Under normal circumstances, if the bones of the two toes do not grow together, and each has an independent and complete bone structure, it only needs to be surgically separated from the middle.
Because it is a deformity itself, various unexpected situations are prone to occur in actual surgery.
For example, the blood vessels of the two toes are crossed, or only one artery supplies blood to them at the same time. In this case, the surgery is a little more complicated. An artificial bypass is required to reconstruct an arterial vessel.
In fact, the anterior tibial and dorsalis pedis arteries are the main blood supply to the toes.
As for the venous return, the great saphenous vein and the small saphenous vein are the sources.
The posterior tibial artery belongs to the two terminal branches of the popliteal artery, and it can also serve as a blood source for bypass remodeling vessels if necessary. It generally supplies blood to the soles of the feet and is rarely used during surgery.
Zhou Can is not clear about the specific operation of this patient.
One thing is for sure, the operation should not be too difficult. Otherwise, he or the doctor will perform the surgery himself.
After the gauze is untied, the sutured wound can be seen.
The suture is relatively neat, without skin grafting, but with suture.
Conditional patients will receive water-filled skin expansion for a period of time before surgery. However, because it is only a minor operation and the patients come from all over the province, it is often impossible to prepare for everything.
Requiring patients to go back and forth to the hospital multiple times is not realistic in itself.
Doctors definitely want the surgery to be as perfect as possible, but patients often find it difficult to accept it in consideration of economic affordability and time cost.
Postoperative suturing is more common.
The skin itself has strong toughness and extensibility. It only needs to rest for a period of time, and it can grow automatically and cover the wound completely.
The only thing to pay attention to during this period is to prevent infection.
Also, postoperative hospital observation time is often only about one to two days. The rest of the time is spent dispensing medicines for patients and taking care of them at home.
Especially in a large hospital like Tuya, there is a shortage of beds, and it is difficult to spend the limited bed resources on a minor surgery patient.
This patient chose to have surgery in Tuya's emergency department mainly because of Zhou Can's reputation.
Originally, this kind of toe splitting operation is usually done by general surgery.
The operating room of the emergency department is now a general operating room. Except for the fourth-level surgery and obstetric surgery, almost all operations are dared to be performed.
The operation is mainly divided into two technical parts.
One is the basic skills of surgery, that is, incision, suture, hemostasis, anastomosis and so on. The second is surgical experience.
Under normal circumstances, as long as the operation is not particularly difficult, all surgeons can become all-round fighters.
Of course, in practice, such a versatile surgeon is very rare.
You ask a surgeon who usually only performs general surgery to open the chest and perform heart surgery on the patient, basically curing one to death.
This is why cardiac surgery and neurosurgery have always been called the two ceilings of surgery.
Because these two fields are high-precision surgery.
Only those with a high level of surgery and rich experience in this field can be qualified.
The training period for surgeons in cardiology and neurosurgery is at least eleven years.
That is to say, it takes at least eleven years to train an ordinary novice doctor to be able to independently complete a cardiac surgery. In fact, the training period will be longer. Without 15 to 20 years of surgical experience, the superior doctors dare not let you preside over the surgery alone.
Life is at stake.
Judging from the suture technique and neatness of the toe splitting operation of this patient, it should be performed by an experienced surgeon.
Because some details are handled quite well.
"Is this toe numb?"
Zhou Can took a sterile cotton swab and touched the patient's right toe. To be precise, this toe is the third toe.
Typically, the second to fifth toes are most prone to syndactyly.
The first toe is the thickest one on the inside.
It is the eldest of the toes, and the chance of deformity with the second toe is very small.
This female patient mainly had deformities of the third toe and fourth toe of the left foot.
"Yes, this is it."
The girl nods.
Family members are accompanying in front of the hospital bed.
Judging from appearance and age, the **** should be the girl's mother. But this woman was very shy and simple, she didn't talk much, she just stood by with a smiling face and watched Zhou Can examine her daughter.
The patient's father only showed up on the day of the operation. It is estimated that after seeing the baby's operation, he went home to work and earn money.
Basically, the men in most families are the pillars of the family.
It is also the backbone of the economy.
"You close your eyes first."
