medical simulator

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"This patient didn't ask you to come on stage, it's just that the patient raised a certain level of requirements for follow-up surgery and rehabilitation, and I thought of you. It's just that we haven't thought of a better solution yet."

"So, can I ask you to come over and refer to it?"

"It's just for reference by our internal staff. Oh, by the way, Professor Liu Zhibin is also here."

Well, Li Xuande hasn't started the stage yet, instead of calling him on the stage to call for emergency, that's okay.

"Professor Li, as long as it doesn't violate the principle, there is nothing wrong with it." Zhou Cheng breathed a sigh of relief.

"That's natural. I would not ask for an emergency consultation at this point, unless it is an exceptional situation." Li Xuande suddenly explained.

……

Zhou Cheng put on his clothes, went downstairs again, and found the car that Professor Li Xuande mentioned at the gate of the community. It must have stopped for a while, and the driver was 'confronting' the security guard at the gate.

After Zhou Cheng got into the car, he said politely to the security guard, "I'm really here to wait for someone. Look. Thank you."

Then in a flash, stepped on the gas pedal, and left.

The driver didn't talk too much after getting in the car, but simply introduced himself and told Zhou Cheng familiarly that he was from a certain equipment company, and hoped that Mr. Zhou would take care of him in the future. It was a random contact.

Zhou Cheng didn't talk to him too much. He just brushed his teeth before going out, and he also wore a mask. There was still a slight smell of alcohol, but it didn't affect Zhou Cheng's thinking.

When they arrived at the underground garage of Renji Hospital, Zhou Chengcheng pushed the door and went down.Then the driver took the initiative to take Zhou Cheng to the elevator, helped him press the trauma surgery floor, and said, "I won't go up, I have to go to the operating room and wait."

Zhou Cheng didn't say much. In fact, emergency surgery is not only tiring for the doctors in the hospital, but also for equipment manufacturers to temporarily adjust or mobilize surgical equipment according to the patient's condition.

However, Zhou Cheng was sure that this operation would not be very simple, otherwise, Professor Li Xuande would not have asked him to come here.

After getting off the elevator, Professor Li Xuande probably received a message from the driver, so he waited at the elevator door, and quickly led Zhou Cheng to an office.

There were not many people in the office, perhaps because Zhou Cheng had been drinking, and there were only four people including Zhou Cheng and Professor Li Xuande.

On the large PPT screen, there are photos of the patient's lower limbs and imaging studies.

Professor Liu Zhibin and an associate professor under Professor Li Xuande's group were discussing in detail there, and the content was more about the issue of amputation or not.

Li Xuande quickly said: "Xiao Zhou, thank you for your hard work. I invite you to come here today because I heard what you and Yu Heng said about muscle and tendon reconstruction during the day."

"Look, this patient's lower extremities were severely damaged, and the muscles and tendons were seriously injured. The fractures were multiple comminuted fractures. Professor Liu Zhibin and I have already considered the issue of fracture reconstruction."

"However, for the damage to the hip joint, if we fix the fracture, can the soft tissue be salvaged? Is there any significance for this patient to undergo limb salvage surgery?"

Limb salvage is an eternal topic in trauma surgery. In case of injury, the first consideration is whether to salvage the limb, and then whether the limb salvage is good or not.

Seeing Zhou Cheng and Li Xuande coming in, Professor Liu Zhibin didn't move, and the associate professor smiled very kindly at Zhou Cheng.Both Liu Zhibin and Li Xuande attached great importance to Zhou Cheng, and he didn't despise Zhou Cheng because he was young even if they called him so late.

He didn't go to the small academic conference yesterday, but had other private matters. Today, he was in the second-line consulting class. The first-line general hospitalist felt that he couldn't handle it, so he called him. He also called Professor Li Xuande to the department.

Zhou Cheng flickered a few times, and asked, "How is the patient's blood supply?"

Zhou Cheng hadn't encountered such an exaggerated injury for a long time, mainly because he had been away from trauma surgery for a long time.

Blood is the source of life, without blood, everything is empty talk.

"When Xiaofu was doing the debridement just now, the news came that the blood supply was okay, that is, this kind of muscle that was crushed to the point of necrosis, should it be removed, and if so."

