medical simulator

"Ah? Professor Chen?" Zhou Cheng went down to the operating room, and after meeting with Chen Tingye, what Chen Tingye said made Zhou Cheng's steps stiffen and his expression complicated.

Finally, he stopped and looked at Professor Chen Tingye with a bitter face.

Chen Tingye is the Ward Director of the First Department of Orthopedics, and is currently the leader in the Hand Surgery Department of the Affiliated Hospital of Shonan University.He is also Associate Professor Ning Xihua's mentor and former superior doctor——

Chen Tingye may also feel that what he said to Zhou Cheng in person was inappropriate, so he eased his emotions and said: "Xiao Zhou, I am just explaining the situation calmly to you, and I am not blaming you. Right, you and I belong to the orthopedics family."

"I didn't treat you as an outsider, so I told you these things. If I saw an outsider, I could have kept it all a secret."

"It's not that when you were in Changshi, you taught Wei Hong from the Second Affiliated Hospital of Shonan University, which put a lot of pressure on Ning Xihua." Chen Tingye's tone was serious, and his explanation was very straightforward. .

Amputation of limbs to save life, and then replantation of limbs to restore limbs. This kind of surgery is a pioneering surgical concept. Zhou Cheng was the first to propose it. At that time, Zhou Cheng did not have much contact with the Affiliated Hospital of Shonan University. relation.

Although the creation of the concept of surgery is far less difficult than subverting the foundation, as the founder, Zhou Cheng has the deepest understanding.

When he was in the Orthopedics Department of Changshi Hospital of Traditional Chinese Medicine, Wei Hong, who was also the "inheritor" of the Hand Surgery Department of the Second Affiliated Hospital of Shonan University, went down to follow Zhou Cheng for a period of time, and now he is doing a good job in the Second Affiliated Hospital. It is equivalent to Zhou Cheng personally brought it...

As for Ning Xihua, also an associate professor, about the same age as Wei Hong, he saw that Wei Hong was doing so enthusiastically, and then the lower-level hospital called him to have a consultation operation, and Ning Xihua also went.

He also didn't want to fall behind others and embarrass Chen Tingye, so he was studying the replantation of severed limbs by himself.

But this thing—

Whether someone takes it or not is two different surgeries.

not to mention?
The person who took Wei Hong was still Zhou Cheng. Therefore, Wei Hong, as an associate professor, could carry out the work now. Ning Xihua felt that he would not be weaker than him, so he figured out the basic theories and so on, and started to be the chief surgeon.

The result now is that even though Chen Tingye went, he couldn't continue the severed limb. In fact, the places that should be sutured have already been sutured, but the sutures are not particularly good. It may be that the affected limbs, blood vessels, etc. are all lost. active.

Also, the time has passed...

The most difficult part of replantation after amputation is not the proximal stump of the amputation, but the distal end of the amputation. There is a time limit, that is, it must not exceed 24 hours.

After being away from the body for too long, it is difficult for the gods to be revived.

The problem now is that when the amputation was performed to save his life, he was out of blood for a while, and then Ning Xihua fiddled with it for a while, and then Chen Tingye fiddled with it, and now he was transferred to the Affiliated Hospital of Shonan University.

24 hours have passed.

"Professor Chen, that's not what I mean either." Zhou Cheng restrained his inner emotions.

How to put it, now it seems that the relationship between Ning Xihua and himself is naturally closer than that of Wei Hong, but when he and Wei Hong worked together, Zhou Chengcheng couldn't figure out who Ning Xihua was on duty.

How could he have thought of so much, and he never thought that he was just cooperating with others to do a new project at that time. At that time, Wei Hong took the initiative to come to the door, and it would bring such a big impact to Ning Xihua, whom he now knows and is familiar with. pressure.

"Professor Chen, at that time last year..." Zhou Cheng still had to explain a few words.

Chen Tingye didn't want to waste any more time: "The past has nothing to do with the present, Xiao Zhou, you must take a good look at it, if you can save it, that's the best, if you can't, then you can only go and get along with it." The patient talked with his family about re-amputation."

After the amputation, the severed limb was replanted, and now it is going to be amputated again.

Such a toss, what kind of family members will be angry?

However, this kind of thing has been discussed before, so I don't blame Ning Xihua.

At present, there are very few hospitals and doctors who can perform such operations. It is only natural that they are not successful, and it is only a miracle that they succeed.

