Chapter 443 Didn't you say that debridement can't do tricks?
Chapter 443 Doesn’t it mean that debridement can’t be used in any way? (Please subscribe)
"Professor Qin, thank you for your hard work." Ningling and Zhou Cheng went down to the operating room together, and Niling told Professor Qin Dingmo to give the patient anesthesia.
Since there are difficulties in the treatment of this patient, Ningling did not simply call Zhou Cheng over for a meeting. With ample time, Ningling also hoped that Zhou Cheng could perform the debridement of this operation.
.
Qin Dingmo had a relationship with Zhou Cheng before, and it was during a justice battle to send the patient named Luo Sangen in.
Therefore, when he learned that Zhou Cheng was going to be the chief surgeon and asked him to undergo anesthesia, he was willing to do so, but he had some regrets: "It's not hard work, but I heard Yang Yifeng from your department say some time ago that Dr. Zhou's anesthesia skills are even better."
For the top.”
"It's a pity that Dr. Zhou's surgical skills are good, but if he comes to our department, he will bury the talent. I just hope that if I have the opportunity, Dr. Zhou can give me some advice."
Zhou Cheng looked at Qin Dingmo: "Professor Qin is too praised. This is all Yang Yifeng's praise."
But these words could not deceive Qin Dingmo, and his tone was sour: "Dr. Zhou, Xiao Yang also said that the new topic of lacunar anesthesia in the No. 9 Hospital of the Magic City..."
Qin Dingmo didn't even finish what he said, so he probably got the idea. He was sour.
Now Zhou Cheng is from the Shonan University Affiliated Hospital, but all the good topics he had done before were given to his wife, who took him to a "brother" hospital.
Ningling did not answer the question and directly led his men to perform disinfection and draping operations before the operation.
Zhou Chengcheng didn't know how to answer, so he could only say: "Thank you Professor Qin for your trust."
Wang Huan immediately straightened up, his face full of astonishment, and his tone was dull: "Prevention and treatment of infectious diseases."
Ningling felt numb again, fearing that Zhou Cheng would break it.
"The subcutaneous fascia layer: wrapped around the superficial muscles and ligaments of the foot, has a supporting and protective effect."
Just a plan can achieve such an effect. Can Zhou Cheng's name not impress and convince them...
Ningling's main reason was to be thorough. With Wang Huan around, Zhou Cheng's teaching process would increase. He needed this, so he did what he wanted.
Zhou Cheng frowned slightly, and after more than ten seconds, asked: "What are the key points of debridement during the treatment of diabetic foot?"
Wang Huan still stood there, motionless.
"This circle!" Zhou Cheng started teaching anatomy based on the materials on the spot.
Wang Huan's current knowledge reserve can only go so far as to know the principles of treatment. It would be a bit difficult for her to be more detailed.
And all of these are standardized treatment plans "discussed" between Zhou Cheng and Ningling. They say they are discussions, but they are all students in the Department of Orthopedics. Who doesn't know that Ningling was a hand surgeon before.
"The superficial plantar fascia layer: consists of a thin film covering the superficial muscles and ligaments of the plantar, which has a protective and stabilizing effect."
"But!" Zhou Cheng deliberately raised his tone.
"The dressing ensures a dry and clean environment: Appropriate dressings need to be applied after debridement, including antibacterial dressings, penetrating dressings, absorbent dressings, etc. The dressings need to be changed regularly to keep the wound surface dry and clean."
"What does what I'm talking about correspond to?" Zhou Cheng continued to help Wang Huan sort out the knowledge structure.
"Wait a moment, Xiao Wang." Ningling said when he saw that Zhou Cheng was about to undergo surgery.
Ningling didn't say he didn't understand the treatment of diabetic foot at all, but he was definitely an outsider, and he wasn't even as well-researched as the burn department.
When Zhou Cheng said this, everyone looked up at Zhou Cheng, but Zhou Cheng moved the surgical field to the level of the deep fascia: "The blood vessels of the deep fascia layer: branches of the plantar artery and plantar vein.
These blood vessels pass through the deep plantar fascia layer into the plantar muscles, providing them with oxygen and nutrients."
Wang Huan looked embarrassed and said: "Control the infection, carefully and thoroughly debridement, and postoperative drainage. The principle of asepsis, the principle of small lacunae, and nutritional support."
"Contains tendons, nerves, blood vessels and adipose tissue. This is the inner layer of adipose tissue. Right!"
The cure rate is also quite good. When this type of disease was snatched away from the burn department, there were many complaints, but now it is all gone.
"It's easier to find in normal structures, but after infection, most of these cavities are semi-sealed, so we have to find them." Zhou Cheng explained in a low voice, not scolding Ningling like a student.
scold.
