Come on, Dr. Wu

Chapter 262 Bullet!

Modified radical mastectomy for breast cancer.

Fang Ying had seen Wu Xiaofu's skills in thyroid surgery, but she had never even heard of his skills in breast surgery. Now that she was going to see it with her own eyes, she was really looking forward to it.

Modified radical mastectomy for breast cancer has many advantages. After radical mastectomy for breast cancer, the possibility of recurrence is high, but the probability of recurrence after modified radical mastectomy for breast cancer is lower than that after radical mastectomy.

As for the appearance, radical mastectomy causes great trauma, unsightly appearance, and may even cause upper limb dysfunction, while modified radical mastectomy for breast cancer usually does not leave major trauma.

This patient had bilateral breast cancer, with the left side more serious. Her condition was less severe than that of the patient in the outpatient clinic in the morning. She was admitted to the hospital before Wu Xiaofu came to Jinhu County.

The surgery chosen was non-laparoscopic bilateral breast cancer modified radical mastectomy.

That’s right, breast cancer can also be treated laparoscopically, but the operation is more difficult and expensive. In Wu Xiaofu’s case, it was certainly not because of the difficulty of the operation, but because of the cost.

The patient in front of him is already 59 years old. She said that she does not have too many requirements for the appearance of her breast. She is also relatively poor, so naturally she will choose a more economical and affordable surgical method. For Wu Xiaofu, conventional surgery will not cause more damage than laparoscopy.

Without the need for aesthetics, the entire surgery cost can be saved by nearly one w.

This is also the reason why many breast cancer patients choose conventional surgery.

There are actually many procedures for bilateral modified radical mastectomy. Of course, the current mainstream procedure is the modified radical mastectomy that preserves the pectoralis major and minor muscles.

It is also a supine position, but for the convenience of surgery, the patient's affected shoulder blade should be raised a little, and then the affected upper limb should be abducted 90° to allow the muscles to be fully stretched and the breast to be fully exposed. Because this is the posture during the examination, it is not only convenient to expose the armpit, making the operation smoother, but also makes it easier for the surgeon to locate the tumor.

Because there are cancer lesions on both sides, the patient needs to stretch both arms.

"Okay, let's get ready for general anesthesia."

After Wu Xiaofu gave some instructions, he went to wash his hands. In fact, breast surgery can be performed with local anesthesia, but it also depends on the operation time. If it is a general breast nodule surgery, Wu Xiaofu can basically get it done within half an hour.

In this case, only local anesthesia is needed, but breast cancer surgery usually takes more than an hour, and unexpected situations may occur during the operation. The patient is not young anymore, so complications may still occur. Therefore, general anesthesia is safer.

After general anesthesia, the patient will suffer less.

In this position, if general anesthesia is not performed, the patient will start to become agitated within ten minutes, which is really uncomfortable.

Wu Xiaofu didn't want to delay the process any longer, so he decided to go with general anesthesia to be safer.

After washing their hands, Fang Ying and her assistant started to disinfect and lay the sheets.

Wu Xiaofu designs the incision, generally choosing a horizontal fusiform incision or a vertical fusiform incision based on the location of the tumor.

This is selected based on the location and type of the tumor. For example, in this case, the left breast tumor is in the inner lower quadrant, so a transverse fusiform incision is the best choice. The scalpel should be placed in the middle of the inner side of the breast or at the junction of the middle and upper 1/3, and then the transverse fusiform incision should be started.

When Fang Ying saw Wu Xiaofu making the incision without hesitation, she knew that Wu Xiaofu must be an old hand. If he had not performed several operations, it would not be so smooth. However, what he didn't know was that Wu Xiaofu was like this no matter what operation he performed.

Wu Xiaofu had only performed breast surgery a few times, but the ideas were similar, so Wu Xiaofu was very confident.

After the subcutaneous incision, the free skin flap began. Wu Xiaofu used the electric knife to free the skin flap, straight up the clavicle, then inward to the midline, outward to the front edge of the latissimus dorsi, and down to the costal arch, completely exposing the surgical field of view.

The smell of meat wafting out made Wu Xiaofu feel like he was back in familiar territory.

