Gou in the operating room to add some upgrades

Chapter 13 There is a big fish (please collect and recommend)

[With the cooperation of your assistant, you completed an operation, causing 4 points of damage to the postoperative infection of an open fracture (accounting for 1.0%), and gained 4 skill points! 】

[You cooperated with the suture operation and caused 23 points of damage to the skin and soft tissue surgery wound (accounting for 5%), and gained 23 skill points! 】

[Current skill points remaining: 28. 】

One operation added 28 skill points, which was not a small amount. Fang Xian backed away happily.

But when Fang Xian retreated to the operating room to carefully consider the detailed information on the panel, his brows instantly twisted into Sichuan characters.

The hand that untied the collar tie stopped——

There is nothing wrong with this amount of damage, but the percentage of damage is problematic!

Fang Xian once again used the mind control panel to pull up the skill point acquisition details——

[You cooperated with the suturing operation, causing 21 points of damage to the skin and soft tissue surgical wounds (accounting for 33%), and gained 21 skill points! 】

When I was working as an assistant, the diagnosis showed post-operative infection of an open fracture!
But when I sewed it up, the infection didn't show up. What's going on?
Fang Xian was not dazzled by the large number of skill points obtained. Instead, his mind was spinning rapidly, analyzing the doorways inside.

It didn't take long for him to obtain this thing himself!
At present, we only know that the amount of damage = skill points. As for the latter proportion, Fang Xian rarely pays special attention to it.

Little special attention does not mean that Fang Xian does not pay attention.

The operation on the operating table is still going on——

After Fang Xian took off his clothes, he couldn't analyze the results for a while and didn't dare to speak rashly, so he left the operating room and washed his hands first to calm himself down.

Surgery is not child's play, nor is treating and diagnosing patients. Reporting one's suspicions to superior doctors is even less child's play. Therefore, Fang Xian must be cautious and make every advance and retreat well-founded!

Fang Xian is not stupid, his IQ has never been a problem, otherwise he would not be able to enter the Affiliated Hospital of Shonan University to become a regular trainee, and he would have the opportunity to replace a master's degree, and finally graduate with a master's degree.

This ratio is not right!

Even though the degree of infection and fractures of the lower limbs operated by me and Associate Professor Song Yu were lower than those operated by Professor Lin Jiemo, the wounds were basically the same size.

What is serious is the internal fracture and the size of the infection. For surgical incisions, the ratio is at most 4:6, which is normal.

At least this is the case considering the length and depth of the wound.

So, even if we look at the ratio of 1:9, which means that Professor Lin Jiemo's infection is more severe and the nature is worse, after he completes the suturing, the proportion of injuries should not be less than 10%. .

With the same trauma field size, why would it fall to 5% in the end?
There are only two possibilities, either there is some hidden cavity in the leg treated by Associate Professor Song Yu that has not been opened, so the infection and debridement are ineffective.

Either that or the left lower limb that Professor Lin Jiemo is dealing with now contains a large crocodile, or even a large crocodile that has not been discovered yet!This makes the damage required on this side account for a very high proportion!

Extremely high.

5%: 95%, one to nineteen.

Which possibility is it?
Fang Xian's head was a little messy, it was just a directional push, only one direction was given without details, and this direction was screwed out by him alone.

There were two lines in the direction, which Fang Xian couldn't grasp for a while.

Associate Professor Song Yu is currently a Level 3 senior associate professor certified by the Medical Association. It is impossible for him to have hidden cavities that are not opened during the operation, which will lead to ineffective debridement of infection.

However, this patient did not show any details of infection in the surgical wound operated by Associate Professor Song Yu.

So can we boldly speculate that the lower limb operated by Associate Professor Song Yu only had deep infection, and there was no infection on the superficial surface of the skin.Under the leg that Professor Lin Jiemo operated on, there was a relatively large infected cavity, but it was not discovered?

If based on this calculation?

The patient did not have an MRI before the operation, and even if he did, he may not be able to read it from the MRI.

The focus of trauma surgery reading is on X-rays, mainly to see fractures, and they did not specialize in learning MRI reading techniques that focus on soft tissue during the residency stage!

It's still not enough knowledge reserve, otherwise, I can definitely figure out some clues.

If there is no better way, just go to the operating table and continue to watch Professor Lin Jiemo's operation process, and then slowly explore it.

This is a problem related to diagnosis. What is needed is theoretical analysis and thoroughness, and then to find the diagnosis, at least one line must be found.

Either Associate Professor Song Yu didn't clean up the abscess cavity, or there was something big in the leg that Professor Lin Jiemo was dealing with!

These two directions focus on, and Fang Xian has already found out.

This patient is still in his own bed, so it must be reasonable for him to ask questions at an appropriate time. After all, in the operating room, only he is the most familiar with this patient.

