Chapter 472: Improper time for others (please subscribe)
Author: A lancet
The operation Zhou Cheng is doing now is actually very simple, it is an incision.
Incision is the first step in surgery. It refers to the surgical process of using a certain instrument (usually a scalpel) to create an incision on a tissue or organ. It is one of the most basic operations of surgery.
Basically, if you call an intern, he can hold a knife and do a rough incision.
During the internship, the interns were able to do a skin incision. Although it seemed like a Chinese New Year, it meant that the entry level of this technology was very shallow and it was not something mysterious. You only need to master some key points.
For example, the principle of sterility, for example:
For larger incisions, the operator and assistant use their hands to fix the skin on both sides or up and down of the incision. For small incisions, the operator uses his thumb and index finger to fix the skin on both sides of the incision. The operator takes the scalpel and holds the blade edge perpendicular to the tissue to prevent
For oblique cutting, the tip of the knife penetrates the skin vertically first, and then turns it to form a 45-degree angle with the skin surface. Use the knife to evenly cut the skin and subcutaneous tissue until the length of the predetermined incision, and then turn the knife 90 degrees with the skin surface.
Vertically, lift the knife out of the incision.
Then be more proficient, master the strength of the knife when incision, and strive to incise the full thickness of the skin at one time, so that the incision is linear and the edges of the incision are smooth, so as to avoid multiple cuts that will cause uneven edges of the incision and affect healing.
Do not use excessive force when incising to avoid accidentally injuring important deep tissues. The subcutaneous tissue should be incised at the same time as the skin and must be kept at the same length. If the incision length of the subcutaneous tissue is shorter than the skin incision, scissors can be used to cut it.
After incising the skin and subcutaneous tissue, cover the area around the incision with a surgical towel (in clinical practice, sterile film is often used to paste the incision site before incision) to isolate and protect the wound from contamination...
However, all these theories and the content presented in the textbook cannot describe Zhou Cheng's current operating process and fluency.
As the saying goes, outsiders watch the fun, while insiders watch the door.
Ning Xihua, who knew that Zhou Cheng was tinkering with teaching theories, asked in a respectful tone at this moment: "Dr. Zhou, if you follow the so-called skill level system you teach your students when you teach them, this incision will be different between different levels.
, how to divide it?”
When Ning Xihua asked this question, she was immediately scolded by her teacher Chen Tingye.
"Talk less and watch more!"
"Dr. Zhou, just ignore him and continue the operation." Chen Tingye's tone was serious.
What time is it now? You are already an associate professor. Do you still need me to teach you these basic rules?
Don't lose face in front of outsiders. We masters and disciples can do whatever we want when doing surgery, but outside, we still have to follow the most basic rules.
Zhou Cheng was not distracted. He heard Ning Xihua's question, but did not reply. Instead, he continued to quickly follow the shape of the artery, dissecting it one by one, untying the artery from a person's calf like a cow.
Deformed gaps.
In the gap, the artery is quickly exposed.
There is no waste of time or lack of time as Chen Tingye said before.
In just a few minutes, Zhou Cheng reshaped several arteries below the popliteal artery, exposing them all to outsiders and making the separation extremely clear.
This kind of blood vessel exploration can be called a miracle.
Who can basically expose all the arteries in just a few minutes?
"Huh!" Zhou Cheng breathed a sigh of relief.
"Teacher Chen, let's explore the blood circulation together. If it doesn't work, we can temporarily make a short connection to restore the blood circulation first," Zhou Cheng suggested and invited.
"Okay, Dr. Zhou, you make the decision and I will cooperate."
"Ning Xihua, help pull the hook and pass the equipment." Chen Tingye once again instructed his students and wiped his eyes.
Now I'm treating you. Don't cause trouble for me anymore. If you have any questions, please wait until after the operation is over.
In fact, if the arteries are exposed to this level, the operation will be relatively simple. With direct vision, you can see with the naked eye where the blockage is, which artery is not working, and if it is not working, what should be done next?
After the blood is passed through, even if there are small blood vessels that are still blocked, the blocked areas can be treated with medication after the operation.
Once the surgery is done, it will basically be quite clear.
And all this became clear only because Zhou Cheng demonstrated an almost superb incision technique.
Is incision difficult?