However, before finally losing hope, anyone still hopes to have a chance.

"Professor Chen, I will try my best!" Zhou Cheng could only respond, and his pace accelerated a little.

Chen Tingye asked again: "Doctor Zhou, this time of being out of the body is a little over 24 hours, shouldn't it be a big problem?"

"I don't know about this either, let's go and see it first and then evaluate it." Zhou Cheng replied.

……

When he arrived in the operating room, Zhou Chengcheng saw that Ning Xihua was still seriously operating on the patient, assessing the blood supply status and other things.

"Doctor Zhou." Ning Xihua called out when he saw Zhou Cheng enter the operating room, put on his overalls and then go on stage.

I couldn't see the expression clearly, but his eyes seemed to be filled with a hint of pleading and longing. I don't know if he was afraid that his skills were not enough, so he would be troubled by the patient's family.

Zhou Cheng didn't reply, but looked at the leg first.

It should be a girl's right leg. The girl is not very old, she should be in her 20s. The skin above the broken end is still quite white and tender, but there is a little bit of blood at the moment.

Suddenly, I saw that the severed end of the amputated limb had been re-sutured.

Under the severed end, the skin color is white, which should be due to long-term ischemia.

"Did pan-heparinization treat the descending blood vessels at the beginning?" Zhou Cheng asked after sorting out the previous steps.

"It's been dealt with. After I went, this step was the first to be dealt with." Ning Xihua nodded.

Chen Tingye hadn't come yet, so he could only answer this question.

Zhou Cheng then looked at the connected hemodialysis machine, and found that the blood in it was not moving at all.It should be the case of blockage at the far end, otherwise.

The blood purifier must have started working.

Immediately afterwards, Zhou Cheng removed the arterial and venous ends of the connecting tubes to observe the blood supply respectively. At this time, Zhou Cheng found that there was liquid blood flow in both the arterial end and the venous end. Slowly oozing out.

This means that there is a certain amount of blood supply at the place where the blood purification device is connected, but after both ends are connected, there is no flow, which means that the lumen of the blood vessel must have stagnated again.

Another way to judge is that at this moment, the arteries and veins have channels to the outside world. If the flow is smooth, it must not be extravasation, but spewing out.

"Do you need an instrument for removing the bolt?" Chen Tingye asked Zhou Cheng.

In the current situation, everyone knows that there must be a blockage, and the greatest possibility is thrombotic blockage.

If there is a thrombus, it is natural to deal with the thrombus first, and then cause recanalization.

"No. Don't take it for the time being. This situation may no longer apply to interventional thrombectomy, and may require incision and thrombectomy." Zhou Cheng said with a serious expression.

"You decide, Doctor Zhou." Chen Tingye didn't force him just because Zhou Cheng said the word "possible", but gave Zhou Cheng the initiative.

After Zhou Cheng finished all this, he seemed to remember something, and then tried the back of the calf of the affected limb.

In such a situation, priority should be given to whether there is compartment syndrome, which compresses the weak compression of blood vessels, rather than thrombus.

"Doctor Zhou, I have already checked, and there is no increase in the pressure in the fascia chamber." Ning Xihua immediately reflected Zhou Cheng's purpose and responded immediately.

The pressure in the osteofascial chamber can be measured by instruments, which is better than touching it with hands.

"Take a syringe!" Zhou Cheng hurriedly ordered Xun Xun.

At this time, there is actually a simpler testing method.

That is to go along the shape of the artery and poke open one by one to see where it is. The situation is not very good.

It’s just that such an operation requires very rigorous and proficient knowledge of anatomy, and the shape of the blood vessels can be reshaped through the patient’s current posture.

"Syringe." Xun Xun immediately gave it to the equipment nurse, and the equipment nurse handed it to Zhou Cheng, without the insurance to remove the syringe.

After Zhou Cheng took it, he took apart the insurance jacket, and then pierced it against the deformed tibial artery, which was a little eight centimeters below the sutured end.

This plunge, after feeling a slight breakthrough, Zhou Cheng immediately saw that there was nothing in the syringe, as if it had been plunged into a vacuum!
At this time, Zhou Cheng chose to withdraw again.

During the withdrawal process, the pumping was very casual and effortless, and then I saw that a small amount of blood entered the syringe.

In this way, it seems to mean that the blood supply here is smooth.

"There seems to be no problem here, right?" Ning Xihua asked.

