assuming his role.
Zhou Cheng asked: "Brother Xuan, do our hospitals routinely handle and treat patients with this kind of infection on weekdays?"
Somewhat curious, if beds 5 and 8 are handled and treated routinely, then he feels that what he considers to be the perfect level of skills needs to be rethought and recognised.
Mao Yuxuan also shook his head and smiled bitterly.
He replied: "Xiao Zhou, how can it be as amazing as you think? In fact, in clinical medicine, there are only a lot of principles. Surgery is surgery and medication, but the process and details of the surgery are slightly different."
"The reason why there are more patients now is because it is during the winter vacation. Generally, patients with this kind of infection rarely have the chance to come in summer, and it is hot and humid in summer. It is possible that such patients will be admitted to the ICU before they can be transferred..."
At this point, Mao Yuxuan hesitated to speak. The general meaning is that when it is cold, there are more such patients, and those in other seasons may not be able to carry them to the devil's capital.
But this kind of thing is not something that Mao Yuxuan can control, so he continued: "For example, Kyoto and Magic City are better at doing complex infections, but the other one is Xinjiang Province."
"There are many infected patients there, and the reimbursement ratio is also very high. Patients hardly have to spend any money."
"But no matter what, it still comes down to complete debridement. It's hard to say. If the debridement surgery is done well, the number of surgeries can be reduced."
"If the dosage and variety of antibiotics used are well selected, the duration of anti-infective treatment can be reduced. But these are issues that professors should consider. We junior doctors can only slowly rely on experience to figure it out."
Zhou Cheng had also heard Luo Yun say this conclusion before.
"What is the prognosis for such a patient in normal times?" Zhou Cheng continued to ask.
"Not necessarily. Ninety percent of patients can still get a relatively good prognosis."
"Of course, there are still about 10% of patients with complex infections whose prognosis is not very good due to various reasons." Mao Yuxuan did not hide or brag about the awesomeness of his department, and openly admitted that there are some
The prognosis for a small number of patients is poor.
But in fact, this is Mao Yuxuan's confidence.
I am able to treat so many patients that other provinces cannot handle until the cure rate reaches 90%. This is where I am awesome.
As for why it is not 100%, there are many factors.
It may be that the patient's family cannot afford the money, it may be that the patient himself is unwilling to receive treatment, or it may be that a small number of patients have infections that are simply weird and eventually develop into multiple infections throughout the body and eventually lose their lives.
, you may encounter them.
In addition to the theory of traditional Chinese medicine, which can cover 100% of diseases and has a super high "cure rate", modern medicine has always acknowledged its shortcomings.
It’s just that some people think that the reason why modern medicine does not have a once-and-for-all treatment method is because of the operation and operation of capital.
Zhou Cheng knew that people like Mao Yuxuan could openly admit that there were diseases that could not be cured in the Ninth Hospital of Modu. However, in the eyes of some outsiders, Ninth Hospital of Modu was supposed to be a fairyland where patients came.
Just have to walk out.
Where is such a magical place?
…
Following Mao Yuxuan all the way into the operating room, Zhou Cheng was also familiar with the process. After all, he had been here before the Chinese New Year.
"Xiao Zhou, you have been in our hospital for a while, right?" Mao Yuxuan looked at Zhou Cheng's familiar movements, smiled, and asked.
"Why didn't you think of coming to our trauma surgery department in advance?"
"I was doing experiments before, and I was trying to get some experience in sports medicine. And as you know, Brother Xuan, I am from Hunan Province. Professor Lin Ziyuan's senior sister Ding Dian is also from Hunan Province."
"It's almost because of this relationship that I didn't come directly to our trauma surgery department."
To convince Mao Yuxuan, it is naturally best to be truthful. Of course, don't be too truthful, otherwise it will be difficult for Mr. Zeng to save his face.
Mao Yuxuan didn't say much. He talked about other departments, other professors, and other directors. As a chief resident, he couldn't get in the conversation, and he wasn't even qualified to comment.
