Anastomosis is closely related to two surgical techniques: suturing and knotting. Nowadays, anastomosis is only a proficiency level.
And his continuous sutures, square knots, and surgical knots are all at the Xiaocheng level, which is equivalent to being upside down.
The level of basic skills is one level higher than that of advanced skills, which naturally allows the level of advanced skills to be improved quickly.
After practicing several times and mastering the basic steps of advanced skills, your progress will be as fast as flying.
Successfully anastomosing a blood vessel increases proficiency by 10 points, which may seem exaggerated, but is actually quite normal.
When his anastomosis skills reach the level of suturing and knotting, his improvement will become slow. It is even affected by suturing and knotting. Only when they are improved can the anastomosis be advanced.
Li Jingsheng had more confidence this time and chose the anterior tibial artery for anastomosis.
"Director Hua, arterial blood vessels have higher requirements for anastomosis technology, so it is still a bit worrying to let him do it!"
Director Bi was still a little worried.
"The great saphenous vein is not broken. Aren't there only a few blood vessels that need anastomosis? Let him try. If it doesn't work, let Director Chen take over."
Director Hua acts as a strong backing for Li Jingsheng.
With his words to tell the truth, Director Bi had nothing to say.
Li Jingsheng has become more and more courageous now, his anastomosis technology continues to make breakthroughs, and he has become more proficient. Some incorrect operations were quickly corrected, as if a surgeon with many years of experience in vascular anastomosis was in charge.
Compared with the first performance, it is a world of difference.
Director Hua's smile became thicker and thicker, and his eyes narrowed with laughter.
Chen Anchen looked at Li Jingsheng's operation as if he were looking at a monster. This guy is indeed a genius. The difficulty of anastomosis of blood vessels is quite high, but it is not something you can do well just by mastering the suturing technique.
Because when anastomosing blood vessels, each stitch needs to leave at least three to four centimeters of suture, and keeping them from knotting is enough to give many doctors a headache.
Next, make sure every stitch is accurate.
Because you cannot sew one stitch or lock it, you need to reserve enough space to ensure that the subsequent anastomosis can go smoothly.
Therefore, when inserting the needle, insert the needle from the broken end A of the blood vessel, and then insert the needle from the broken end B. It is difficult to master this needle position well without practicing thousands or tens of thousands of times.
Li Jingsheng made many novice mistakes when he performed his first vascular anastomosis.
But looking at his current operations, every move is so sophisticated, making people really envious of his talent.
Ou Qinglan was also worried about her boyfriend at first, but now her bright eyes were full of smiles, admiration and pride.
This time, Li Jingsheng took less than five minutes to anastomose this important artery and blood vessel.
Only the last one is left.
He rushed to do it without hesitation, and when Director Hua saw this performance, he naturally smiled knowingly.
What general doesn't want his soldiers to fight bravely?
Li Jingsheng rushed to anastomose the last blood vessel, and his drive to make progress naturally made Director Hua happy.
To get exercise opportunities in the operating room, you have to rely on grabbing them.
This time it took four minutes and fifty seconds, another ten seconds shortened. And the fit is getting better and better.
The sutures are tight and fine, and the blood vessels fit tightly.
What's even more rare is that the size of the vascular anastomosis is also very good, and there is no obvious anastomotic stenosis.
Regardless of intestinal anastomosis or vascular anastomosis, it is easy to cause the internal space of the anastomosis site to narrow.
This affects blood flow.
There are many consequences, such as insufficient blood supply to the extremities of the limbs, weakness in walking, edema, and inexplicable pain. It may also cause the intravascular pressure to increase, and over time, the blood vessels will harden.
"Loosen the tie and do a blood test!"
Director Hua said directly to Li Jingsheng.
When binding limbs to stop bleeding, do not do it for too long.
Usually it needs to be loosened once every half hour or so to allow the end of the limb to receive blood supply.
Except for severe injuries.
The most common thing is that after someone is bitten by a snake or spider, they are worried that the venom will invade the heart, so they are tied tightly.