Not difficult!
But can incision have a miraculous effect?
In the past, Ning Xihua would never have asked himself this question, but now, for the first time, he had some doubts about his own understanding.
After a while, Yang Yifeng opened the sensor door from the operating room and came in. At the same time, he had already washed his hands.
When he put on his clothes and gloves and approached the operating table, his eyes suddenly bulged out: "Professor Chen, are you good at this blood vessel exploration technique?"
Yang Yifeng is good at vascular surgery, and he knows how to judge the level of this vascular exploration machine.
"This was not done by me, but by Xiao Zhou. Xiao Yang, you came just in time. This patient had his limb replanted after amputation. Now his blood flow is blocked. There should be avulsion of the intima of the artery, so Zhou
The doctor will ask you to take care of it and see if it can be replaced or short-circuited."
"Can you call Professor Jin?" Yang Yifeng heard this and replied casually with a smile, but he immediately took the corresponding tool and started operating it.
However, this operation was much easier than most of the lower limb vascular surgeries he had done before.
Because usually when such an operation is performed, the arteries and blood vessels will not be exposed like they are now.
This is equivalent to playing with mud with your hands, and you can handle it however you want.
In traditional surgery, large incisions are chosen for the convenience of operation.
…
Then, the final result was that an operation that Chen Tingye and Ning Xihua found particularly difficult was completed by Zhou Cheng and Yang Yifeng within half an hour, and the rest was a long and high-intensity operation.
's sewn up.
The blood vessel exploration is done well and is large, but the opening is also large, and the corresponding suturing time will be longer.
But as long as he can save his legs, Ning Xihua thinks it's okay to go through the trouble.
Chen Tingye left the stage to rest first. He probably worked hard with Ning Xihua last night. After all, he was an old professor and his physical function was a little weak, so only three young people were left to continue to stand strong on the stage.
Ning Xihua asked Zhou Cheng and Yang Yifeng to step down and rest.
However, Zhou Cheng knew that Ning Xihua was tired all night yesterday: "Professor Ning, why don't you go and have a rest, and Xiao Yang and I will be responsible for finishing the treatment. This patient's current condition is not life-threatening. We can take it slow at worst."
"
Ning Xihua took the opportunity to make a joke: "Xiao Zhou, you can't be slow, right? The title of fastest man in the operating room must belong to you, let's do it together."
"Hurry up together?" Zhou Cheng also replied.
Circulating nurses, equipment nurses and others are not surprised and are almost immune to such driving.
Yang Yifeng waited for Chen Tingye to leave the operating room for a while before asking: "Zhou Cheng, did you really expose such a long blood vessel in just a few minutes?"
"To be precise, it's seven minutes." Ning Xihua returned to serious matters and explained to Yang Yifeng with specific data.
Yang Yifeng took a deep breath.
Next, Cao Zou was not worried at all. This was not the first time for Zhou Cheng to perform such an operation. He had participated in it several times. He had also performed the operation once, so he knew that the prognosis of subsequent patients would not be particularly bad. It was just
It's definitely not as good as when they first took over.
But compared to direct amputation, being able to save the leg is already a blessing for the patient.
Zhou Cheng took advantage of this gap and smiled at Ning Xihua and said, "Professor Ning, the question you asked me before was just a setting and idea I made out of a joke. Don't take it seriously."
"These are just some of my ideas while joking with my students. They can also be regarded as strict requirements for them."
"The levels of incision can be divided like this."
"The introduction to incision surgery is to make an arc-shaped incision with a length of ten centimeters and accurately control the incision depth of 0.5 centimeters!]
[Requirements: The incision cannot be repeated, the incision cannot have fold lines, the incision cannot deviate from the marked line by 3 mm, the incision depth cannot exceed 1 cm. The operation time should not exceed 20 seconds.]"
"At this level, there are only requirements for lateral offset. There are no particularly stringent requirements for the depth and length of the incision."
"The next level of incision: follow the markings, make an arc-shaped incision with a length of ten centimeters, and incise the deep subcutaneous fascia!"
[Requirements: The incision cannot be repeated, the incision cannot have fold lines, the incision cannot deviate from the laser marking line by 0.5 mm, the depth of the incision cannot be more than 0.5 mm away from the subcutaneous fascia. The length error of the incision should not exceed 0.2 cm, and the operation time should not exceed
5 seconds.】"
"Why can't the incision depth exceed 0.5 mm?" Ning Xihua asked with a gasp after hearing this.