After going in and quickly changing clothes, the anesthesiologist was still anesthetizing the patient, and it would take a while before the operation could officially begin.
Associate Professor Gu Zhongliang and Professor Xue Xiude were not in the operating room. Shen De and a follower were in the hospital, that is, a doctor was watching in the operating room.
After Zhou Cheng and Mao Yuxuan arrived, they consciously helped start disinfecting and spreading towels.
The doctor in charge of the bed is still processing medical orders upstairs. Zhou Cheng, Mao Yuxuan and the three chief residents are the most junior doctors, especially Zhou Cheng, the chief resident and Lin Yousheng, a third-year Ph.D.
Relatively lowest.
Although Zhou Cheng temporarily took Mao Yuxuan's place, he still gave Mao Yuxuan a certain amount of face. He took the initiative to start disinfecting and spreading towels.
After everything was done, Mao Yuxuan was asked to call Professor Xue Xiude and others up.
After coming up, Mao Yuxuan took the initiative and said to Xue Xiude: "Professor Xue, Xiao Zhou said that he has rarely seen such infection cases before. I am thinking about letting him come on stage today, am I lazy?"
This is called reciprocating love. Zhou Chengdu was determined to teach him that miraculous fracture reduction technique. It was reasonable for him to ask Zhou Cheng to participate in the operation for severe infection that he almost vomited.
Xue Xiude glanced at Mao Yuxuan thoughtfully, and his protruding cheekbones moved slightly, causing the mask to rotate, but no sound came out.
Professor Xue didn't say anything, and Gu Zhongliang and Shen De couldn't say much.
To put it bluntly, for Gu Zhongliang and Shen De, their teacher was not Xue Xiude, and they themselves were not professors. The senior doctors they followed had the title of professor, and they were just staying overnight.
The things that you should take care of are those that are within your own duties. It is better to mix less with other things.
A 5-bed patient who underwent sinus resection had a lot of exudate from the wound every day after returning to the ward after the last operation...
Xue Xiude and others washed their hands, changed into sterile surgical gowns, and each wore two pairs of gloves, and then the formal surgery began.
Xue Xiude stood at the chief surgeon's position, Gu Zhongliang was the first assistant, and Shen De was the second assistant. Zhou Cheng was left with only the third assistant. Then the follower was hospitalized, and Lin Yousheng was left with the fourth assistant.
There were enough people on the operating table, so Mao Yuxuan didn't have a seat. However, there was an advantage in not being on the stage. Instead, he went to the bedside anesthesiologist's best viewing position for the operation and started to look at it.
Mao Yuxuan was very familiar with the people on the operating table, but this was his first time meeting Zhou Cheng, and he had never seen Zhou Cheng perform surgery before.
Before disinfection, the gauze and other materials on the patient's wound were removed. The patient's wound was a surgical incision of no more than 3-4cm, and there was a drainage tube wound below the surgical wound. But now, whether it is a surgical incision or a drainage tube opening,
, there is a small amount of light pink turbid liquid leaking out.
At first glance, it looked like it was filled with pus.
In addition to being ugly, there is also a strange smell and a foul smell...
The patient had undergone surgery elsewhere before, and after developing sinus tracts about half a year after the operation, he came to the No. 9 Hospital in Modu for treatment.
Xue Xiude said: "This patient's sinus tract was connected to the right hip joint before. The first operation was intramedullary nailing of the femur, which resulted in postoperative infection. During the last operation, the sinus tract was connected.
The right hip joint, but there was no accumulation of pus inside the hip joint, so I didn’t clean the joint and prosthesis.”
"But I estimate that this time, the prosthesis may still have to be removed and the joint cavity must be debrided together. In this case, the joints must be cleaned according to the total hip replacement surgery. Of course, this
The entrance opening can be slightly smaller."
The patient's sinus tract is located on the inner side of the thigh. Total hip replacement generally uses a posterolateral approach, which is two different directions!