"Then from the upper edge of the knee joint to the middle of the femur, more than half of the posterior tibial muscle group will be removed. There is absolutely no way to recover such a large soft tissue gap after surgery. He has talked with the patient's family about the need for amputation."

"But the patient's family members want us to fight for it, and their attitude is very sincere, so I still try my best to find a way." Li Xuande said.

Xiaofu is estimated to be the total hospitalization.

Zhou Cheng pondered for a while, then smiled and said: "Professor Li, Professor Liu, I'd better listen to your opinions and opinions first, and then if I know something, I will ask for it, but I may also be here to listen to the case analysis class."

This is not only Zhou Cheng's modesty, but also his own position.

Obviously, this kind of damage is completely different from the damage Zhou Cheng has seen before. It is more serious and definitely cannot be solved with a few words. How to fix the fracture? What are Liu Zhibin and Professor Li Xuande's thoughts? , to decide whether to push more or not.

It's not because I just obtained the authorization of the new technique, and then others think it's very good, and after a few words of flattery, I will float to the sky, and then even Liu Zhibin and Professor Li Xuande will be ignored.

That's what idiots do.

Professor Liu Zhibin quickly explained the ideas he and Professor Li Xuande had sorted out. If this patient needs limb salvage, it must be determined in the first stage about the retention of soft tissue, and then the fracture will be temporarily fixed. Anatomical reduction is fixed.

Soft tissue does not play a supporting role in the lower limbs, and bone is the main support.But soft tissue is more important than bone, because soft tissue, that is, muscles and nerve vessels, is the key component that determines whether your bone connection can move or not.

Zhou Cheng probably understood the specific situation of this patient after he had listened to it. The complexity was far beyond his imagination.

Muscle necrosis, nerves and blood vessels have been crushed, nerves and blood vessels may need to be translocated, temporary replacement, followed by muscle reconstruction, tendon transposition or even tendon transplantation.

"Does Xiao Zhou have any other ideas?" Li Xuande asked.

Calling Zhou Cheng over, of course, will not let Zhou Cheng come to attend the class. Even if Zhou Cheng doesn't say anything, he still has to ask, and there is no disadvantage.

After Zhou Cheng's eyes flickered, he said: "Professor Li, Professor Liu, I have an immature idea, because the damage to the soft tissue is too serious, that is, to protect the soft tissue in the first stage, and then do bone connection according to the situation. "

"Skin problems must be looked at in the follow-up according to the specific situation. This may require multiple surgeries, but gradually reducing the difficulty of surgeries is a better way of thinking."

"It is very difficult to preserve the damaged soft tissue in the first phase."

Zhou Cheng looked at the muscle tissue inside, and it was basically rotten.And the first issue is going to be done, he can do it, but he can't go on stage after drinking alcohol.

Li Xuande immediately understood what Zhou Cheng meant. At this critical moment, he was not so flattering: "Xiao Zhou, I can understand what you mean. You are gradually reducing the difficulty of surgery. This idea is advisable."

"But it is this soft tissue preservation surgery. It is difficult to answer the question of who will perform it and how it will be done."

"With such severe crushing, the blood vessels inside may not be very good. It will be difficult to find and suture them one by one."

"And I also asked the vascular surgery department. They can only say to connect the large blood vessels, but small blood vessels, such as the nourishing arteries of the muscles, are almost impossible to operate. We have to be controlled by the orthopedics department. .”

In vascular surgery, operations on large blood vessels are endless, so I basically don’t pay much attention to the problems of small blood vessels.Otherwise, people will be exhausted, this is a big blank in vascular surgery...

Zhou Cheng immediately thought of asking Yang Yifeng, but quickly dismissed the idea.Due to special factors, Yang Yifeng is not easy to contact with the cases of vascular surgery, and he is afraid of being emotional, so it is a bit cruel to ask him to complete such a big task.

But apart from Yang Yifeng, Zhou Cheng's contacts in the capital are quite limited.

There is no way to think about it, so it is better not to be foolish for the time being.

Seeing that Zhou Cheng didn't speak, Li Xuande asked, "Xiao Zhou, can you rest nearby today? You've been drinking now, but we should be able to rest and make up the muscle bed in the early morning."

"When you come to the stage again, do you have a certain amount of confidence?"

"This kid is a college student who was injured by an accident. There is no need to worry about money, but if he loses a leg, it will have a great impact on his future life."

