medical simulator

The operation Zhou Cheng is doing now is actually very simple, that is, incision.

Incision is the first step in surgery, which refers to the surgical operation process of using some kind of instrument (usually a variety of scalpels) to make an incision on a tissue or organ. It is one of the most basic operations in surgery.

Basically, if you call an intern, he can also hold a knife and roughly do an incision.

During the internship, the interns were able to do a skin incision. Although it seems like Chinese New Year, it means that the entry level of this technology is very shallow, and it is not something unfathomable.Just need to grasp a few points.

For example, the principle of sterility, such as:
For larger incisions, the operator and assistants fix the skin on both sides or up and down of the incision, and the operator fixes small incisions on both sides of the incision with the thumb and index finger. The operator holds the scalpel and makes the belly of the knife perpendicular to the tissue to prevent For oblique cutting, the tip of the knife penetrates the skin vertically first, and then turns to form an oblique angle of 45 degrees with the skin surface. Use the knife to evenly cut the skin and subcutaneous tissue until the length of the predetermined incision is reached, and then turn the knife to 90 degrees to the skin surface. Vertically, lift the knife out of the cut.

Then get more proficient, master the strength of the knife when cutting, and try to cut the whole layer of skin at one time, so that the incision is linear and the edge of the incision is smooth, so as to avoid uneven incision edges caused by multiple cuts and affect healing.

Do not use too much force when cutting, so as not to accidentally injure important deep tissues.It is advisable to cut the subcutaneous tissue and the skin at the same time and keep the same length. If the incision length of the subcutaneous tissue is shorter than the skin incision, it can be cut with scissors.

After incision of the skin and subcutaneous tissue, the surgical towel is used to cover the surrounding area of ​​the incision (currently clinically, a sterile film is often used to paste the incision site before incision) to isolate and protect the wound from contamination...

However, in theory, the content presented in the textbook cannot describe Zhou Cheng's current operation process and fluency.

As the saying goes, laymen watch the excitement, and experts watch the way.

Ning Xihua, who knew that Zhou Cheng was tinkering with teaching theories, asked respectfully at this moment: "Doctor Zhou, if you follow the so-called skill level system that you taught your students when you taught them, this incision technique can be divided between different levels. , how to divide?"

When Ning Xihua asked such a question, his teacher Chen Tingye immediately took a look at him.

"Talk less, watch more!"

"Doctor Zhou, ignore him and continue the operation." Chen Tingye's tone was serious.

What time is it now, you are 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 apprentices can do whatever we want when performing surgery, but outside, the most basic rules still have to be taught.

Zhou Cheng was not distracted. He heard Ning Xihua's question, but he didn't reply. Instead, he continued to quickly follow the shape of the artery, dissecting it one by one, and untied the human calf out of the artery like a cow. Out-of-shape gaps.

In the gap, arteries are exposed rapidly.

There is no such thing as wasting time or not having enough time as Chen Tingye said before.

In just a few minutes, Zhou Cheng exposed several arteries below the popliteal artery to outsiders, and separated them very clearly.

Such a blood vessel exploration technique can simply be called a miracle.

Who can basically expose all the arteries in just a few minutes?

"Huh!" Zhou Cheng breathed a sigh of relief.

"Ms. Chen, let's check the circulation of the blood vessels together. If it really doesn't work, let's temporarily make a short connection path to restore the blood supply first." Zhou Cheng suggested and invited.

"Okay, Doctor Zhou, you are in charge, and I will cooperate."

"Ning Xihua, help pull the hook and pass the equipment." Chen Tingye instructed his students again, shaving his eyes away.

Now it’s for your treatment, don’t make trouble for me any more, if you have any questions, ask them after the operation is over.

In fact, if the arteries are exposed to the current level, the operation is relatively simple. Under direct vision, the naked eye can see where it is unobstructed, which artery is not working, and if it is not working, how to deal with it next, After the blood is penetrated, even if there are small blood vessels that are still clogged, it can be treated with drugs after the operation.

