Gou in the operating room to add some upgrades

Chapter 237 Proving the Tao with force (please subscribe)

Fang Xian just took a quick look around Wuling Hospital, and then returned to the dormitory without doing anything else.

Fang Xian couldn't do anything to other hospitals.

The next day, in the operating room of Ci County People's Hospital.

A total of two surgeries were arranged. The first one was to arrange Fang Xian's release surgery.

In fact, surgeries like release surgery should be scheduled after open reduction and internal fixation of fractures.However, maybe Huang Bohang moved ahead of time in order to give Fang Xian face.

With Huang Bohang personally acting as his assistant, Chen Fangqian's decision to perform the surgery disappeared without a trace. The other party said casually: "Dr. Fang, our hospital still rarely touches this kind of disease."

"Dr. Chen has basically no experience. Dr. Fang should be guided by you personally, right?"

"Chen Fangqian, what do you think?"

Huang Bohang is not only the deputy chief physician leading the team, but also the director of the ward. Huang Bohang has said so, so how can Chen Fangqian not give Huang Bohang face.

"Director Huang, what you said makes sense. I didn't think carefully before and was a little hot-headed." Chen Fangqian retreated temporarily.

At this time, Zhou Xiyin, who was not on stage, said: "Director Huang, since Senior Brother Fang is in the operating room today, why not let Senior Brother Fang perform two teaching surgeries? Director Huang, what do you think?"

Huang Bohang narrowed his eyes slightly when he heard this and asked, "Dr. Fang is also involved in fracture surgery?"

The meaning seems to be that trauma surgery is his specialty. Although Fang Xian's basic skills are solid, he is good at emergency first aid such as a trauma center, which does not mean he is good at a specialty.

Before the advent of the Medical Association, first aid such as emergency departments and trauma centers were just transfer stations for clinical departments. They did not have many sophisticated operations at all. They were only developed in recent years.

"A little bit, Director Huang." After Fang Xian replied politely, he stopped worrying, picked up the scalpel, and started the operation.

Although it sounds like a simple release procedure, the entire calf release procedure is not simple to perform.

The difficulty of the operation, the area of ​​the operation, the scope of the operation and the things that need to be grasped delicately are quite complicated things. It is equivalent to Fang Xian having to turn over the entire calf as if it were a plowed field.

And this happens to be the organic integration of various different concepts such as curettage and blunt puncture in level 4 debridement.

There are not many fancy operations in the entire operation, only basic skills that are so solid that it is shocking.

"This is the gastrocnemius muscle."

"Tibialis anterior muscle group, this is..." Fang Xian began to explain to Huang Bohang and others while releasing the muscles. Moreover, when releasing muscle scars, if blood vessels and nerves were encountered, Fang Xian would also Together, the nerves are protected extremely well.

As the operation continued to progress, Huang Bohang slightly changed his thoughts and ideas: "Dr. Fang, this full-thickness release of the calf seems to be extremely relieving."

Regardless of whether Huang Bohang admits it or not, for patients with muscle gap adhesions, the process of the adhesions being continuously released and separated is an extremely decompressing process.

"Director Huang, in fact, the most stress-relieving thing is the patient's feedback after surgery."

"Once the lower limbs become adherent, to them, they are like a piece of stone, as if it is not their own foot, but a foreign object."

"And once it's released, even painful activities can make them feel relieved."

"This is the medial and lateral head of the gastrocnemius, between the medial and lateral heads of the gastrocnemius..." Fang Xian continued to speak seriously.

Huang Bohang's expression immediately changed.

"Ehhh."

"Doctor Fang, you can't get in here, this is the popliteal cavity." Huang Bohang immediately advised him.

Basically, all orthopedic surgeons know that in general, there are four restricted areas in orthopedics, and they should not be opened if possible.

One is the axilla, one is the femoral artery sheath, the other is the popliteal fossa, and the last one is the retroperitoneal hematoma.

Because the blood vessels in these four places have extremely complex shapes and are relatively concentrated, any deviation during the operation may cause damage to multiple nerves and blood vessels, leading to massive bleeding.

Generally, prefecture-level city hospitals will refer to these four places as "no death, no progress."

Unless the patient must go in for hemostasis at that time, otherwise, go to the top, I can't handle it here.

Fang Xian, a good guy, performed the first surgery alone, and he inserted the penis into the popliteal fossa.

However, it was impossible for the sound to stop the surgeon's movements.

"Director Huang, do you have a certain misunderstanding about the complete release technique?"