Zhou Can said to the patient.
"Do you feel it?"
He again touched the patient's left third toe with a cotton swab.
"A little bit, it's not obvious."
"Which toe am I touching you? The left or the right?"
"right!"
"Which one are you touching now?"
"left!"
"Does the toe on the left feel different from the one on the right?"
"Yes! It's so clear, I can tell you're touching my toes with the handshake end of the swab."
The girl's answer was very precise.
This also facilitates Zhou Can's accurate diagnosis.
What I am most afraid of is the kind of patients who don't know what to ask, answer questions with ambiguity, and say nothing.
It's really maddening.
It is now basically certain that there is a problem with the patient's left third toe.
Zhou Can's expression became serious.
"You can open your eyes now, thank you for your cooperation."
Now that the operation has been completed, nothing can be seen from the outside with the naked eye.
The patient's two toes are relatively rosy, indicating that the blood supply is smooth.
It seems likely that there is a problem with the nerves in the toes.
"Have you ever touched those two toes with your hands before?"
"I touched it!"
"When the toe on the right touches, do you feel it?"
"Yes! I used to have clear sensations when I cut my nails and when I scratched it. Dr. Zhou, may I ask if there is something wrong with my toe?"
No matter how stupid she is at this time, she still understands that the third toe is not effective for anesthesia.
Most likely something went wrong.
Zhou Can did not immediately draw a conclusion.
Due to the existence of local hematoma, wound pain and other conditions after the operation, it is really difficult to draw a conclusion immediately.
In fact, there are very few conclusive conclusions in medicine, and the answers given to patients are often relatively vague and flexible.
Even if they know that the patient's tumor is cancer, even if the doctor sees that the pathological biopsy results support a malignant tumor, they will still not tell the patient that you must be a certain cancer. I'll try to be as conservative as possible.
Of course, when a patient is found to have malignant diseases such as malignant tumors and uremia, considering the patient's ability to bear, the patient is often not informed of the examination results.
Instead, inform the family.
"I have this operation because I want to be able to dance ballet better in the future. If there is a problem with this toe, will it affect my dancing?"
The girl seemed a little nervous at this moment.
This is also a normal reaction in most patients.
Once they learn that there is something wrong with their bodies after the operation, they often feel anxious and tense.
"Don't worry too much, take a good rest. If something goes wrong, we will definitely find a way to help you solve it."
Zhou Can doesn't know much about ballet. He only knows that to dance this kind of dance, you need to touch the ground with your toes and spin your whole body like a spinning top. There are high requirements for the bearing capacity and flexibility of the toes.
Patients undergo this surgery not only for aesthetics, but also for better dancing.
Each toe has its own unique function.
In theory, the main function of the toes is to stabilize the body.
In the process of human evolution, apes need to run and jump barefoot in the woods and mountains, and even climb trees to avoid predators when they are in danger.
This requires the foot to have a certain gripping ability.
The toes are used to grip the ground, grasp the trunk, and stabilize the body.
Modern humans have evolved to a high level of civilization, basically walking in shoes most of the time, and the function of the toes has further degenerated. Even if you lose a toe, you can adapt quickly, and basically it will not affect your walking too much.
But for jumping and dancing, there will definitely be effects.
…
After checking the house, Zhou Can found that there were quite a few minor problems.
There is a certain reason why patients dare not let young doctors perform operations and see a doctor.
Among the hospitalized surgical patients in the emergency department, the proportion of inpatients with primary and secondary operations is very low, accounting for only about 30% of the total number of inpatients in emergency surgery. Most of the first-level and second-level surgery patients go with the treatment.
At most, I come to the outpatient clinic to change the medicine once a day, or go to the hospital to remove the stitches and have a reexamination within a week.
The third-level surgery and the second-level complex surgery are basically presided over by Zhou Can and Dr. Xu. The quality is not perfect, but at least it has reached a high level.
But the operations done by other people are a bit hard to describe.
In particular, the emergency department has continuously introduced new surgeons in the past two years, and they are all young doctors with insufficient experience and poor surgical skills.
In this case, the quality of the surgery can be imagined.
The hospital has always been very tolerant of new recruits.