To be honest, each surgery is different.

It's like thyroid surgery. Because of the distribution of subcutaneous fat, the taste of the meat cannot compare to that of the breast, which has a higher fat content.

His eyes fell on the other assistant.

"Does it smell good?"

"what!"

The second assistant was stunned when he heard this, and Fang Ying glared at him, "Smoking, what are you waiting for?"

"Ah oh!"

Erzhu then realized that behind Wu Xiaofu's kind smile was a accusation. She was distracted and didn't smoke in time. Damn it! How could she make such a big fool of herself during her first surgery with her idol? She was going to die, she was going to die.

Hurry up and lower your head and start working hard.

Wu Xiaofu no longer paid any attention to it and began to sever and ligate the 1st and 3rd perforating branches of the internal mammary artery and vein.

This is the main blood circulation branch around the tumor. After cutting it off, the surgery can be performed with more confidence and without having to worry about a stream of hot blood spurting onto the face during the operation.

The pectoralis major muscle is the part that the surgeon directly faces.

"Vascular forceps!"

Fang Ying had already taken over the breast, which was clamped and lifted with several vascular clamps. Wu Xiaofu then took the electric knife and began to remove the breast and surrounding fat tissue from the top to the bottom and from the inside to the outside, behind the pectoralis major fascia to the outer edge of the pectoralis major muscle.

Look at the instrument nurse on the side.

"You can breathe."

call!
Unlike the instrument nurses who worked on the previous two thyroid surgeries, a new nurse was used for the third operation. She was a young one and looked about the same age as him, or even younger than him.

After she came on stage, she was obviously very nervous, with her brows furrowed and her look as if facing a great enemy, which made Wu Xiaofu a little unable to control herself. Moreover, she looked like she was having difficulty breathing. Wu Xiaofu was afraid that she would be short of oxygen and fall directly on the stage.

So, I still gave you a kind reminder.

The instrument nurse took a deep breath and said a little embarrassedly, "I'm sorry, Teacher Wu. Sister Yuan had to leave first because of something at home. I am here temporarily to take over. But don't worry, I have followed several breast cancer surgeries during my training."

Further study!

You've studied at such a young age? Of course.

Wu Xiaofu didn't blame her too much. This nurse did have a good foundation and she didn't make any mistakes.

"Yeah, it's okay, relax a little, I don't eat people."

While speaking, Wu Xiaofu did not stop his operation. He had already begun to free the lateral edge of the pectoralis major and the loose tissue behind the pectoralis major. After pulling up the pectoralis major, the pectoralis minor was exposed.

At this time, it is time to start removing the Rotter lymph nodes.

Rotter's lymph nodes are axillary lymph nodes, also called interpectoral lymph nodes. They are divided into three areas by the pectoralis minor muscle and are an important channel for draining lymph fluid from the bilateral breasts and chest cavity.

This step of the operation is very important. The most common metastatic route of breast cancer is lymph node metastasis. Therefore, when breast cancer metastasizes, the closest route of metastasis is the axillary lymph nodes, which manifests as enlarged lymph nodes and unclear lymph node hilum-like structures.

During breast cancer surgery, this part of the lymph nodes must be cleared.

Of course, you must first free the inner and outer edges of the pectoralis minor muscle, and also perform blunt separation on the dorsal side of the pectoralis minor muscle to facilitate pulling with the retractor, so that the axillary lymph nodes can be completely removed.

"Did you see that? I cleaned the lymph nodes. What difference did that make?"

Wu Xiaofu looked at Fang Ying beside him and asked.

Fang Ying was indeed very insightful. After hearing the question, she did not even hesitate and directly said, "Doctor Wu, when you clean the lymph nodes, you clean from the outside to the inside."

Wu Xiaofu nodded when he heard this. This was different from the current mainstream method of clearing lymph nodes, and the effect was obvious. Wu Xiaofu's way of clearing was obviously more thorough, and the more he cleared, the more at ease he felt. It was unlike other ways of clearing lymph nodes, where the more he cleared, the less at ease he felt, and he had to go back and check twice before he could feel at ease.