"The gastrocnemius is an important component of the calf muscle, and the popliteal fossa is the starting point of the tibialis posterior muscle deformation. Naturally, it needs to be released. Otherwise, there will still be local functional insufficiency after surgery."

"Dr. Chen, look, this is the popliteal nerve..." Fang Xian pointed to Chen Fangqian and Du Lixiao.

But at this moment, both of their scalps were numb.

Even though they all thought that Fang Xian was an expert and bold, at this moment, Fang Xian's behavior had already exceeded their psychological bottom line.

You have to be very careful. If there is any deviation, we may have to open the popliteal fossa for blood vessel exploration. Our hospital does not have vascular surgery consultation.

However, it is obvious that Fang Xian's operation process is still very fast, and there are no dangers along the way.

Moreover, after the release, Fang Xian said: "After the release, the bleeding points on the wound must be cleaned up. Otherwise, if there is hematoma remaining in the muscle gap, the chance of recurrence of adhesion will become Very big."

"And if this can be done well and combined with nerve block analgesia after surgery, the patient's postoperative pain can be controlled to a certain range, and the patient will be willing to do functional exercises to avoid the recurrence of adhesions. This will make the postoperative effect better , worth looking forward to..."

Although Fang Xian said this, it seemed that Fang Xian's actions at the moment frightened both Chen Fangquan and Du Lixiao.

The two of them looked at Fang Xian with fear, as if they were looking at a madman.

After all, Fang Xian is a person who takes a scalpel and goes into the popliteal cavity at will. No matter how skilled a person like this is, he is still a dangerous person.

Out of a thousand patients, you have treated 99, which is all as it should be. If one of them is injured due to unnecessary injury, that is the culprit. This is the medical industry.

But in fact, Fang Xian felt that debridement of the popliteal fossa would be fine, but the worst would be damage to the blood vessels and nerves, and then suturing would be enough. How terrible could it be?
The popliteal fossa is a place where the blood vessels and nerves of the lower limbs are densely packed. With a tourniquet, even if the popliteal artery ruptures, the amount of bleeding will be extremely limited and not so scary.

Just stop the bleeding.

……

Half an hour later, Huang Bohang and Chen Fangqian took turns trying to persuade Fang Xian, hoping that Fang Xian would be more stable during future operations.

"Dr. Fang, patients and the Medical Association do not actually have very high expectations for the tasks that our county hospital needs to undertake. They only need us to be able to ensure basic diagnosis and treatment services."

"Routine diseases can be treated, common emergencies can be treated urgently, and the ability to transport patients in special cases is the limit of what we can do."

"We only need to keep this limit, there is no need to create limits." This is what Chen Fangqian said.And Du Lixiao also said: "Dr. Fang, you see, our place is definitely different from the Affiliated Hospital of Hunan University. At the very least, the anesthesiologists here are not as good as the professors at the Affiliated Hospital of Hunan University." OK?"

When he said this, the anesthesiologist who was anesthetizing the fracture patient looked over.

He frowned for a moment, thought for a moment and said, "Dr. Fang, you are an expert in a big hospital. A small place like ours cannot withstand your troubles."

"When you entered the crotch just now, I was extremely nervous."

"Yeah! Okay, teacher, I'll pay attention to that later." Fang Xian nodded immediately.

The anesthesiology department is not orthopedics, but other departments. Getting along with other departments is the relationship between departments. It is impossible for Fang Xian not to take care of their emotions.

Naturally, Fang Xian also had to take care of the emotions of Huang Bohang and other doctors in our hospital.

The second surgical patient was a patient with a fracture. The nature of the fracture was a double fracture of the tibia and fibula.

The diagnosis was clear and indications for surgery existed, so surgery was scheduled.

Because of Zhou Xiyin, in order to take care of Fang Xian's face, Huang Bohang also gave Fang Xian the authority to perform this surgery.

Fang Xian is the attending physician and performs open reduction and internal fixation of fractures, so there is nothing wrong with that.

In the grade assessment and surgical authority management of Level 2 trauma surgeons conducted by the Medical Association, open reduction and internal fixation of fractures is the foundation among the foundations.

"Dr. Fang, do you plan to perform traction before the operation, or do traction reduction during the operation?"

When he came to his own industry, Huang Bohang was very professional.

The treatment of fractures focuses on reduction, fixation, and functional rehabilitation.

What medical workers can provide patients with is reduction and fixation.

And it is reset first and then fixed.