How much more demanding is Zhou Cheng's request?
Is this just the second level?
"Because there are blood vessels in the subcutaneous fascia layer, if the cut is too deep, there may be more bleeding. It is for this reason that I set this standard." Zhou Cheng explained with a smile that every data is his.
Carefully thought out.
"Then how else can you set the next level?" Ning Xihua asked while sewing.
Yang Yifeng also looked over curiously. He knew that Zhou Cheng was tinkering with something, but he didn't know what was going on with Zhou Cheng's tinkering. He didn't ask about the specific details.
"Level 3 incision, let me describe it this way for now. Level 3 incision has no requirement for the depth of incision. For example, within ten minutes, the fracture end of the trauma surgery can be reached, and the joint cavity can be reached."
"The requirements are that there should be no muscle damage, no damage to blood vessels and nerves, and the amount of bleeding should not exceed 500 milliliters during the process. Otherwise, the rules are too strict and people will be too anxious."
"Hey, this isn't easy either." Yang Yifeng's eyes became cautious, obviously thinking about whether the rules set by Zhou Cheng were feasible or not.
"Level 4 incision requires that the field of view of any surgery within the specialty must be reached within fifteen minutes within the fourth category of specialty operations. It is required that the blood loss does not exceed 100ml."
"Level 5 incision, the wound is less than one-third of the normal incision and reaches the core part of the operation. The bleeding volume does not exceed 200ml. After the operation is completed, the overall bleeding volume does not exceed 1500ml. No unnecessary damage to the tissue should be done during the operation.
.”
"And the surgical incision can be closed at any time during the operation to avoid entering places that should not be entered and causing massive bleeding and blood surges."
"I haven't thought about level 6 incision surgery yet. This is the last level." Zhou Cheng showed a harmless smile.
But at this time, both Ning Xihua and Yang Yifeng looked at Zhou Cheng in astonishment, with complicated expressions in their eyes.
Yang Yifeng began to complain: "When your students are really unlucky, I haven't read what you sent me. If I had known what you sent me earlier, I would have written it into the novel a long time ago.
A detailed and realistic setting.”
"It's definitely going to sell well."
"It's just a joke! You don't have to take it seriously." Zhou Cheng explained.
Such standards are somewhat too harsh, so when setting them, the actual situation must be taken into consideration. Otherwise, many professors may not be able to reach level 4 in reality.
Surgery is about accuracy, not speed. The quality of surgery is the first priority, not other techniques.
Of course, if all of these can be done better, the quality of surgery will be greatly improved, and this is right.
When Ning Xihua continued to suture, he breathed a deep sigh of relief, and then said: "What you are performing now should be at level 6. If you want to ask me to define it, then I will definitely say, incision
For Level 6 surgery, the entire nerve and its branches must be peeled off according to the shape of blood vessels or nerves within ten minutes.”
"The requirement is that there should be no breakage of the target tissue or other..."
Zhou Cheng heard this and smiled and said: "Professor Ning, these details you mentioned are the classification of blood vessel and nerve exploration. If the incision is also divided in this way, it would be a bit tedious."
"What I'm doing now should only be considered a blood vessel exploration, not a simple incision."
"This is the basic skill!" Ning Xihua nodded and began to suture in earnest. After thinking about it, he wanted to ask Zhou Cheng whether there were horizontal divisions in suturing.
However, Ning Xihua didn't dare to ask, fearing that her corresponding level would be too low and she would be embarrassed and too straightforward.
It is better to wait until the operation is over before asking for advice.
"Xiao Zhou, after your game is launched, you must notify me as soon as possible. I feel that I am also very interested." Ning Xihua said.
"That's for sure, Professor Ning." Zhou Cheng was determined.
Ning Xihua was not interested, but he was a little unconvinced. He wanted to see what Zhou Cheng could do, because if the game Zhou Cheng was playing now failed, it would be just a joke.
But once he succeeds, Zhou Cheng may leave his name in history, at least in the history of Chinese medicine, he will leave the most dazzling and intense ink, and of course it may also be the biggest infamy!