After coming to the hospital, the sinus tract was cleaned and excised. Naturally, the entrance of the sinus tract was taken, because the previous MRI results showed that the sinus tract was a semi-blind end sinus tract.
The intramedullary nail prosthesis is an inert metal and a material that can be used for magnetic resonance imaging.
Many of today's prostheses are made of materials that can be used for magnetic resonance imaging, unlike the implants of many years ago.
Before the operation, Xue Xiude discussed with Gu Zhongliang and others whether to open the original incision for joint replacement. After all, the sinus opening was too far away from the original surgical incision.
The result of everyone's discussion was to open it and take a thorough look at the situation inside the joint cavity.
Of course, the preoperative discussion for this operation was in broad daylight yesterday. At that time, Zhou Cheng had not yet decided to come to the department, so Zhou Cheng did not participate in the preoperative discussion.
However, now that Xue Xiude said this.
Gu Zhongliang suggested: "Teacher Xue, how about we clean up the inside a little first. Otherwise, when the joint cavity and the wound on the inside are connected, a lot of fluid will accumulate when we treat the wound here."
Although Xue Xiude was a professor, Gu Zhongliang still used to call him teacher Xue Xiude.
"Okay! That's okay." Xue Xiude thought for a moment and felt that it would be advisable to deal with the inner side first.
Although the last step still has to be done on the inside, sometimes the extra steps are necessary. Otherwise, treating the inside last, may cause pus to pour back into the hole that has been treated on the outside, which would be troublesome.
The outer side is still a blind end, and can pass through the original sinus opening to form a certain degree of drainage.
Xue Xiude then looked at Zhou Cheng, then at Gu Zhongliang, and then asked: "Xiao Zhou, can you handle the sinus tract on the inside? If you can handle it, I will handle the joint cavity directly from here."
When something goes wrong, there must be a monster. Mao Yuxuan suddenly changed his mind towards Zhou Cheng. This is difficult to explain with common sense, so Xue Xiude wanted to see what was weird about Zhou Cheng.
"Okay, Teacher Xue." For Gu Zhongliang, the partial incision and debridement of this operation has no improvement or promotion. If he does less, he will rest and earn money.
gave way to his position.
"Okay, thank you, Teacher Xue."
"Then let me give it a try." Zhou Cheng was stunned for a moment when he heard this, and took only half a step back. When he heard what Xue Xiude said, he nodded politely.
In fact, he was also very curious about what was so difficult to deal with such a relatively complicated condition.
This is the first time Zhou Cheng has encountered something so difficult and it was simply an infection caused by a fracture after surgery.
He looked at his corresponding skills: [Debridement and Suture (Perfect - World Defining Level)]
What is perfection - the definition of the world?
That is, they are absolutely first-class in the world. Not to mention the first, they are definitely among the best.
This kind of debridement and suturing technique is simply used for debridement and suturing of simple wounds. In fact, it is really a bit of a big skill but little use.
But with big skills and small uses, you can master it all at once.
It feels really good...
Zhou Cheng agreed?
Lin Yousheng and Mao Yuxuan were both a little stunned, because in fact, anyone with a discerning eye could see and should be able to hear that the conversation between Professor Xue Xiude and Associate Professor Gu Zhongliang just had a hidden meaning, and they were directly looking at Zhou Cheng.
Go away in depth.
Zhou Cheng's most normal reaction should be to be humble and then slowly plan the matter of being the surgeon.
Isn’t it a bit rash to agree immediately?
What if it were you?
Lin Yousheng felt that he would definitely not dare to agree to be the surgeon for this operation, because it was beyond his ability. If he performed the surgery on the patient himself, he would undoubtedly be asking for trouble.
Make it more difficult for yourself.
Mao Yuxuan was slightly nervous for a while, then became even more curious.
It may be that Zhou Cheng dared to agree, but it may not be so. After all, Zhou Cheng cannot be inferred and evaluated based on common sense. When I first met him, Zhou Cheng was also very calm and very charming.
Confidence.
