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In the operating room, the patient has been anesthetized by the anesthesiologist on the operating table. Because the scope of the operation is relatively wide, general anesthesia is given.

However, when Zhou Cheng went to the operating table, he saw that the patient's right lower limb, from the thigh to the ankle above the calf, had surgical scars and incisions, like a graceful dragon swimming, and the water inlet and outlet pipes of the drainage tube were buried in the skin. .

This is a fresh surgical incision, and there are old surgical scars, black, like a few huge centipedes clinging to it, it is a little shocking to see.

At this time, several other tube bed doctors and subordinate doctors were preparing to pull out the drainage tube and complete the disinfection operation before debridement.

"Director Quan, you said earlier, where are the patient's drainage tubes placed?" Zhou Cheng couldn't remember clearly, or maybe Quan Zhuolin didn't describe clearly before.

"The side of the thigh and calf. The thigh is through the quadriceps gap, and the calf is through the tibia gap." Quan Zhuolin still gave a professional reply.

"Doctor Zhou, is there a problem?"

Zhou Cheng shook his head: "I'll just ask casually."

In front of so many people, Zhou Cheng naturally wouldn't tell the truth in his heart. There is a problem, but there is no problem. It's just that their cognitive levels are different.

Someone finished the preoperative preparations, and Zhou Cheng, Quan Zhuolin, and Lu Bin all washed their hands, and because of the participation of Tong Xun and Lu Bin, the deputy chief physician of Quan Zhuolin's group, after washing their hands and taking the stage, all He could only stand on the edge of the operating table and wander.

Zhou Cheng stood at the main operator's seat, and after putting on double-layer gloves, he said: "Teacher Tour, our hospital should have a large saline bag for sports medicine. This patient needs a lot of water for washing. Do you want to use it?" Go get a few bags, so that you don't hurt your hands when you open the normal saline solution for flushing."

The small bottle of normal saline is only [-]ml, and the large one is [-]ml. It is very convenient to connect multiple bags at the same time.

In severe infection surgery, thorough debridement and thorough lacuna flushing are particularly important.

Quan Zhuolin immediately said: "Xuan, go get the flushing gun and flushing tube, I didn't think of it before."

Tour responded quickly.

During the tour to prepare these things, Zhou Cheng had already led people to start the exposure work, and the wound was a bit big. This can be said to be the biggest wound since Zhou Cheng's surgery.

From the proximal end of the femur to the distal end of the tibia, the surgical incision is as long as the entire lower limb. It is estimated that it will take two hours to suture...

There was a surgical incision before, so Zhou Cheng didn't make any other incisions, but went down along the original surgical approach.

There is nothing special about this process at all. The original incision is opened, that is, the sutures are cut, and the exposure process is quite satisfactory, and no tricks can be made.

Seeing this, Quan Zhuolin and Tong Xun glanced at each other, seeming to say that Dr. Zhou Cheng is not as good at dealing with infection as he is at performing fracture surgery.

During the fracture operation, from the very beginning, Zhou Cheng would give people a sense of surprise, which brought a sense of surprise, and even if he watched it many times, he could still see the difference.

This makes them slightly disappointed.

Moreover, after the opening was exposed, Zhou Cheng still completed the debridement operation step by step. Debridement is nothing more than cutting the necrotic tissue and the rotten tissue on the surface of the infected muscle, scraping it off, and completely removing it. This is the most basic. In principle, there is nothing to see.

Coupled with the washing of the washing gun and the soaking of multiple dilutions of complex iodine, the re-exposed wound is not surprising. Zhou Cheng's operation is not fast. It took about an hour to complete the superficial debridement , a normal surgical rhythm.

Seeing this, Lu Bin said, "Doctor Zhou, can the incision be closed now? I think the parts that should be debrided have been cleaned up."

Zhou Cheng shook his head: "Director Lu, don't rush to close it for the time being. This is just the most basic debridement, and there are still some latent cavities that we haven't opened. If they are left untreated, the patient's postoperative The chances of re-infection will still be higher.”

"This operation has just begun." Zhou Cheng said helplessly, but at the same time he was a little excited.