However, he lacked the necessary medical knowledge. By the time he was sent to the hospital, the ends of his tied limbs were already bent purple and cold. When the doctor asked, he learned that the binding time was much longer than half an hour.
The result can be imagined. It might not be a big deal at first, but with such a bundle, the end of the limbs lost blood for too long, and irreversible necrosis directly occurred.
Then amputation was required.
This is such an injustice.
Patients who make the above mistakes are relatively rare, because now the national literacy level has improved, and junior high school students will learn some first aid knowledge.
There is another mistake that most patients are most likely to make.
After being bitten by a highly venomous snake, tie the upper end of the wound near the heart to prevent the snake venom from invading the heart.
In fact, doing so will most likely lead to amputation.
Of course, it depends on where you are. If you are in a mountain where transportation is inconvenient and the time to get to the hospital is too long, tying up is a very good way to save your life.
It is better to lose a leg than to have venom invade the whole body and cause death.
But if you are in the city, the best way is to go to the hospital for emergency injection of the corresponding type of antivenom.
Because after binding, the venom of highly venomous snakes is very deep and highly toxic.
It is concentrated in a small area at the end of the limb and can lead to necrosis of the end of the limb.
When sent to the hospital at this time, it is often difficult to save the legs.
Also, many people watch TV and movies. After being bitten by a poisonous snake, they make a cut to squeeze out the poisonous blood, or even suck it out through their mouths.
This is all undesirable behavior.
Some snake venoms can cause bleeding.
Cutting the wound will cause bleeding that is difficult to stop. Moreover, it is extremely difficult for the wound to heal after being scratched by a snake.
The best way is to avoid being bitten by venomous snakes.
After Li Jingsheng untied the bandage on the patient's leg, blood immediately flowed over.
You can see that the blood vessels are filling up little by little.
The first anastomotic vein leaked.
The second anastomosis was normal, but the vascular anastomosis seemed narrow and the venous blood return was extremely slow.
"Director Hua, can I reanastomose this vein?"
"Hurry up and do it! There's no need to ask about this."
Director Hua may have felt that he was losing face, so he signaled to Li Jingsheng to be smarter.
There are doctors from other departments present.
Li Jingsheng asked the nurse to bring a needle holder and sutures to ligate the vein first. This is where the slip knot comes in handy.
He didn't dare to embarrass the department anymore.
He quietly spent 43 health points to upgrade Sliding Knot from proficient to mastery.
He has an attending-level knotting ability, which is barely enough for a place full of masters.
I saw Li Jingsheng skillfully ligating blood vessels and making a strong and beautiful smooth knot. The whole process was very skillful. This made Director Hua nod again.
Director Bi glanced at it and paid no attention to it.
In any case, Director Bi was satisfied that the two arteries anastomosed by Li Jingsheng were unobstructed.
His performance is not particularly outstanding, but he is already a unicorn among doctors of his age.
This young doctor in the Department of Orthopedic Surgery is really good.
After Li Jingsheng removed the sutures, he trimmed both ends of the blood vessel again and then re-anastomized it.
The length of blood vessels is fixed and has a certain degree of elasticity, but it can only be trimmed once or so at most.
If the blood vessel loses too much length, it will not be able to anastomose properly.
At this time, either an artificial blood vessel is connected or the great saphenous vein is harvested for blood vessel transplantation.
Superior doctors are generally reluctant to allow young doctors to anastomose important blood vessels because of these concerns.
Because the risk is really high.
Soon, the reworked vein was successfully anastomotic.
Li Jingsheng breathed a sigh of relief.
Once the slippery knot of the ligation is untied and the blood circulates, everything is normal.
He breathed a sigh of relief.
Tonight's surgery allowed him to take an extremely important step.
Once you master the anastomosis technique, you will be qualified to participate in more difficult surgeries.
Today, only blood vessels were anastomosed. Next time, I can find an opportunity to challenge the nerve anastomosis.
However, nerve anastomosis is much more difficult.
Even the chief physician often makes mistakes, so it is best to improve the anastomosis technique to a minimum level before performing nerve anastomosis.
As the blood circulates in the anastomotic blood vessels, after such a long time, the patient's severed limb actually has a trace of blood.