Based on Zhou Cheng's expertise in fracture reduction techniques, it can be deduced that the debridement and suturing he did would not be particularly bad, at least it would not make the matter worse.
Therefore, Mao Yuxuan did not explain anything to his teacher.
Although Shen De looked expressionless on the side, his heart was still a little tumbling once again when he saw that Zhou Cheng didn't have any stage fright when facing such a complicated patient.
The complexity of this patient is not comparable to those patients with simple fractures encountered in the emergency department.
Are the ignorant fearless, or are they really confident?
…
Soon, Zhou Chengcheng took the sharp surgical knife handed over by the instrument nurse.
Then I opened the outermost suture, and used a saline pad to stick to the lower edge of the wound. Then I opened the suture of the wound, and then used a sharp knife to cut the inner sutures. I found that the fat layer
Below, a large amount of liquid gurgled out, very thick.
The color is an ugly, rich yellow and extremely sticky. Although I don’t smell the unpleasant smell through the mask for the time being, seeing this sticky stuff seeping out of my body is a bit vomiting-inducing.
Shen De stood opposite Zhou Cheng, acting as Zhou Cheng's assistant. He quickly put the negative pressure suction device in, and then:
"Bah!"
"bububu!"
It emits bursts of abnormal noise as the air is incompletely blocked and creates turbulence.
It can be seen that the liquid inside is indeed too thick.
Zhou Cheng watched as Shen De sucked away the thick pus little by little, and then steadily removed the sutures under the skin, including those in the muscle layer.
Then I discovered that there was still a lot of thick liquid in the inner layer of the wound, even more than under the fat layer before. However, the color at this time was no longer dark yellow, but turned into light green.
of.
When Zhou Cheng was about to say a reminder, he realized that Shen De on the other side was very smart and didn't put the suction tube in.
Zhou Cheng then closed his mouth. Yes, standing opposite was Shen De, the chief physician of the No. 9 Hospital in Shanghai. He knew the principles of surgery better than he did. Maybe he was at the technical level of surgery.
, not as strong as myself.
However, never underestimate the other party’s professionalism and foundation.
"Tourist, please order two bacterial culture tubes and send me a general microscope and bacterial culture. Thank you." Zhou Cheng's voice was very decisive and calm, but also very heavy.
If the entire cavity is filled with such a large number of bacteria, then the scale of this operation will not be simple.
Extensive muscle space infection, muscle necrosis!
And it is a special infection. Although according to treatment experience and the latest literature, the minimum preoperative anti-tuberculosis chemotherapy is only 2 days, Zhou Cheng still feels that the preoperative anti-tuberculosis treatment cycle may still be a bit short.
.
Of course, these are just Zhou Cheng's temporary thoughts on the disease.
After opening the sutures, the pale white flesh mixed with dark red flesh-colored muscles were exposed. Zhou Cheng felt very uneasy in his heart.
"Here, culture tube!" After the circulating and equipment nurse determined the nature of the culture tube, she handed it over.
"Thank you." After Zhou Cheng transferred the liquid in the wound into the culture tube, he handed both of them to the instrument nurse again: "One is for quick microscopy, and the other is for bacterial culture."
The circulating nurse understands and does not need to explain too much.
They are all professionals, which will save a lot of effort and trouble, allowing Zhou Cheng to focus more on the subsequent surgery.
"Huh!" He breathed out, and then carefully looked at the situation inside the wound.
In the end, he decided to turn his head and said to Xuan Xuan, who was about to send the culture tube down: "Teacher Xuan Xian, please open a sharp blade as a backup."
Xianyou was a little reluctant: "Didn't you open one? I just saw the one you were holding in your hand? Did you drop it?"
While asking, he walked towards the spare instrument table in the operating room.
It can be heard that she just said this out of instinct.
"Open a spare." Zhou Cheng replied without looking up.
The circulating nurse felt depressed after hearing this and turned it on as a backup? What the hell is the reason for this?
He is not that big, and his skills may not be very good, but he has a lot of airs.