This is what the superior trusts you to let you manage the bed, what you have to do!

Beside the operating table, Fan Chengpeng was still discussing in a low voice with his senior brother Wu Xiong the difference between Associate Professor Song Yu's current level of debridement and Professor Lin Jiemo's level of debridement.

Liang Longqi and Zhou Xiaosheng, who are in the same grade as Wu Xiong, are trying to figure out the next step of debridement, which operation details to pay attention to, and how to control the direction.

There was also a senior fellow with a Ph.D. who kept touching his chin, occasionally looking like he was suddenly enlightened, and occasionally frowning. He was obviously reading the surgery very carefully.

Fang Xian was also paying attention to the operation of Lin Jiemo and the other two doctoral brothers, and then saw Associate Professor Song Yu and the attending physician Xue Li also carefully observing something on the stage.

Almost everyone is focusing on the debridement performed by Professor Lin Jiemo at this moment, because the debridement performed by Professor Lin Jiemo is not only the debridement of soft tissues, but also the debridement of fractures and bone surgery. , Bone cavity, debridement inside the periosteum.

Finally, about 10 minutes later, Fang Xian really discovered the weirdness.

This patient's left lower limb, that is, the posterior gastrocnemius muscle of the limb with deep vein thrombosis, has severe signs of edema!
Previously, Fang Xian and everyone in the department thought about this. Due to the obstruction of venous return, the outflow of fluid in the vein caused edema on the back of the calf. Most of the injured parts of the patient were in the front of the calf, and there was a certain degree of pain. skin defect!

But as a trauma surgeon, Fang Xian knows!
Everyone has four compartments in their lower legs, which is the anatomical basis for compartment syndrome.

Including anterior chamber, lateral chamber, posterior deep chamber, posterior shallow chamber!
But what is more troublesome is that the incision made by the patient is an anterolateral incision. The anterolateral incision generally corresponds to the anterior fascial compartment and the lateral fascial compartment, and no special signs can be seen.

To open the posterior deep fascial compartment and superficial fascial compartment, a posteromedial incision is usually required.

Moreover, because this patient's tibia is fractured, and the tibia is an important part of the posterior deep fascial compartment, if there is a large amount of infection in the posterior deep fascial compartment, it must have appeared by now.

Currently the only blind spot is the posterior superficial compartment.

Do you want to mention it?
If you mention it, you have to make an extra cut, what should you do if you don’t have it?
If we don't mention it, then this operation may be in vain, and a third operation in the operating room will be required later.Thorough debridement is a prerequisite for infection healing. If there are remaining bacteria, a large number of bacterial colonies can form in a short period of time, causing recurrence of infection.

After hesitating again and again, Fang Xian moved to the side of Associate Professor Song Yu, and said in a low voice, "Mr. Song, this patient had edema during the hospitalization, especially in the left lower limb. Can you take a look inside the superficial fascial chamber at the back?" How's the pressure?"

Generally speaking, the infection occurs in a closed chamber, and the internal hydraulic pressure must be increased, because the bacteria will secrete a large amount of fluid and emulsify the normal tissue.

"This patient never visited the posterior superficial fascial compartment during the first operation. The fascial compartments are relatively separated." Associate Professor Song Yu knew Fang Xian's concerns and asked in a low voice.

"But this is a comminuted fracture. The first open fracture operation did not enter the superficial fascial compartment, which does not mean that the fracture fragments did not enter!" Fang Xian said.

Associate Professor Song Yu heard the words thoughtfully, returned to the operating table, and then slightly probed the back of the patient's left lower limb. After a slight pinch, his complexion changed instantly!

When the patient came to the hospital, the external fixation device was wrapped with gauze, which was inconvenient for physical examination.

During the disinfection process, Associate Professor Song Yu and Professor Lin Jiemo did not participate in the disinfection process, so they did not have the opportunity to conduct a comprehensive physical examination.

Even if Fang Xian is the doctor in charge of the bed, it is impossible to do the grinding and physical examination of the back of the calf after the external fixator is installed!
Song Yu's physical examination skills were very thorough. After a moment, he whispered: "Professor Lin, there is a problem with the posterior superficial fascial compartment of the left lower limb."

Lin Jiemo is currently concentrating most of his operations on the debridement of the surface of the tibia, and has no time to take care of it.

"If you have any questions, check it out. There is a gap between the posterior superficial fascial compartment and the current fracture site. The chance is not high." Apparently, Lin Jiemo also thinks that the probability of this happening is very small!
Song Yu immediately followed the instructions. After squeezing out a position, he just made a very small incision on the back and inside of the left lower limb from the direction of the right lower limb. After breaking the deep fascia of the calf, a light white color immediately oozed out from it. Purulent mucus, like milk drops.

Lin Jiemo, who noticed this scene, immediately stopped all operations!

(End of this chapter)