However, after Zhou Cheng took a closer look at the state of the blood in the syringe, he immediately remembered something.

"No, Professor Ning, there is something wrong with the blood. This patient must have arterial dissection after reperfusion!"

"Look at this blood, its color looks more like venous blood than arterial blood, but our blood collection site is an artery, so the blood inside should flow back."

"This may be an arterial dissection. We need artificial vascular stents. Does our hospital have this?" Zhou Cheng asked quickly.

Ning Xihua was stunned, but Chen Tingye chose to believe: "I'll call and ask right away!"

Vascular stents are instruments used in vascular surgery. Only by contacting the vascular surgery can we find the corresponding equipment suppliers.

Moreover, the diameters of vascular stents are different, and it may not be known whether there are stocks in the hospital.

Chen Tingye quickly dialed the phone number of the director of the vascular surgery department. After a while, the corresponding stent was brought into the operating room by the itinerant nurse. At this time, Zhou Chengcheng had already prepared the arterial sheath...

The position of the introducer sheath is further down.

Soon, Zhou Cheng pushed the vascular stent in with fluent operation.

And in the process of doing this, one end of the blood purification device finally started to move.It seemed that blood was slowly flowing.

"It's done!" Seeing this, Ning Xihua exclaimed happily.

However, Zhou Cheng was not happy about it.

Because he didn't see the flow at the vein end, which means that even after the artery at this place is recanalized, there are still blood vessels blocked at other locations, and the location is still unknown.

So under such circumstances, he seems to have to follow the current steps and do it again, maybe even more than once. A blind temptation like this is obviously not feasible...

Ning Xihua's smile only appeared, but soon became stiff again.

He looked nervous, but dared not say a word.

Chen Tingye also looked at Zhou Cheng, and at the same time his eyes were turning rapidly, thinking about ways and countermeasures.

The current case is estimated to have evolved into a special case. There is no previous treatment experience to learn from, and the current diagnosis is not clear.

It may be a thrombus, or there may be other avulsive dissection of the intimal layer of the vessel.

Although everyone didn't say a word, they all looked at Zhou Cheng, which made Zhou Cheng feel a certain pressure, but this pressure did not affect Zhou Cheng's thoughts. Zhou Cheng thought for a while, and said: "I don't know now. Is it because dissection and thrombus exist side by side, if you want to keep this leg that has been out of the body for more than the time limit."

"There is only one stupid way to do it. Let's open up and do the whole blood vessel dissection! Professor Chen."

Chen Tingye was taken aback when he heard the words, and immediately replied: "Xiao Zhou, it's okay to do blood vessel exposure, but I'm just afraid that there is not enough time. After finishing it, it still won't help."

Exposing blood vessels is actually time-consuming and laborious, let alone the whole process?
This kind of anatomical exposure of blood vessels is not just like digging eels and loaches, just dig along the hole.

It took a lot of time, and in the end the limb must have been necrotic. Even if it can be reconnected, there is no way to restore vitality.

"If the whole anatomical exposure is done and the necrosis is still in the end, then it is a matter of luck, and we can only do this now!"

"Professor Chen, call Yi Feng over here, let him be the arterial and venous circulation channel at any time. We have to do it little by little." At this time, stop being clever, and follow the simplest method honestly Find the cause.

This is not a simple theory or some accident or special case can find the cause.

"Okay!" Chen Tingye's suspicion was just a suggestion, not to refute Zhou Cheng's treatment plan.

He immediately arranged a tour and called Yang Yifeng.

Then when I looked back at the operating table, I found that Zhou Cheng's scalpel seemed to be cut open, and the knife went directly from the middle of the calf to the dorsal side of the foot. The smooth incision curve was not messy at all.

And the depth of the cut turned out to be just right——

There wasn't much blood oozing or even surging.

Is it because the blood supply is already blocked, so there is no blood?
Zhou Cheng's operation was too fast. While Chen Tingye was still thinking, Zhou Cheng had already started blunt peeling. Before he could react, Zhou Cheng had already stretched the muscle layer through blunt peeling, and stretched the shins. Part of the anterior artery had been pulled out.

As proficient as digging a bird...

Chen Tingye gulped two mouthfuls of saliva, and said silently, I take back what I just said, this kind of operation is the same as what I thought, but the stupid method Zhou Cheng mentioned may not be the stupid method I thought...