Of course, now that Zhou Cheng is the chief surgeon, she can't say much.
It's just that I'm complaining in my heart.
Xue Xiude has never had an operation with Zhou Cheng, so he doesn't know what the usefulness of Zhou Cheng's asking the traveling nurse to prepare an extra sharp blade is. However, sharp blades are not expensive and are not included in the regular surgical consumables.
No questions asked.
Gu Zhongliang and Shen De also looked at each other, their eyes flashing, meaning.
It's all trivial, don't argue with young people.
After Zhou Cheng called the circulating nurse to prepare a sharp blade, he told Shen De and Lin Yousheng: "Please use a little more force to expose the epiosseous membrane as much as possible."
Zhou Cheng believes that Shen De and Lin Yousheng can do it.
In fact, Shen De and Lin Yousheng responded quickly to Zhou Cheng, meeting the exposure conditions Zhou Cheng said. Although it was not perfect, such professional cooperation gave Zhou Cheng a feeling.
What was the surgery I had done at the Eighth Hospital before?
You have to do everything by yourself.
Zhou Cheng used both hands, holding tweezers in his left hand and a sharp knife in his right hand like a pen. Starting from the incision of the skin, he slowly began to debridement.
It's not particularly fast, and it doesn't have any unpredictable movements.
Shen De took one look and smiled bitterly. Then when he was about to make eye contact with Associate Professor Gu Zhongliang, he found that no matter how he winked, Associate Professor Gu Zhongliang ignored him.
Then, Shen De turned his head slightly and saw Xue Xiude who was performing the surgery. At this moment, he also focused his eyes on Zhou Cheng's surgical field.
Actually——
Zhou Cheng just took action, and Xue Xiude caught Zhou Cheng's movements very keenly. Although Zhou Cheng's sharp knife and tweezers did not cut off much necrotic skin, Zhou Cheng's right hand was moving slightly and quickly.
Or rather, toggle...
His movements looked like those of an intern doing surgery for the first time, with his hands shaking nervously, but...
However, this kind of jitter is absolutely different from that kind of jitter. It is extremely different.
Although Xue Xiude had not taken care of Zhou Cheng before, it could be seen from Zhou Cheng's previous operation of opening the sutures outside the surgical incision that Zhou Cheng had done surgery and was very skilled.
It is estimated that he has performed surgeries on at least one or two hundred patients. Therefore, the nervous shaking like that of an intern performing surgery will definitely not appear on Zhou Cheng's hands, but now?
When Professor Xue Xiude looked more carefully, he could find that while Zhou Cheng's right hand was shaking slightly, his thumb, index finger and middle finger were constantly changing the angle, controlling the tip and shoulder of the sharp blade, rapidly
Scratch inside the skin and subcutaneous spaces!
The principle of operation is somewhat similar to the curettage of benign bone tumors in the Department of Osteopathic Medicine!
Xue Xiude has always admitted that he is only a trauma surgeon, not an orthopedic surgeon, because he knows how big the gap is between trauma surgery and bone tumors.
Although he doesn't understand, as a professor, he may have more research on tumors than the general director of a prefecture-level city hospital. Because he has read countless documents, done research, and participated in defenses...
However, bone tumors are generally hard in the bone or on the periphery of the bone. When scraping with a curette, there will be feedback on where the scraper has hit.
The area Zhou Cheng is currently operating is only soft tissue. It is not easy to complete the scraping action in this area.
If the force is not enough, it will be insignificant. If the force is too strong, the knife can directly destroy the muscles, blood vessels and other soft tissues.
A sharp knife or a round knife can perform amputation, and soft tissue cannot be cut anywhere. This is no joke.
"Xiao Zhou, what are you doing?" Xue Xiude asked immediately.
If you don’t understand, you must ask.
Of course, I am also afraid that Zhou Cheng will do something wrong, although the chance of doing something wrong is very small.
There is no shame in asking questions.
If you hear the Tao in the morning, you may die in the evening.