Cases are the best teacher and the best subject undertaker. Infection cases are the best materials for him to explore his basic anatomical theory in actual clinical practice. He has an in-depth understanding of the needs of patients, which is perfect!

Lu Bin was a little embarrassed when he heard this, but still chose to respect Zhou Cheng's choice.

Just curious, what Zhou Cheng will do next.

However, immediately after, Lu Bin discovered that Zhou Cheng began to move the quadriceps muscles in strips starting from the proximal side of his thigh, carelessly pulled them apart, and, using blunt hemostatic forceps, continuously Provoking something.

This is an operation on a single muscle. What is it for?

But soon, Zhou Cheng's manipulator gave Lu Bin an answer, and saw that Zhou Cheng inadvertently exposed a milky white liquid the size of a grain of rice, which appeared in everyone's eyes. In front of the field of vision.

In the normal structure of the human body, there is no milky white color.

Muscle is red, even if it is rotten muscle, it is mostly dead milt, not milky white, fat is light yellow, and necrotic fat tissue is that kind of dry white.

Milky white is usually formed by emulsification after the infected tissue destroys the structure of normal tissue.

Can Zhou Cheng also find it this week?
"Doctor Zhou, there are still abscess cavities in this place, under normal circumstances, it is difficult to find it?" Quan Zhuolin's expression became serious.

Don't underestimate the existence of this rice-grain-sized infection focus. With its existence, it will take another five days to refill all the infection focus that has been cleaned up before. This is not alarmist talk!

There was already a slight sweat oozing from Quan Zhuolin's back. If Zhou Cheng hadn't discovered such an infection focus, I am afraid that the debridement effect this time after the operation?

"It's hard to find, but I have carefully read the patient's MRI before the operation, and I think there is almost an edema signal in this place." Zhou Cheng gave a reasonable explanation.

Yes, on the NMR, there is a lot of information, so much that the average person may have a brain explosion if they have to fully accept it. An ordinary doctor can read one-tenth of the information above, and he is already at the level of a professor with profound skills. .

"Ah!~~~" Quan Zhuolin felt a little embarrassed.

It was found on the NMR, why didn't I see it?This was the first time that Quan Zhuolin felt that Zhou Cheng could be so terrifying.

However, it wasn't over yet. Immediately afterwards, Zhou Cheng moved a little further down and used the hemostatic forceps again to peel off the second milky thing, which was the size of a little fingernail.

Although it is milky white, it is like red, with white sticky substance hidden inside, and even scabs.

Zhou Cheng took it out and observed it in front of his eyes for a while: "This thing still has a capsule? Send it to a bacterial culture. I guess, this patient has multiple bacterial infections, and there are different bacterial sources."

At this moment, the scalps of Lu Bin and the others began to go numb.

Before that, they all felt that the operation of this operation should have been completely completed.

Zhou Cheng was also able to find the first infection focus, which may have been due to luck and strength, but the existence of this infection focus sounded a wake-up call on their heads.

Perhaps, the reason why the infection will repeat is not an accidental event, but an inevitable event due to lack of strength!
However, how did Zhou Cheng discover such a hidden focus of infection?

The eyes of Lu Bin and Tong Xun intertwined, and they could see doubt and shock from each other's eyes.Quan Zhuolin is the chief physician in charge of the patient. He doesn't have the time to question, but is afraid and reflective.

What I thought before was that I had done my best, but was it really my best?

So many infections, could it be because of my own ability?

However, how to find such a hidden focus of infection?

"Doctor Zhou, is this also seen through MRI?" Ask if you don't understand, the big deal is to strip yourself more thoroughly and admit your shortcomings, which is not a shameful thing.

Because Quan Zhuolin knows very well that if he is still ignorant in the field of orthopedic trauma surgery, then at least 90.00% of the doctors in the country are laymen.

It can only be that Zhou Cheng is too outrageous.

"Yes. There are actually a lot of information we can read on the MRI. If Director Quan is interested, we can discuss it next time, or after the operation is over, we can do a review of the scans." Zhou Cheng did not reply proudly.

The first state of film reading is not to watch the film, but only to read the report, which is what most residents do.

The second state is to be able to see the problems of specialists. It belongs to the state that doctors in the imaging department cannot see it, but specialists can see it. It is separated from the report and only looks at plain films.This is the beginning of not being a film doctor.