"Professor Ning, this is the combination of basic anatomical theory and debridement. In addition to delamination, there are some fascial spaces in the sole of the foot before delamination."
Ningling's eyes widened and he pointed at Zhou Cheng, looking very angry.
"Are you still Mr. Wang next door?"
"Debridement should be performed in a suitable environment, including controlling diabetes, keeping the foot clean and dry, and avoiding friction and pressure to promote healing."
"Time is still a little tight now. I am the chief inpatient, so I have to do my clinical work well first, and then find time to consult with Professor Qin later." Zhou Cheng said.
While waiting for disinfection, Zhou Cheng and Wang Huan stood side by side.
It's a pity that Wang Huan was not taken directly to the emergency trauma center by Zhou Cheng. Instead, he continued to stay in the trauma surgery department and served as a long-term intern on the Ningling team.
Zhou Cheng washed his hands and disinfected his hands and came in. After putting on a sterile surgical gown, everyone was waiting for him and had made all the preoperative preparations.
Learning medicine is difficult. Debridement is the simplest operation to get started with, but it has different requirements at different times. Only by clarifying the requirements of different diseases can it be standardized and profound.
You must know that the branches of the plantar artery and plantar vein are random, not fixed, and have no special anatomical level.
Wang Huan nodded and raised his little paw to express his stance: "Master, I have also checked some corresponding content."
Zhou Cheng is now well-known in the hospital, but he is even more famous within the department and within the group.
"That's okay, can I be transferred there?" Qin Dingmo probably knew that the application of lacunar anesthesia in the No. 9 Hospital of Shanghai was also honed in the operating room of the emergency department.
"This is the second time to build a sterile environment. The first flushing is before disinfection, right."
Learning is an active process, so Wang Huan also needs to express his attitude to Zhou Cheng.
I just sighed in my heart, alas, Ningling is not Yang Yifeng after all. If Yang Yifeng made such a fuss, he would definitely frown.
Everyone was thoughtful, but of course they still couldn't reach the state that Ningling said.
"The principle of asepsis is to avoid new bacterial infections, and nutritional support is to strengthen one's own resistance."
At this time, Zhou Cheng stopped talking and started debridement, but Zhou Cheng had only been doing it for half a minute.
It is based on the textbook but beyond the scope of the textbook.
"Subcutaneous fat layer: Located below the skin layer, it is mainly composed of adipose tissue and has the function of absorbing shock and relieving pressure."
Then, the wound on the patient's sole becomes as white as after washing the flesh.
"Debridement is to create a sterile environment and remove the cavity environment."
Ningling's expression behind the mask was very exciting, his eyes were particularly stunned, and his voice trembled slightly: "Xiao Zhou, you. You."
As Zhou Cheng said this, he took out these things from the "cesspit" and the rotten meat and picked them up with tweezers.
"Hey, did you see it?" Zhou Cheng picked it up.
Prevention and treatment of infectious diseases, managing sources of infection, cutting off transmission routes, and protecting susceptible groups!
Zhou Cheng shook his head: "It's not comprehensive enough. To describe and understand it accurately, it should be difficult to predict. The prevention and treatment process of transmissible pathogens is not necessarily an infectious disease. But anything you can't see with the naked eye is the basis of prevention and treatment."
"
How should I put it? Qin Dingmo's skills in the anesthesiology department are top-notch. If he can go to the emergency department's operating room, it will be particularly useful for carrying out major surgeries in the emergency department's operating room in the future.
There is a big framework, this is what Zhou Cheng taught her.
Ningling was stunned: "Xiao Zhou, this branch? It's not introduced in the anatomy book, right? How did you separate it?"
When Zhou Cheng asked this question, Ningling just came in and looked a little surprised: "Xiao Zhou, is it a bit too difficult for you to ask Xiao Wang such a question?"
Wang Huan was also asked to go out to wash her hands, disinfect her hands, put on clothes, and go on stage. She was also given the position of second assistant, that is, the subordinate position of Zhou Cheng.
Ningling's assistant was a bit unreliable, so he shook his hand.
Ningling asked this and was replying in his mind, you didn't fart before, you are just making a fuss about debridement now, don't think I don't know!
"Postoperative drainage is the way to control infection, flushing away free bacteria. The principle of small spaces is also the same, so that there are no spaces where bacteria can lurk, blocking the way of infection."
"Then there are nerves. The deep plantar fascia layer contains numerous nerve endings and branches, mainly branches from the plantar nerve and posterior tibial nerve. The plantar nerve is the main nerve in the deep plantar fascia layer, and its
The branches are responsible for most of the sensation and muscle movement control in the bottom of the foot."
