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The incomplete right thumb, coupled with a good X-ray of the right foot bones.
He couldn't help being shocked.
Could it be... Director Shen said that he wanted to recreate a thumb for the patient, because he wanted to intercept the thumb of the right foot and transplant it to the position of the thumb of the patient's right hand?
The ingenious idea of this move is really a brain hole.
Non-ordinary people would never think of such a trick.
In ancient times, those who built palaces for the emperor were called skilled craftsmen, and modern doctors actually deserve this title.
Although this idea is bold and ingenious, it is very difficult to transplant.
At least according to Zhou Can's understanding.
The difficulty of replanting a severed finger is relatively low, because the size, tissue location, and division of the severed finger are all the same as the fracture site.
Blood vessels, tendons, nerves, phalanges, and even skin can all be perfectly connected.
But the big toe on the right foot is quite different from the thumb on the hand.
How to pick this up?
If the operation fails, the patient's loss will be too heavy.
Not only will I lose my right thumb, but my good right foot will become disabled. But also need to bear the high medical expenses, as well as the pain caused by the operation.
That's really spending money to pay for it.
"Transplanting a toe to a toe is extremely difficult and risky. This is the first time I have seen this kind of surgery when I grow up!"
Dr. He rubbed his hands excitedly and said.
"Toe replacement surgery is a real fourth-level operation, do you think it is not difficult?"
Doctor Shan was not much older than him.
Indications are indications, and he has more knowledge than him.
"We doctors need to have the courage to challenge and innovate. There have been two successful cases of toe replacement surgery in the Shanghai Metropolitan Hospital. As long as the operation is careful, meticulous, and rigorous, the success rate of the operation should not be too low. I have talked to patients After talking about the risks in case the operation fails, he expressed his willingness to give it a go.”
Director Shen subtly guided the thinking of the doctors under him.
Establish good medical ethics and medical ethics for them, as well as the concept of practicing medicine.
An excellent chief physician can lead an excellent team. In addition to excellent skills, their noble spirit of doctors can also influence generations of people.
"There are many difficulties in this operation that need to be overcome, and it is difficult for me to complete it alone. Dr. Shan is good at microscopic and delicate operations such as vascular anastomosis and nerve anastomosis. When the time comes, the anastomosis of blood vessels and nerves will be handed over to you." Dr. Chi is an expert in tendon reconstruction and repair. I leave this to you. I am responsible for amputating the patient's toe, and then making an incision at the incomplete position of the patient's right thumb, implementing the docking of the phalanx and the thumb bone of the hand, and the subsequent Flap repair and other work."
Director Shen made a division of labor.
"During the amputation of the toes, the patient's hemostasis, foot wound repair, and suture work need to be undertaken by a resident doctor. Who of the resident doctors under the two of you is competent for this job?"
Even doctors in the same group still have competition.
Both Dr. Shan and Dr. Chi are excellent, but it's not enough to be excellent alone.
If the resident doctors under him are also excellent, they can get a lot of bonus points.
"Yang Fuhai under me has done a good job in hemostasis, and Dr. Gandhi is great in wound repair. It should be very safe for the two of them to undertake this task together."
Doctor Chi acted quickly.
He directly helped the two residents under him to **** the exercise opportunity.
"Dr. Tang and Dr. He under me are actually quite good. Dr. Gui Peisheng Zhou is also not weak." Dr. Shan is far behind Dr. Chi in terms of qualifications and strength.
She has no way of robbing the other party of the opportunity to exercise in surgery.
So I could only weakly help the doctor to groan twice.
"The wound treatment after the amputation of the toe is more complicated. Dr. Chi's two residents have more experience in surgery. This time, they will handle it well. The doctors under Dr. Shan will give other opportunities to exercise at that time."
Director Shen finally chose two residents with more experience in surgery.
The two doctors Yang and Gan looked at each other and smiled.
Dr. Tang and Dr. He looked dark.
The patient was quickly brought into the operating room, where general inhalation anesthesia was administered to him for safety.
The anesthetist monitors the vital signs of the patient throughout the process.
Surgery began soon.
Follow the plan.
After Director Shen amputated the patient's toe, he processed it first and then refrigerated it.
Immediately after that, the operation for the next transplant began at the position of the patient's right thumb.
The two doctors, Yang and Gan, have been busy for a long time.
Hemostasis, bone grinding, nerve closed loop and other treatments are performed on the patient's foot wound.
Both of these two are senior residents, and they have received a lot of training in the operating room, and their surgical ability is not weak.
Doctor Yang's ability to stop bleeding should have reached the middle level of a resident doctor.
It is infinitely close to the excellent level of residents.
But it's still a little bit short.
Dr. Gan's debridement level is also excellent, barely close to the excellent level of residents.
No wonder Dr. Chi had so much confidence in these two under his command.
Compared with these two, Dr. Tang under Dr. Shan was far behind. As for Dr. He, he is even worse than others.
At the beginning, Dr. Yang did a good job of stopping the bleeding, and Dr. Gan also did a good job of debridement.
It's just that something went wrong very quickly.