Hearing Li Xuande's words, Professor Liu Zhibin didn't respond, but the associate professor next to him was stunned. Li Xuande should hand over such a critical and difficult operation to Zhou Cheng?

What the hell is this thinking?

Li Xuande's suggestion is a reference.

After getting drunk, there will be a time for metabolism, and in the early morning, it can basically be metabolized cleanly.Just in this way, it will affect Zhou Cheng's normal work in the Ninth Hospital of the Shanghai Metropolis tomorrow.

After thinking about it carefully, Zhou Chengcai said with a smile: "Professor Li, I dare not speak nonsense about the word confidence. I can only say that I can try my best."

Don't talk too much, this is the rule of the rivers and lakes.

Li Xuande and Professor Liu Zhibin both glanced at Zhou Cheng when they heard the words, and the light in their eyes flashed slightly.

It seemed that he was waiting for Zhou Cheng's words.

Then, Zhou Chengcheng was arranged to go to a nearby hotel to rest, saying that he would call Zhou Cheng at that time.

……

Zhou Cheng fell asleep at about ten o'clock in the evening, but when the phone rang, it was already three o'clock in the morning.

When Zhou Cheng rushed to the operating room again, Professor Liu Zhibin was no longer in the operating room, and then he heard Professor Li Xuande say that Professor Liu Zhibin was on a plane in the early morning and had already landed, so he went home to rest.

Well, Professor Liu Zhibin and others can only stay until Monday at most, each has its own business.Associate Professor Zou Xingkong is the most free.

After waking up from the alcohol, Zhou Cheng got dressed and came to the operating table. After carefully looking at the wounds on the operating table, he breathed a sigh of relief.

I still think a little too much, how can the team where Professor Li Xuande is in can't even make a good debridement and muscle bed?However, the more critical point is whether these muscle beds can be kept.

After Zhou Cheng came to the stage, Professor Li Xuande said it was hard work, and then took the initiative to give up the position of the chief surgeon.

The associate professor of the first assistant became the second assistant, the general hospital of the second assistant became the third assistant, and the doctor in the surgery class of the third assistant went to the fourth assistant to play with "sterile instruments", and there was no time for him.

Several people looked at Zhou Cheng, and Professor Li Xuande said comfortingly, "Xiao Zhou, don't have psychological pressure. The family members of the patient have arrived in Shanghai in time, and are outside the operating room. We have finished communicating with the family members of the patient. The worst thing is amputation, they are also acceptable."

"It's just that we still hope that we can give patients hope. If we can keep a leg."

"Well, do your best." At this time, Li Xuande didn't show off his feelings anymore.

Although the previous Li Xuande was Zhou Cheng's authorized judge expert, he hadn't actually seen many manipulations of anatomical structures by Zhou Cheng.

However, after Zhou Cheng pinched the equipment that Li Xuande had specially brought from the hand surgery department, he stared at him immediately, and understood!

This time, the bet on inviting Zhou Cheng over was the right one.

I saw that Zhou Cheng skillfully used the small blood vessel forceps and forceps specially used for hand surgery to poke in the muscles. It seemed that the size of the extremely small blood vessels was not a problem at all in Zhou Cheng's field of vision...

Chapter 262 Sao operation begins!

Zhou Cheng carefully separated a section of the blood vessel, and saw that the shape of the blood vessel was already in a segmented state.

Recalling the general picture he saw on the ppt before, Zhou Cheng really used his hometown dialect to describe it.

The hemp skin is rotten on one leg.

Zhou Cheng had a headache, and the operation was interrupted for a while.

On the opposite side of Zhou Cheng, Li Xuande did not blame Zhou Cheng, but said with a sinking heart: "The state of the blood vessels is very worrying. Maybe our previous estimate of the wound surface was conservative. The previous bleeding did not come from the muscles. oozing out, but this segment of blood vessel."

The state of the blood vessels was not caused by Zhou Cheng's operation, on the contrary, it was very difficult for Zhou Cheng to find out the blood vessel segments from the muscle tissue so quickly.

(Note: A small popular science experiment, every household can buy pork, and there are nourishing blood vessels in the muscles of pork...)

"Xiao Zhou, do you want to go out and talk directly to the family members about the amputation?" Li Xuande quickly calmed down.