However, it is not easy to sweep like this.

The operation is obviously more difficult, and the prerequisite is to free it more completely and leave all the desired parts. Only then can you dare to work from the outside to the inside. Otherwise, who can be sure that you have not left any part behind?

At least, Fang Ying is still afraid to learn. Wu Xiaofu didn't even ask for any prerequisites and started cleaning from the outside to the inside. Fang Ying was still worried, so Wu Xiaofu showed her the situation of the lymph node cluster. With Fang Ying's experience, she could clearly see that it was indeed cleaned up.

This is outrageous. Is it possible for her to learn this idea?

Incise the coraco-clavicular fascia, protect the medial forearm cutaneous nerve and intercostobrachial nerve, free them outward and downward from the serratus anterior fascia, cut off the intercostal nerves and intercostal perforating branches of blood vessels, and dissect to expose and protect the long thoracic nerve, thoracodorsal nerve and subscapular vessels.

Wu Xiaofu moved faster and faster, and it seemed that he was getting into the state as time went on.

Finally, the breast and axillary lymphatic fat tissue are removed in one piece, and the operation on one side is basically completed.

half an hour.

Fang Ying looked at the time. This speed was a bit too fast.

Looking at Wu Xiaofu, "Boss, can you do it slower? This will make me feel that this operation is very simple."

“It’s very simple.”

Ah!
Fang Ying and her assistant were stunned. It was really that simple! Was this human language? They had finally figured out that Wu Xiaofu was just a walking forklift machine. They shouldn't have any illusions.

Suddenly I remembered what Fan Xin had said to them. No matter who follows Wu Xiaofu for a long time, they will get used to pretending to be good for Wu Xiaofu, or being a perfect supporting actor.

Look, in just one afternoon, they have already got into the mood.

"Look at this side first. I'm going to proceed to the other side."

Fang Ying quickly agreed. The big work was done. The next step was to check whether there was active bleeding on the wound, flush the wound, place a multi-hole drainage tube in the armpit under the pectoral muscle and in the inner mammary area, lead it out through the lowest point and fix it properly.

To sew the leather, wait until Wu Xiaofu finishes the other side and then sew them together.

On the other side, Wu Xiaofu seemed to be moving faster. The steps were similar and Fang Ying looked at them again, but her understanding was not as good as the previous one because Wu Xiaofu stopped explaining to her and the pace suddenly quickened.

It's like a good student giving her a lecture. She didn't quite understand it the first time and wanted the good student to explain it again, but the good student refused. So she did it again in front of her. She could see it and recognize the words, but she really couldn't do it.

She looked at Wu Xiaofu with some resentment. After all, she thought Wu Xiaofu would be considerate enough to tell her again, but she was wrong. "Huh, it's done. We each take one side and sew it up quickly. It's almost six o'clock."

ha?
Fang Ying was stunned when she heard that and looked at the time. It would be six o'clock in ten minutes. What did that mean? Could it be that Wu Xiaofu was working so fast because he was in a hurry to get off work before six o'clock?
Wow, are there any workers who don’t want to work overtime?

Thinking of this, Fang Ying suddenly understood a little. Well, that’s good. In this regard, Wu Xiaofu seems to be the same as her. They finally found a common point: unwillingness to work overtime.

It was time to get off work and start working, so Fang Ying didn't delay and hurriedly began to deal with it.

After the excision, the suture tension of the two breasts is relatively high, so tension-reducing sutures are required. This is a small job for Wu Xiaofu and Fang Ying. If they were not in a hurry to get off work, they would have handed it to their assistants.

Poor Ersuke looked at the two of them pitifully. They were just finishing the work, and they didn’t even give her a chance?

After suturing, negative pressure suction and pressure bandage were applied, and the operation was finally over.

Wu Xiaofu looked at the time. It was perfect. There were still five minutes until six o'clock. He could change his clothes and punch in just in time.

Oh, I forgot. You don’t need to punch in at Jinhu County Hospital.

call!
Wu Xiaofu took off his surgical gown and took two steps when he heard a heavy sigh behind him and couldn't help but look back.