When Dr. Gan debrided the wound, he opened the ligated blood vessel again.
Then it was found that the nerve closure was not easy to do.
Worse still is the stitching.
The depth of the wound treatment was not enough, the wound surface was too wide, and the skin on both sides could not be pulled together at all.
One wrong step, one wrong step.
I saw that the two doctors were in a hurry and almost didn't fight.
The patient's thumb was amputated but had arteries. Blood splattered all over the place.
Both Dr. Yang and Dr. Gan's clothes were sprayed a lot.
Dr. Gan even had a little blood on his face.
Director Shen frowned at this scene.
Doctor Chi helped his subordinate doctors smooth things over.
"It may be the first time for them to deal with this kind of amputation wound independently, so they are somewhat inexperienced."
"Teacher, can I let my subordinates, Dr. Tang and Zhou Can, try to take over? I think the two doctors Yang and Gan are really inexperienced, and the white coats on their bodies are about to be dyed with new patterns!"
Doctor Shan took the opportunity to strike again.
A humorous metaphor vividly pointed out the embarrassment of the two.
Dr. Yang and Dr. Gan could not help but blush.
They were all experienced and senior residents, and it was a mess because of insufficient cooperation and insufficient prediction.
"Opportunities should be equal for everyone, let doctors Tang and Zhou try it! Otherwise, Doctor Shan should say that I am partial!"
Director Shen couldn't stand it anymore, so he agreed to Dr. Shan's request.
He also wanted to take this opportunity to see Zhou Can's surgical ability.
Rumors are rumors after all, and only by seeing them with his own eyes can he be confident.
I saw Zhou Can's level of separation with my own eyes yesterday, and it was amazing.
"Dr. Shan asked a resident doctor and a regular trainee to take over. This arrangement is very interesting!"
Doctor Chi looked at Zhou Can who walked out.
He still understands Dr. Tang's ability.
What made him curious was that Dr. Shan did not let Dr. He, who had poor surgical skills, play, but let a Gui Peisheng do it. This arrangement definitely makes sense.
It shows that she has great confidence in this Gui Peisheng surnamed Zhou.
In the past two days, Dr. Chi has also heard someone say that a very strong Gui Peisheng has come to the orthopedic surgery department.
Just according to his thinking, how strong can Gui Peisheng be?
Soon, Zhou Can let him see how strong Gui Peisheng's surgical skills can be.
After Zhou Can took over, he immediately bandaged the patient's heel.
The bleeding stopped immediately.
Then calmly clamp a blood vessel with severe contracture with tweezers, elongate it, and ligate the deeper root of the blood vessel with one hand. The whole process is skilful and confident.
After treating this vessel, proceed to the second vessel.
"Doctor Zhou, why did Dr. Yang ligate these blood vessels smoothly at the beginning, but later debridement caused the ligation of blood vessels to loosen, and it became very difficult to ligate them again?"
Doctor Tang is really not ashamed to ask.
Zhou Can's operation stunned him.
Everyone worked under Dr. Shan, and Zhou Can performed well, and he also followed suit.
Doctor Yang blushed, and he wanted to know the answer to this question very much.
Zhou Can explained the reasons in detail.
Doctor Yang's ability to stop bleeding and ligate can only be regarded as relatively strong.
It may not be a problem to deal with the blood vessels of fresh wounds.
However, when Dr. Gan debrided the wound later, the ligation of the blood vessel was loosened, or the blood vessel was directly broken again.
It is much more difficult to think about ligation.
Because at this time, the blood vessels have retracted and become smaller.
After hearing this, Dr. Yang was greatly educated.
At the same time, seeing the blood vessels that were very difficult for me to deal with, in Zhou Can's hands, it was like playing.
His level of hemostasis and ligation is obviously much higher than his.
This level is not even weaker than that of Dr. Chi.
A regular trainee is better than an attending doctor?
He subconsciously turned his head to look at Dr. Chi next to him.
Then I saw Dr. Chi's eyes widen, if he wasn't wearing a mask. The mouth is likely to be opened wide.
Dr. Chi was probably also intimidated by Zhou Can's surgical prowess.
Mumble!
He swallowed hard.
"Doctor Shan, where did you find such a powerful Gui Peisheng? No wonder you asked him to treat patients' wounds with Dr. Tang."
"Hehe, now you know how powerful he is! Who told you to be unruly Peisheng, this time I got a big deal."
The two residents under Dr. Shan couldn't compare with Dr. Chi's staff at all.
Now with Zhou Can, it's different.
One regular trainee can play two.
Zhou Can quickly finished dealing with the blood vessels and nerves, and looked at Dr. Tang.
"Leave the debridement to me, and you grind the bones, okay?"
"no problem."
Dr. Tang has one of his greatest strengths, that is, he does not strive for merit. Happy to let newcomers perform.
Zhou Can debrides the patient's foot wound.
That is really merciless, some excess meat, tendons and other tissues should be cut off and never kept.
Finally, an indented wound shape with a concave in the middle and preserved epidermis is formed.
[Debridement experience value +1. 】
It's really not easy to earn this bit of experience.