If Zhou Cheng is messing around, then he should beat Zhou Cheng out as soon as possible. The reason why he is still treating each other politely is that firstly, Zeng Lao's behavior is a bit unreasonable, and secondly, his student suddenly changed, which made him feel abnormal.
.
"Teacher Xue, I am doing lacunar debridement."
"If you don't think this is appropriate, I won't."
Before Zhou Chengdu said whether he should do it or not, Xue Xiude shook his head, smiled and said: "No, you continue! And you have to continue."
"Of course, you still have to tell me a preliminary basic principle according to the procedure."
"After all, as the professor leading the team, I have to give you the full details of all the operations you do. You have to let me know roughly what the worst result will be if you do this."
Modou Ninth Hospital, as the affiliated hospital of Modou Jiaotong University, is one of the most well-known hospitals in China. If you can't even accept a new thing and don't dare to defend a capable student, then it would be a joke.
.
However, Xue Xiude still had to ask Zhou Cheng. If he couldn't explain the specific principles, that would be embarrassing.
Zhou Cheng temporarily stopped the operation in his hands and continued to explain: "It can be roughly divided into two parts. The first part is similar to the application of osteopathic curettage techniques in debridement. Micro-operation is used to achieve the goal of not injuring normal cells.
Muscle tissue and the ability to scrape away necrotic tissue quickly and cleanly.”
"The second part is the lacunar theory. Our conventional debridement mainly focuses on removing necrotic tissue and not retaining tissue that cannot be determined to be infected."
"But I have always believed that the bacteria that infect patients' wounds generally lurk in various lacunae. If these lacunae can be limitedly removed through micro-manipulation, it can ensure that the normal tissue remains to a greater extent."
"And it can clean up infected tissue to a greater extent and reduce the chance of infection recurrence."
"Because according to the principles of normal debridement, the lacunae that can be left open should be kept as low as possible. However, we found by searching the literature that many experts at home and abroad have actually achieved complete debridement during debridement.
The effect is effective, but there is still a recurrence rate of more than 10%.”
"so……"
Zhou Chengxin picked it up and spoke skillfully.
Zhou Cheng has many perfect skills. With a little organization and overlapping, he can make sparks out of different skills. He can also explain the principles. I borrowed the theory from the bone tumor department, not made it out of thin air.
I also have literature and theoretical support.
Reasonable and well-founded!
Xue Xiude nodded, smiled and said, "You can continue."
Then, Xue Xiude continued his surgical operation...
Gu Zhongliang and Shen De continued to look at each other, and their eyes slowly began to shine when they looked at Zhou Cheng.
Zhou Cheng's ambition is big enough, and he even wants to improve surgery, so why would he come to Xue Xiude? Wouldn't it be better to go to Professor Yu Qiuhua?
However, it seems that this time, Professor Xue Xiude did not mean to object too much.
The hand-washing nurse looked at Zhou Cheng blankly for several times. First, she read the literature, and then some of the operations of experts at home and abroad. It seemed that it sounded similar...
Aren't you afraid of getting yourself into trouble by boasting about such a big mouth all at once?
It would be a pity for such a tall and handsome guy to lose his balls...
Although the anesthesiologist has nothing to do with orthopedics, he has doubted the authenticity of Zhou Cheng's theory. He just feels that Zhou Cheng's theory is a bit fanciful.
Debridement and suturing is the foundation of surgery, yet Zhou Cheng actually chose to start with debridement.
What is the basis of surgery? Every medical student will tell you: debridement, debridement, debridement.
The first step in the development of surgery is debridement. The development of all current surgical techniques cannot be separated from debridement.
Debridement teaches surgeons how to distinguish between necrotic tissue and healthy tissue. The essence of more than 95% of surgical operations is to remove necrotic tissue and then preserve the patient's functions.
However, basically all techniques are derived from debridement, so this aspect has been basically studied to a fault and thoroughly studied during the more than 100 years of surgical development.
Then you can still play tricks?
Of course, if we can really play tricks, then?