The third state is to be able to see part of the anatomical structure, through the anatomical structure, completely read the specialized diseases, abnormalities and abnormal places, and speculate the diseases that should be based on the clinical.This is the strength that only many professors have.

If it goes further up, it will be a deeper layer. Through the MRI, all the above contents can be read completely, which is equivalent to completely cutting the patient's lower limbs in front of the doctor, and constantly stripping and reorganizing them in the brain.

The size of the lesion, normal structure, and damage can all be read out completely.

This is not something that can be done by printed plain film. The microscopic level on the MRI can fully display the microvascular structure, but this is time-consuming and brain-intensive. Only the world's top-level film reading at this level Only experts in the imaging department and specialists can achieve it.

Therefore, this cannot be blamed on Lu Bin and others, the director of a prefecture-level city hospital. It is impossible for them to have such profound strength.

People with such abilities will not only stay in prefecture-level city hospitals.

"Thank you, Doctor Zhou!" Quan Zhuolin replied without hesitation.

Of all the people in the operating room now, Quan Zhuolin is the one under the greatest pressure. He is the director in charge of the patient and the core of a group, but Zhou Cheng has defeated the outside defense time and time again.

Up to now, he had to be convinced, standing in front of Zhou Cheng like a child.

This is absolute strength, there is no skill at all, and Zhou Cheng is not trying to beat him, just seeking truth from facts.

"I'm also going to send the bacterial culture here," Zhou Cheng said.

The itinerant nurse also noticed something was wrong on the operating table, so she quickly called in another helper. She might not be able to handle this operation by herself.

I thought it was coming to an end.

However, Lu Bin and others still underestimated Zhou Cheng's abnormality, or underestimated the severity of this patient's infection.

Twelve hidden infection foci were found by Zhou Cheng from various places one by one. His actions were precise and not procrastinated. The actions would definitely yield something, and they were of different sizes.

"Doctor Zhou, is there any more?" Tong Xun, who was piously pulling the hook and constantly observing and studying, asked in a very respectful tone.

This is the first time that Zhou Cheng has shown this kind of pressure from the superior doctor in front of them!
Before, although Zhou Cheng's minimally invasive fracture surgery was very delicate, Zhou Cheng pioneered that surgery. Now this surgery is debridement and suture.

Resident doctors can carry out, but their strengths are not the same.

However, Zhou Cheng gave them a painful blow in this most basic field. This kind of blow can make everyone despair and see the difference in level.

"No, the infection foci in this cavity have almost been cleaned up. However, there should be some small infection foci in the periosteum of the joints and bone surfaces. This number is quite a lot. We have to find them carefully. Find it."

"It's probably going to be late at night in the operating room today." Zhou Cheng said helplessly.

"More? A lot?" Hearing Zhou Cheng's words, Lu Bin despaired not only because of the long operation time, but also because of his own ignorance.

However, Zhou Cheng's words cannot be false. The re-discovery of so many infection lesions before is the best proof.

"It's not too much, it's just that it's very troublesome to clean up. After cleaning up all these things, it can be considered a complete debridement."

"After surgery, it is necessary to use antibiotics in combination, followed by continuous irrigation and drainage, so as to prevent the recurrence of infection to the greatest extent, but it cannot be absolutely avoided."

"It's too annoying to be infected with this thing," Zhou Cheng said.

This infection case is at least five times more troublesome than what Zhou Cheng encountered in the Ninth Hospital of the Shanghai Metropolis before. This is what Zhou Cheng finds interesting, so it is this interesting that attracts him. on stage.

This is not the patient that Lu Bin and others should take over. It really needs them to deal with it. The most direct and final way is probably just amputation.

It's not that the level is not good, but the problem of cognition. Perhaps even Professor Xue Xiude, and even Zeng Diwei, faced with such patients, there is a high possibility that they will overturn!

Patients with postoperative infection have a certain degree of absolute amputation probability. The proportion of these patients is not large, but every time one occurs, it is the greatest pain and torture for the patient.

It is impossible for Zhou Cheng to solve the similar problems of all patients one by one, tearing him apart is not enough, so this basic anatomical theory must be done!