It is basically quite clear that the surgery can do this.

And all this is clear only because Zhou Cheng showed a near-perfect incision technique.

Is incision difficult?
Not difficult!

but?Can incision work wonders?

If it was before, Ning Xihua would never ask himself such a question, but now, for the first time, he has some doubts about his own cognition.

After a while, Yang Yifeng stepped on the sensor door from the operating room and came in, and he had washed his hands at the same time.

When he put on his clothes and gloves and approached the operating table, his eyeballs popped out suddenly: "Professor Chen, did you do a good job of blood vessel exploration?"

Yang Yifeng was already good at vascular surgery, so he knew how to judge the level of this vascular exploration technique.

"I didn't do this, it was Xiao Zhou. You came at the right time, Xiao Yang. This patient had a limb replanted after amputation. Now the blood flow is blocked. There should be an avulsion of the arterial intima. So Zhou The doctor told you to deal with it. See if you can do a replacement or a short pass.”

"Can you call Professor Jin?" Yang Yifeng listened, smiled and replied casually, but immediately took the corresponding tools and started to operate.

However, the operation this time was much easier than most of the lower extremity vascular operations he had done before.

Because usually when doing such an operation, the arteries and blood vessels will not be exposed as they are now.

This is equivalent to playing with mud with your hands, and you can handle it as you want.

In traditional surgery, the reason for choosing a large incision is for the convenience of operation.

……

Then, the final result was that an operation that Chen Tingye and Ning Xihua thought was particularly difficult was completed by Zhou Cheng and Yang Yifeng within half an hour, and the rest was a long period of high-intensity surgery. The stitches are up.

The blood vessel exploration is well done and large, but the opening is also large, and the corresponding suturing time will be longer.

But as long as he can keep his legs, Ning Xihua thinks it's okay to toss.

Chen Tingye left the stage to rest first. He guessed that he had been tossing around 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 firm on the stage.

Ning Xihua asked Zhou Cheng and Yang Yifeng to step down and rest.

But Zhou Cheng knew that Ning Xihua was tired all night yesterday: "Professor Ning, why don't you go to rest, and Xiao Yang and I will be in charge of the finishing. The patient's current situation is not life-threatening, we will take it slowly at worst. "

Ning Xihua took the opportunity to make a joke: "Xiao Zhou, you must not be slow, right? The title of the fastest man in the operating room is definitely yours. Let's go together."

"Let's go together soon?" Zhou Cheng echoed back.

Itinerant nurses and equipment nurses are no strangers to it, 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 out of shape in just a few minutes?"

"To be precise, it's 7 minutes." Ning Xihua returned to seriousness and explained to Yang Yifeng with specific data.

Yang Yifeng took a deep breath.

The following Cao Zou is not worried at all. It is not the first time that Zhou Cheng has performed such an operation. Certainly not as good as they first took over.

But compared to direct amputation, being able to keep the leg is already a blessing for the patient.

Taking advantage of this gap, Zhou Cheng smiled and said to Ning Xihua: "Professor Ning, the question you asked me before was just a setting and idea I made while joking, don't take it seriously."

"It's just some of my ideas while joking with the students, which can be regarded as a strict requirement for them."

"The level of incision can be divided in this way."

"The beginning of incision is to make an arc-shaped incision with a length of 0.5 centimeters, and accurately control the incision depth of [-] centimeters!】

[Requirements: Do not cut repeatedly, no broken lines appear in the incision, the lateral movement of the incision cannot deviate from the marking line by 3 mm, and the incision depth cannot exceed 1 cm.The operation time does not exceed 20 seconds. 】”

"At this level, there is only a requirement for lateral offset, and there are no particularly strict requirements for the depth and length of the incision."

"The next level of incision: according to the marked line, make an arc-shaped incision with a length of ten centimeters, and cut deep into the subcutaneous fascia!"