When their eyes met, the nurse froze involuntarily and stammered, "I, I'm not nervous."

Haha!

Wu Xiaofu couldn't help but laugh. He didn't say anything and just left.

But I heard the equipment nurse say to the person next to her, as if to prove something, "I'm really not nervous."

After getting the phone, Wu Xiaofu saw Fan Xin's message, asking if he wanted to wait for him to have dinner together.

Not only Fanxin, but also many other information.

Wu Xiaofu looked at the message sent by Wu Mingjie and asked him to call him back after get off work.

"Hey, second brother, what do you want to talk to me about?"

At this time, Wu Mingjie was still in the office. After receiving Wu Xiaofu's call, he remembered to look at the time. It turned out that it was almost six o'clock. He was very busy these two days.

"If there's nothing else, I can't look for you. You must be off work now. Wait for me at the hospital. I'll pick you up and we'll have dinner together tonight."

Wu Xiaofu agreed readily and was originally planning to leave quickly, but now he had to wait for Wu Mingjie, so he just took a shower first.

At the entrance of the hospital.

Wu Xiaofu sat cross-legged on the stage, replying to messages.

Wu Xiaofu has two mobile phones and receives countless messages every day, some from colleagues and friends, and some from patients.

Among these information, the most information is about patients.

No matter whose message it is, Wu Xiaofu will take the time to reply. Of course, for some advertising messages, he will directly delete the owner of the message.

First, I sent four 60-second voice messages to Qu Ying, mainly introducing today's life and what I encountered. Well, it is necessary to report from time to time so that my wife who is in a long-distance relationship can maintain a sense of security.

Not only Wu Xiaofu, but also Qu Ying, neither of them made any demands on the other.

But I don't know how this tacit understanding was formed, and it seems that Qu Ying started it first.

Not to mention, it has become one of the pleasures of their lives.

what!
Wu Xiaofu looked at the note with Linlin's name. She had sent Wu Xiaofu a lot of messages, most of which were photos.

Looking at the sunny and positive girl with a sweet smile in the photo, Wu Xiaofu couldn't help but smile.

This Linlin was the first person Wu Xiaofu performed radical resection of pancreatic cancer on after he came to Donghai, and also the first person to climb Mount Everest.

Wu Xiaofu still remembers the despair in Linlin's eyes as she is a girl in her early thirties. However, Linlin has now found the meaning of life again. According to Linlin's information, she came to Yunnan Province with her best friend a week ago and planned to stay there for a while. She said it was really relaxing there and she also met a very interesting guy.

Wu Xiaofu was so happy for her that Linlin seemed to have really forgotten about her illness. However, she did not forget to go for follow-up examinations. She sent him the results of these examinations regularly, and there has been no recurrence so far.

This is the importance of mentality. You know, after Wu Xiaofu performed surgery on Linlin, even other colleagues in the hospital were not optimistic.

But it has been half a year, and the recovery effect is better than those patients who underwent surgery for early-stage pancreatic cancer.

Tell Linlin to take more pictures of the scenery of Yun Province for him in the future, he likes to see them.

"County Magistrate, is this really Professor Wu?"

Wu Xiaofu sat cross-legged on the platform, replying to messages frantically. To outsiders, he was just playing hard with his phone, with a changing expression. Was he playing games? Or was he chatting with his girlfriend? No one could tell.

After Wu Mingjie came over, he was preparing to call Wu Xiaofu, but he saw Wu Xiaofu sitting there without any burden at all.

The secretary beside him, as well as the propaganda minister and his secretary who left work with him, also realized at this time that this was Wu Mingjie's legendary younger brother. During this period of time, they had all heard of Wu Xiaofu's name.

The various honors he has received have made them have high expectations of Wu Xiaofu.

But now that they met, they were somewhat unable to hold back. It seemed that this man was no different from the lazy guys in their county town.

Although the halo was shattered, it also made them feel closer.

"You don't know my brother. Xiaofu is not a spoiled child. He grew up on the grassland. He is good at riding horses and wrestling. If you want to learn riding, find a stable and let Xiaofu teach you."

"That's a good feeling."

Wu Mingjie smiled and called out to Wu Xiaofu twice.