After the patient is anesthetized, the surgeon can try an early reduction to see if the reduction can be completed or partially done without pain for the patient, in order to slow down the workload of traction and reduction under sterile conditions during the operation.

Fang Xian said: "Director Huang, let me try to reset it before surgery."

"Xiyin, please put on a sterile examination glove and cooperate with me."

Zhou Xiyin nodded hurriedly when he heard this, quickly went to get the gloves, and handed one to Fang Xian.

No one suspected him, and Huang Bohang ordered resident doctor Ning Han to quickly prepare for the C-arm machine's irradiation.

After each reduction, a temporary C-arm fluoroscopy, which is a simple X-ray, is required during the operation.

In the operating room, whenever you see the surgeon, anesthetist, etc., they all run out of the operating room one after another. They are basically orthopedic or spine surgeons doing things with the C-arm machine.

Temporary fluoroscopy during surgery is very commonly used.

Then, Fang Xian and Zhou Xiyin cooperated a little to traction and reset the lower limbs.

Naturally, the operation cannot be gorgeous, it is just a reset technique.

However, there is nothing eye-catching between the two of them.

After the cooperation was completed, Huang Bohang, Chen Fangqian and others saw that the deformity of the tibia and fibula of the patient's right lower limb disappeared within the visible range.

All knowledgeable people in the operating room rubbed their eyes violently.

The diagnosis of fracture lies in the following points.

The first is the patient's pain, the second is the local swelling, the third is the deformity of the affected limb, and the fourth is the physical examination and auxiliary examination showing signs of fracture.

Pain is not felt by the anesthetized patient and swelling continues.

But the disappearance of the deformity seemed to symbolize something.

Huang Bohang couldn't believe his eyes, and then ordered Ning Han to quickly push the C-arm machine closer, and then everyone went out. In the isolation room, after stepping on the foot-operated shooting pedal, the patient's reset image appeared in In everyone's sight.

As soon as the results of the X-ray film appeared on the display screen, even Zhou Xiyin bowed forward in astonishment and glanced in Fang Xian's direction from time to time.

Those innocent eyes seemed to say, Senior brother, didn't we agree on this before?
Didn’t we agree to use technology to conquer?
Fang Xian touched his nose at this moment and said softly: "Director Huang, it seems that the restoration is pretty good. The fracture line is almost hidden, whether it is the fibula or the tibia."

"And the broken end of the fracture has a certain degree of alignment, and there is no lateral displacement or shortening. If we take a lateral radiograph and there is no anterior-posterior angular displacement, can we look forward to it..."

Before Fang Xian finished speaking, Huang Bohang quickly told Ning Han: "Go in first, change your posture, and take a lateral radiograph."

Huang Bohang's scalp was slightly numb.

Logically speaking, it is impossible for Fang Xian, a person from a trauma center, to have such high attainments in trauma surgery.

He understood what Fang Xian meant. Fang Xian was asking whether surgery was no longer needed now.

Direct manual reduction and plaster external fixation can complete the operation.

Huang Bohang couldn't be sure. Fang Xian was angry at him. He felt that he and Chen Fangqian and others had told him that Fang Xian had too many scenes and didn't need too many operations. He just pulled the plug and performed a second surgery. Then don't have any surgery.

The second anger is that Fang Xian did it on purpose, to seduce him on purpose.

Fracture reduction is a specialized basic skill in trauma surgery. This basic skill is the foundation of improving open reduction and internal fixation of fractures. It can be said to be the core of this type of surgery.

Now that Fang Xian has shown such high quality and proficiency in the manual repositioning technique, is he just waiting for me to find him, come fishing with Jiang Taigong, and anyone who wants to take the bait will take the bait.

Huang Bohang didn't like all of Fang Xian's basic operations such as hemostasis and debridement, but this reset technique hit the biggest G-spot in his heart, and he couldn't help but envy and covet it.

In grassroots hospitals, no one cares how solid your basic skills are. Being able to learn specialized skills well is your greatest ability and the best thing to help people eat.

However, after 30 seconds.

Huang Bohang proved that his guess was correct.

Everyone in the operating room, including the busy instrument nurses, circulating nurses and anesthesiologists, fell silent.

As soon as the operation started, it seemed that it was over...

Fang Xian sat firmly on the Diaoyutai, looking indifferent. He was only responsible for operations, not talking or signing.Anyway, the current reduction effect is here. Whether to continue excessive medical treatment depends on Huang Bohang's attitude.

(End of this chapter)