They worked hard, and they did enough. From ten o'clock to three o'clock in the morning, five hours were spent on debridement, carefully stripping out all kinds of sundries inside, and reconnecting the soft tissue bed. Well, and the relatively large blood vessels were also sutured by a vascular surgeon.

But sometimes, hard work does not necessarily lead to satisfactory results. Learning to face all disasters honestly and letting yourself go is also a kind of salvation for yourself.

When manpower is limited, there is no need to worry about everything. Even if such a thing falls on your own head, it is still the same. When you embarrass others, you may not be happy, but others must be in pain.

Zhou Cheng knew that this was not Li Xuande's original intention, if he didn't want to do this for this college student, he would have amputated his leg long ago.However, since we have worked so hard to reach this point, and everyone has stayed up late for so long, we should work harder.

He raised his head and said, "Professor Li, let's take a look at the specific situation inside. I'm just getting started. It's just that you have to work hard for a while."

Li Xuande smiled and didn't care: "Anyway, we've made it to this point."

At this point, everyone understood what the other party meant, and tried their best to make the final struggle.

Then, Li Xuande saw that after Zhou Cheng sent the tiny tweezers in again, he took out another section of blood vessel, which was still bloody inside, and the wall of the blood vessel was ruptured and completely rotten.

However, Zhou Cheng still did not give up, and continued to take such blood vessel tissue from other places.

This soft tissue that has been crushed is really shocking. The blood vessels inside have been crushed like this, which is a bit too scary.

Just after Zhou Cheng took out the vascular tissue in the three muscles, it was still the same.

Li Xuande felt that it was better for him to look at it first, and not to make Zhou Cheng difficult: "Xiao Zhou, stop the operation, I will talk to the family members, this leg can't be saved, and it may be destroyed after it is saved."

Recognizing the limitations of modern medicine, knowing how many catties a person has when he realizes that manpower is limited, is a necessary basic skill of modern medicine.

Li Xuande felt that it would be better for him to let Zhou Cheng go. With such an organizational structure, not to mention how to rebuild the blood supply is a problem, even if it is rebuilt, it will still be a useless leg that cannot function.

Zhou Cheng's ability and strength had already reached a limit, but this limit could not reverse the consequences of the current trauma. This is a living and cruel reality.

Li Xuande is the supreme controller of this operation, he has absolute decision-making power.

This time, it was Zhou Cheng who stretched out his hand to stop Li Xuande who was about to step down, and said, "Professor Li, wait and see, there may not be a solution."

Zhou Cheng's mind was spinning rapidly, and then he asked: "Professor Li? Did this patient talk about the possibility of making an incision on the healthy limb before the operation?"

Li Xuande's stepping down froze, he was a little puzzled and asked, "Xiao Zhou, what do you want to do?"

As the chief director of the orthopedics department of Renji Hospital affiliated to Shanghai Jiaotong University and the director of trauma surgery, it is his goal to bring the strength of the orthopedics department of Renji Hospital to the fore. Not missing.

He didn't personally interview the family members, but he could instruct someone to do so, but he had to know Zhou Cheng's specific thoughts first.

"The healthy limb has rich blood circulation. Even if I take a few arteries, I can still provide blood supply by rebuilding the collateral circulation."

"And the nutrient arteries we removed can be used as the vascular bed between the muscles of the affected side to provide arteries. It will not affect the condition of the healthy side of the patient, and it is the best substitute for the nutrient arteries." During the operation, Don't talk too much, but express the meaning well.

Therefore, Zhou Cheng only said half of what he said, leaving half blank.

But what kind of person Professor Li Xuande is, he immediately understood Zhou Cheng's meaning, blood vessel transplantation, and it is also a nutrient artery transplantation, similarly, this is also intramuscular vascular reconstruction.

Vascular artery grafting, which is a combination of suturing and cutting blood vessels, is also a variant, and reconstruction remains the same.However, most of the operations performed by vascular surgery are on large vessels, and there is no time to take care of small arteries.

Such an operation is not difficult in principle, but it is extremely difficult to find such a small artery. To find a complete anatomical structure, it requires a lot of patience, and the transplant process is even more unimaginable.

Such a difficult technique is conceivable by humans, but is it possible for humans to complete it?