[Requirements: No repeated incisions, no broken lines in the incision, no sideways movement of the incision by 0.5mm from the laser marking line, and no more than 0.5mm of incision depth from the subcutaneous fascia.The incision length error does not exceed 0.2 cm, and the operation time does not exceed 5 seconds. 】”

"Why can't the incision depth exceed 0.5 millimeters?" Ning Xihua asked after hearing that.

Zhou Cheng's request is more than harsh?

Is this just the second level?

"Because there are blood vessels in the subcutaneous fascia, if the cut is too deep, there may be more bleeding. It is for this reason that I set up this standard." Zhou Cheng explained with a smile, 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 bother to ask about the specific details.

"Level 3 of incision, let me describe it like this for now. There is no requirement for incision depth for level 3 incision. For example, within 10 minutes, it can reach the fracture end and the joint cavity in trauma surgery."

"The requirement is that there should be no muscle damage, no blood vessel and nerve damage, and the amount of bleeding should not exceed [-] milliliters. Otherwise, the rules are too rigid, and people are afraid of being too anxious."

"Hey, it's not easy." Yang Yifeng's eyes became serious, apparently thinking about whether the rules Zhou Cheng made were feasible or not.

"Level 4 incision surgery is required to reach the field of view of any operation within 15 minutes in the four types of specialist operations, and the bleeding volume is required to be no more than 100ml."

"Grade 5 incision, the wound surface is less than one-third of the normal incision, reaches the core part of the operation, and the bleeding volume does not exceed 200ml. After the operation is completed, the overall bleeding volume does not exceed 1500ml. Do not damage any unnecessary tissue during the operation .”

"And it can also close the surgical incision at any time during the operation, so as to avoid entering places that should not be entered, causing massive bleeding and blood surge."

"I haven't figured out the level 6 of incision. 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 eyes.

Yang Yifeng began to complain: "It's really unlucky to be your student. I haven't read the things you sent me. If I knew about the things you sent me, I would have written them in the novel. A detailed and realistic setting."

"It's sure to sell well."

"It's just a joke! It doesn't have to be serious." Zhou Cheng explained.

Such standards are somewhat too harsh, so when setting them, we must also take into account the actual situation, otherwise, many professors may not be able to reach the level of level 4 in reality.

The surgery lies in the precision not in the speed, the quality of the surgery is the first, definitely not other techniques.

Of course, if all these can be done better, the quality of surgery will be improved even more, which is right.

When Ning Xihua continued to stitch, he breathed a deep sigh of relief, and then said: "What you are performing now, should be at level 6. If you want to call me to define it, then I will definitely say, cut it open." For level 6 surgery, the entire nerve and its branches must be separated within 10 minutes according to the shape of the blood vessel or nerve."

"The requirement is that there can be no rupture of the target tissue or other..."

Hearing this, Zhou Cheng smiled and said, "Professor Ning, the details you mentioned are the grading of blood vessel and nerve exploration. If the incision is also divided in this way, it will be a bit cumbersome."

"What I'm doing now should only be regarded as blood vessel exploration, not a simple incision."

"This is the basic skill!" Ning Xihua nodded, and began to start his own suturing seriously. After thinking about it, he wanted to ask Zhou Cheng if there is any level of suturing.

However, Ning Xihua didn't dare to ask again, fearing that his corresponding level would be too low, and he would lose face and be too straightforward.

It's better to wait until after 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 so.

"That's for sure, Professor Ning." Zhou Cheng was sure.

Ning Xihua is not interested, but he is a little unconvinced. He wants to see what Zhou Cheng can come up with, because if the game Zhou Cheng is playing now fails, it will be just a joke.

But if he succeeds, Zhou Cheng may be famous in history, at least in the medical history of Huaguo, he will leave the most dazzling and strong ink, and of course it may be the biggest infamy!