【Congratulations, your debridement has been upgraded to level 4. The current experience value is 1/10000, and the attending doctor is at the lower level. 】
This medical skill has finally risen to the attending level.
It's not easy.
Relatively speaking, the opportunity to use debridement is not bad. With 1,000 first-level operations, there are about 350 debridement opportunities.
It's a pity that you can only get 1 experience point for each debridement.
Unlike injections, hemostasis, sutures, ligation and other medical techniques, one operation can earn more experience points.
After this medical skill was upgraded, he was pleasantly surprised to find that his debridement ability also improved significantly.
For example, in the treatment of the same wound, he has now been able to predict how to clean the wound, which is more conducive to suturing and wound healing. Even whether the follow-up of the wound is susceptible to infection, and whether it will have a serious impact on the patient's life after healing.
There can be a clear prediction.
In addition, during debridement, there is a more comprehensive understanding of nerves, blood vessels, vital organ tissues, and tumors.
The processing method will also be more perfect.
For example, for the wound that has already been treated, his cognition has improved after his debridement technique has been upgraded to level four.
It's easy to see where things are not doing enough.
Some repairs were made to the wound again.
Take that nerve as an example, before only thinking about how to close it. Little is known about the effect on this nerve after the wound has healed.
Looking at it now, he can clearly find that after the wound has healed, as long as he walks in shoes, the phalanx will continue to compress and stimulate this nerve.
It will definitely affect the patient.
So he improved it and moved it to a proper position. With the protection of the fat layer and the buffer, it will be fine.
This is just a processing detail.
But it fully shows that his debridement level has been greatly improved.
Sometimes, the difference between the level of the director and the attendant may be a slight difference.
But in surgery, this slight difference may be thousands of miles away.
For example, in tumor removal surgery, after the attending surgeon has cleaned up the tumor, a small hidden danger is left near the nerve. His ability is limited, so he dare not cut it.
The director completely eliminated that hidden danger.
The difference between the two seems to be a little bit, but the prognosis is very different.
If the main treatment is not cleaned up, the tumor cells will metastasize, which may cause the patient to relapse quickly.
The operation performed by the owner has been completely cleaned up, the patient will not relapse and can live healthy all the time.
In terms of medical skills, the higher the level, the smaller the gap.
It is often reflected in the subtleties, just a slight difference.
After Zhou Can's debridement technique was promoted to the fourth level, he was really happy in his heart.
"Doctor Tang, I'll leave it to you to grind the bone! It's about this position, and it's best to round the front end of the phalanx a little bit."
This is done so that after the patient's wound heals, the flesh will not be pierced because the bone is too sharp.
"OK!"
Dr. Tang is a senior resident in orthopedic surgery at any rate, so if he grinds his bones, he's still fine.
Grinds quickly.
"Doctor Zhou, how are you doing? Do you need to fix it?"
"Excellent grind!"
Zhou Can gave a thumbs up. After checking the wound, there is no problem. Start suturing the patient.
He sewed the patient's wound into a duckbill shape.
This is also a common suturing method for amputation wounds.
Indications for medium-level suturing, medium-level ligation, and low-level debridement, well-treated wounds are enough to score high.
After the stitching was completed, he did not report to Doctor Shan or Director Shen.
Instead, he respected Dr. Zutang mercilessly.
"Doctor Tang, can you see it?"
Most of the work of the operation was done by him, but in the end he asked Dr. Tang, who was not as capable as him, for instructions.
This also deeply won the favor of Dr. Tang.
No one will refuse to deal with a person who is like a spring breeze.
"I can see that the sutures are very good~www.mtlnovel.com~ Doctor Tang's face is full of smiles.
"Doctor Shan, please help us check if there is any room for improvement in the stitching of the patient's foot wound."
Dr. Shan is currently watching Director Shen build the interface for the transplant.
Wen Yan came over to check it carefully.
"You two sewed quite well! I'll ask Director Shen to take a look after the operation is over." She was extremely satisfied with the performance of Zhou Can and Dr. Tang.
Earn enough face for her.
Usually, when did his doctors beat Dr. Chi's doctors?
Today is the only time.
It is also the first time.
"Damn, the stitching is so perfect, I wouldn't believe that he is just a Gui Peisheng."
After Dr. Yang and Dr. Gan saw it, they were deeply shocked.
Today is an eye opener.
It is true that there is a sky beyond the sky, and there are people beyond people.
Zhou Can surpassed them in more than one medical field. But in many fields, it is almost completely surpassed.
This frustrates both of them.
"Doctor Shan, let's discuss it! I usually have a lot of operations, why don't I let Dr. Zhou exercise with me?" Dr. Chi saw how good Zhou Can was, so he directly made up his mind.
At the attending level, most of the time, the operation is performed alone with an assistant.
Their income is also linked to the operation commission.
In addition, when evaluating the deputy director, academics are a very important part. The cumulative number of operations, the quality of operations, and the difficult operations completed are very important evaluation criteria.
Dr. Chi should be a senior attending doctor, and he has already started to work hard for the deputy senior title.
Being able to get a powerful assistant will be of great help to him in the evaluation of the deputy high school.