It is to allow doctors to make some small mistakes and problems in the process of learning and evolution. As long as there is no accident, the hospital will turn a blind eye.
It is unrealistic to ask every novice surgeon to perform surgery at a high level like Zhou Can and Dr. Xu.
"Which doctor performed the one-bed surgery?"
Zhou Can asked Dr. Jiang Shuangshuang who was in charge of the bed.
Because she is a doctor in the Department of Endocrinology, when she was transferred to the emergency department, an inpatient ward happened to be established in the emergency department, so she was transferred to the inpatient ward as a bed doctor.
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At present, there are more than 100 beds in the emergency department, and her status here has also increased significantly.
If nothing else happens, I should be able to get an opportunity to study further this year, and then come back to be the head of the hospital to prepare for promotion to attending.
Every resident basically grows up like this.
When there are few doctors in the department, each doctor will be forced to take turns to be hospitalized for a period of one year.
If there are too many doctors, it's hard to say.
Hospitalization always requires staying in the hospital for a whole year, which can be said to be on duty 24 hours a day.
Very unfriendly for married people or young doctors who are in a relationship.
It is an extravagant wish to go home and live a normal married life with your lover.
Many doctors love and hate the position of general inpatient.
Because after being hospitalized, all aspects of ability, including ward management ability, will be greatly improved and exercised. Next, he will be promoted to an attending doctor, as long as he can pass the exam, it is basically a certainty.
In fact, the examination for attending physicians is not particularly difficult.
More than 80% of doctors can pass.
If it doesn't work, you can take the exam again in the second year.
Therefore, the key to being promoted to an attending physician is not the attending physician examination, but the one-year total hospitalization exercise.
Those doctoral students who didn't work were always hospitalized, and after working for a year, they were directly promoted to attending physicians.
Clinically, there will definitely be certain defects.
Maybe the management ability, the ability to solve the patient's sudden illness and the deterioration of the disease, is not as good as this kind of attending physician who is steadily promoted step by step. Hospital leaders are not stupid. When appointing important management positions in clinical departments, they usually don't give such untrained doctoral students directly.
Besides, the development path of others is completely different.
Doctoral students pay more attention to scientific research and write high-quality papers desperately to prepare for the impact on the sub-high and the high-level as soon as possible.
It is also this kind of talent promotion system that is somewhat divorced from reality, which has led to the fact that many postgraduate and postgraduate students who have studied for eight years may not be able to do anything after entering the hospital.
Many famous doctors may not even cure diseases.
This is also a strange phenomenon in the current medical circle. The relevant competent authorities have discovered this problem and are formulating a more scientific and reasonable personnel training mechanism.
The old American medical student exam uses living people.
Obtaining a medical license abroad is very difficult. It often takes very wealthy families to train doctors or nurses. Old American doctors belong to the high-paying class.
At present, there is no shortage of medical students in China, but there is a shortage of medical students who can see a doctor.
The last time Tuya Hospital recruited people for the emergency department, there were only two positions, and they were relatively poor technical positions. As a result, more than 300 postgraduates and masters submitted their resumes. Including a few doctoral students also sent their resumes.
It can be seen how far medical students are now looking for jobs.
There is also a very strange phenomenon. Everyone is trying to get into a big hospital. However, it is difficult for those small and medium-sized hospitals to recruit senior talents.
The more top hospitals like Tuya, the more sought-after UU Reading www.uukanshu.com.
When Zhou Can participated in the general training recruitment, the hospital initially gave only ten to twelve places, but thousands of people participated in the recruitment.
Over the past few years, Tuya's overall strength and ranking have improved a lot, and the recruitment will only increase.
Jiang Shuangshuang has always had special respect for Zhou Can.
During Zhou Can's ward rounds, as long as she was on duty, she would basically wait for Zhou Can to arrive early.
Because following Zhou Can's ward rounds together, I can learn a lot.
Zhou Can often gave her some guidance, which benefited her a lot.
"The toe splitting operation in the first bed was performed by Dr. Fu. Do you need to check the operation records?"
Jiang Shuang asked.
"You can help me adjust the operation records. I have to find Dr. Fu to find out the situation. There is probably something wrong with this patient's toes."