The foundation, what is the foundation, is the cornerstone of everything.
Just like, mathematics is a tool and a foundation for many disciplines. If some theorems of mathematics come true, then many things derived from it will immediately undergo earth-shaking changes.
Just like how long ago the mass-energy formula was proposed, how much has humankind accomplished in a hundred years?
Medicine, every discipline, has two major experimental directions, one is called clinical experiment, and the other is basic experiment.
In clinical experiments, many conclusions or conjectures made are not as influential as the results of basic experiments. Basic experiments are usually done in the laboratory, and once they are done, high-scoring articles can be published.
Why can we publish high-scoring articles? Naturally, the impact is greater than clinical trials.
Some basic clinical skills, such as debridement and suturing, have basically become commonplace operations. After graduating from junior college, students can also know how to suture and some basic concepts of debridement.
Currently, the basic operations being studied internationally are actually various fancy sutures.
Has anyone ever thought about debridement?
Yes, and there are many.
I really want to take action.
It’s not that I don’t want to, it’s just that it’s too difficult.
Therefore, if we can really add something to the outdated basic theory of debridement, then I'm sorry, brother, you don't even want to be famous.
You are all rushing to write about conceptual things in textbooks.
Zhou Cheng's ambitions are not that big yet. Now, his theory is not particularly complete, and the theory needs to be converted into data first, and then theorized from the data.
Don't be so hasty.
But Zhou Cheng's operation became smoother and smoother. He hadn't done it properly for some time, and he had already gone from the skin to the fat layer under the skin.
When operating on the fat layer, Zhou Cheng has changed another operating mode...
When he saw this, he thought that he should be a very calm Professor Xue Xiude, and he could no longer calm down. He thought for a moment, and then said: "Xiao Zhou, for the time being, there are other things you can do about this debridement and suture."
What’s your opinion?”
Xue Xiude understood it clearly.
It turns out that debridement can still be done this way?
It turns out that debridement can be reinterpreted.
Debridement, and a new understanding!
To re-understand and reinterpret debridement, what is the concept in surgery? It is to redefine initial consonants, finals and part of the tones in Chinese characters. If it can be done, then all concepts,
Maybe everything will change because of this!
The foundation, although simple, is the cornerstone!
This kind of thing that can change the entire orthopedics and even surgery is only a possibility, but as long as there is a little sign, it can be done.
It was absolutely impossible for Xue Xiude to let Zhou Cheng give up.
Even if you persist for five or ten years, your efforts are still in vain, so what?
Zhou Cheng is still young now, he can still afford to delay, what if?
Zhou Cheng heard the meaning of Xue Xiude's words, but Zhou Cheng felt that it was a bit too hasty to take out this debridement suture as a topic now, so he said: "There are some, but not systematic, Professor Xue. I am currently studying,
It’s another subject.”
Zhou Cheng's words were like a pair of scissors, cutting off Xue Xiude's thinking.
ga.
It's like cutting!
What could be more important than what Zhou Cheng just said?
Xue Xiude felt that he had to find an opportunity to have a good talk with Zhou Cheng. Things had to be prioritized. Xiao Zhou, you are still young. In fact, the whole world that you can see is just the tip of the iceberg that you think it is.
Now is obviously not the time to talk, so Xue Xiude just asked one more question: "Xiao Zhou, what are you researching now? I think if it is not particularly important, we can still prioritize the research."
"Open reduction and internal fixation for small incision fractures, and manual reduction and plaster external fixation for fractures." Zhou Cheng thought for a while and said truthfully.
you.
Me?!
Xue Xiude then kicked off his feet and reached the luan.
It probably means that after the vastus medialis muscle contracted too hard, it pinched and it hurt a little.
Zhou Cheng didn't notice this at all and continued to perform the operation on hand.
PS: It’s the end of the month, please vote for me.
There will be an update next month, preliminary plan, 4 starting coins plus one word update. Unlimited accumulation.
It’s up to you to think about how cost-effective it is.