"Xiao Fu, let's go."

Only then did Wu Xiaofu realize that Wu Mingjie had arrived. He put away his phone and got into the car.

"Xiao Fu, this is Minister Zhou and her secretary. We are having dinner together tonight."

Minister Zhou!
Wu Xiaofu looked at the sister who was about 40 years old and immediately took the initiative to greet her. When Wu Xiaofu first came to Jinhu, Wu Mingjie came to pick him up, and Minister Zhou was with him. Now it seems that Wu Mingjie has won this person over.

"Hello, Minister Zhou."

"Hello, Professor Wu. We didn't have a good chat the other day. We should have a good chat today while we have dinner together."

Of course Wu Xiaofu agreed readily, said hello to his two secretaries, and set off.

On the way, Wu Mingjie asked Wu Xiaofu how his work was going. Wu Xiaofu told Wu Mingjie about what happened in the past two days. Wu Mingjie was dumbfounded. "Aren't you in too much of a hurry? You can't tire yourself out. Where do so many patients come from in Jinhu?"

Thinking about what Wu Xiaofu said, Wu Mingjie found it a little unbelievable that they had admitted more than thirty patients in just this morning.

"County magistrate, there is no hospital in Jinhu, but there are some in other places. I heard that Professor Wu is here, but there are many patients who come here because of his reputation."

"Sister Zhou, please don't call me professor. If you don't mind, I will call you sister and you can just call me Xiaofu. I think you are kind, so don't be so distant."

Minister Zhou was also stunned when he heard this, and then he laughed happily.

"Okay, Xiaofu, I see you are very friendly, I'm just afraid you don't mind, so let's eat outside today, and let your brother-in-law cook for us at home some other day. Your brother-in-law is a good cook."

"Then I'll make a note of it. I must try my brother-in-law's cooking."

……

Wu Mingjie couldn't help but shook his head when he saw Wu Xiaofu becoming friendly with Minister Zhou in a short while, just like real siblings. To be honest, in his opinion, even if Wu Xiaofu didn't become a doctor, he would definitely be a good politician as Wu Jinglie said.

No matter what people do, what they actually compete on is their emotional intelligence, IQ and background.

Wu Xiaofu has all three of these qualities, and they are all top-notch. In terms of emotional intelligence and IQ, Wu Mingjie is ashamed of himself.

It was not until dinner time that Wu Xiaofu discovered that Wu Mingjie had also invited other people.

He is a senior political and legal official in Jinhu, named Jiao Yang. He is about fifty years old, has a straight build, looks very capable, and speaks fluently.

At the end of the drink, Wu Mingjie told Wu Xiaofu that Jiao Yang's father was an old policeman who was now in his seventies. He had been feeling unwell recently, but they could not find out what was wrong with him, so he wanted Wu Xiaofu to help take a look.

"It's just a stomachache. I've been to the provincial capital before, but they still can't determine what's wrong. At first they said it might be a cold or something, since it's an old man, so it's all possible. But it's been a month and it still hasn't gotten better. The county magistrate said you might have a solution, so I was thinking if I could ask you for help."

stomachache!
Can’t the provincial capital find out?
Wu Xiaofu also became interested and hurriedly asked about the details, but Wu Mingjie looked at Jiao Yang meaningfully. It was obvious that he was the one who took the initiative to introduce Wu Xiaofu to Jiao Yang, but in Jiao Yang's mouth, it seemed that Jiao Yang took the initiative to ask him for help.

Well, one by one, everyone has the same emotional intelligence.

"Hit by a bullet?"

"Well, it happened more than 20 years ago. It was not removed at the time, but it turned out to be fine after all these years of follow-up examinations. When I went to the provincial capital for a checkup this time, the doctor also said that it should have nothing to do with the bullet."

Wu Xiaofu nodded.

"How about this, I drank a lot today, so I don't want to bother you. I'll contact Secretary Jiao tomorrow afternoon after the surgery and go to the old man's house to see him."

"That's too much trouble, Doctor Wu. Please contact me after get off work tomorrow and I will come to pick you up."

(End of this chapter)