"Deep plantar fascia: This membrane is the main component of the deep plantar fascia layer. It is a dense connective tissue film that covers the deep plantar muscles and ligaments and has a supporting and protective effect."
"Didn't you say that there is nothing that can be done about debridement?"
While starting his own teaching mode, Zhou Cheng said: "The diabetic foot is essentially an ulcer, and the ulcer needs a suitable healing environment. In addition to controlling blood sugar, this suitable healing environment also requires the following environmental preparations."
"It can be seen on MRI." Zhou Cheng replied.
"Deep fascia, muscle layer, bone layer..."
Zhou Cheng nodded: "There are two steps to control infection. The first step is the application of drugs, which are divided into two categories, the application of systemic drugs and local drugs. The second step is to control the source of infection, which means thorough debridement and removal of necrotic tissue."
There were no highlights during the rinse, so Zhou Cheng finished the rinse step by step.
"It's so easy to move around, isn't it?" Ningling's scalp was really numb.
Zhou Cheng joked: "Teacher Ning, are you talking about me, an old bastard?"
Hearing this, Qin Dingmo seemed to be waiting for Zhou Cheng to say this: "Is Dr. Zhou in the emergency department now?"
"It's possible, but it's not possible."
He didn't say anything, but he gave me a questioning look.
"More than dry."
But after Zhou Cheng showed it to everyone, he said: "After knowing these structures, the rest of our debridement will be easier to handle. Regardless of these places, we must first flush them, flush them in large quantities, and flush out the slough and necrotic tissue first.
.”
Zhou Cheng raised his head, looked at him, and gave him a death stare. Ningling, you are an associate professor and you are making such a fuss when you are an assistant. Are you irresponsible?
Zhou Cheng said this, and then continued: "The ulcers we can see now are basically the deep fascial layer, which is the content inside. It looks very messy and complicated. When debriding, most of it is
No way to start.”
But this is the normal surgical atmosphere in surgery!
Wang Huan came on stage, and Zhou Cheng immediately picked up the scalpel and obtained sterile toothed forceps: "Before this diabetic foot surgery, we must first clarify the levels of the foot."
Even people who originally thought that Wang Huan was a disciple of Meng Lang are now particularly envious of Wang Huan.
After Qin Dingmo achieved his goal, he stopped being a good boy and returned to the anesthesia machine honestly.
Qin Dingmo had already had this idea, so he told Ningling that if Zhou Cheng came to the operating room at any time, he must tell him.
"Then once we figure this out, we can proceed directly to surgery?"
"Professor Ning, should I wash my hands first?" Zhou Cheng walked out of the operating room with a smile.
Ningling didn't reply, he was deep in thought. After half a minute, he told all the students watching: "This is when you have reached a certain level of reading. It is logical and transparent, and you can draw parallels at will. You can tell the truth."
"
"Knowing means you know it, and telling means you can tell it. Reading if you can't tell it proves that you haven't read it all."
"Professor Qin, you are blaming me for not being sensible. But there will always be opportunities in the future. We can discuss it with each other."
With such a nudge, Wang Huan's knowledge structure began to be reshaped.
Ningling smiled slightly. Wang Huan's foundation was good, otherwise he wouldn't be valued by Zhou Cheng.
"Skin layer: The outermost layer of tissue covering the surface of the sole of the foot, providing protection and sensation."
Qin Dingmo is now the deputy director and professor of the Department of Anesthesiology. So where do you want to go? Isn't it a matter for you to tell the director?
"The key points of debridement are something that only intermediate or even advanced experts need to master in detail. After all, this is not the debridement of ordinary trauma."
Diabetic foot, which was rarely touched by trauma surgery before, has now become a feature. Although it has just begun to be carried out, the cure rate is very high, and even many patients from the Second Hospital and the Third Hospital come here because of its reputation.
…
As Zhou Cheng said, Ningling immediately came over with a flushing gun. The flushing gun was connected to a large saline bag. Each bag is 3000ml. It can be flushed for a long time, and the water pressure is enough to rinse thoroughly. It is convenient and fast, and can save a lot of time.
.
Zhou Cheng passed on the basic anatomy theory through certain means, but Zhou Cheng did not hand over the combined application of the basic anatomy theory and some surgeries he knew.
Although the current application of basic anatomical theory is the future of surgical development, and many people are making a fuss about it, Zhou Cheng himself is the one who can make the most fuss.
After all, who can understand the combination of basic anatomy theory and practical operation as well as he does?
This will be the second project he is about to start. For this project, it is not necessary to apply for general funds. Zhou Cheng has his own research start-up funds, which are provided by hospitals and schools!
"You said you can find it if you find it?" Ningling muttered in a loud voice, a little bit strange, but it was not a complaint, but a secret resentment.