Director Hua pressed it and then observed it carefully.
"The vascular anastomosis was successful! Let's anastomose the tendons!"
It sounds like this means that Li Jingsheng should continue to take advantage of it!
You should avoid doing bad things in the future, otherwise in the hands of a chief doctor with a sense of justice, there is a high chance that you will be rewarded with training by his novice doctors.
Li Jingsheng quickly recalled the steps and technical points of tendon anastomosis.
Fortunately, I learned some basic skills while doing surgery with Professor Wu.
Although Professor Wu's surgical skills are average, he is the chief physician after all, so he can't be any worse.
The knowledge of extraskeletal surgeries that should be mastered can be said to be profound.
With a proficient level of anastomosis skills, tendon anastomosis is actually slightly easier than vascular anastomosis.
But the technical requirements are still high.
Li Jingsheng used the figure-8 suture method. This is also the most commonly used method of tendon anastomosis.
It took a lot of effort to reconnect the first ruptured tendon.
As expected, his life value increased by more than a hundred.
The level of proficiency in anastomosis has increased even more.
Almost every time a blood vessel is connected, the proficiency level will increase by 10 points. The same goes for connecting this tendon, which will increase the proficiency level by another 10 points.
According to this trend, as long as he stays in the operating room and performs a few more such surgeries, his anastomosis skills can be directly improved to a minor level.
…
Nearly forty minutes later, the patient's tendons, blood vessels, nerves, tibia, and fibula were all effectively anastomotic or reduced. Although it still looks bloody, the limb-sparing surgery is nearing completion.
"Director Hua, can you ask Dr. Ou to sew the patient's skin?"
Li Jingsheng brought Ou Qinglan in, so he could help his girlfriend get some exercise opportunities!
"Xiao Ou, are you confident?"
Director Hua looked at Dr. Ou.
"Yes, yes!"
Ou Qinglan was so excited, she was quite courageous.
In addition, after hearing the crimes committed by this injured man, there is nothing to be polite about.
You must work hard to grab opportunities to exercise!
"Jingsheng, stay by your side to help her! Make sure there is no problem with the wound healing, otherwise it will have to be reworked and re-sutured."
Director Hua finally got the answer.
What I mean is that it doesn’t matter if the stitches are ugly, as long as they heal well.
That is, in a large hospital, and with Li Jingsheng's help, she was able to get a good chance of suturing the skin so easily.
You know, Li Jingsheng has been running a clinic for a few months, and he has only received three or four wound suturing opportunities in total.
Master Liu alone gave him two suture opportunities.
And the requirements are very low, as long as it can heal.
Li Jingsheng naturally taught Ou Qinglan how to sew attentively. If there were any problems, as long as they were serious, he would point them out to her in time.
Girls seem to be naturally more ingenious.
Her suturing skills were obviously very poor, but under Li Jingsheng's guidance, her suturing skills got better and better.
At the beginning, she seemed very nervous.
Gradually, the whole person enters a good state.
Later on, Li Jingsheng hardly needed any more guidance.
It can be seen that she has made great progress.
Basically, all surgeons are similar. As long as they practice a few times, they can make significant progress in mentality, technique, skills, etc.
Director Hua has already gone to see Director Bi and the others to repair the intestines and abdominal cavity.
The operation is gradually coming to an end.
Director Bi was in a pretty good mood when he saw that the patient's vital signs were stable and the operation was about to be completed. It was entering the final stage.
"Director Hua, I see that you took the opportunity to train today."
"Haha, nothing can be hidden from Director Bi's eyes! Although our orthopedic surgery department does not have a small amount of operations, when it comes to training opportunities for young doctors, your general surgery department still has a sufficient volume!"
Director Hua laughed and admitted openly.
He looked at the young doctor who was suturing the patient's waist wound.
"This young doctor who sews the waist wound is very good at sewing! Is he Ouyang Cheng from your general surgery department?"
"Thank you, Director Hua, for the compliment!"
The male doctor who was suturing the waist wound raised his head and smiled politely at Director Hua.
"Why are you so familiar with our general surgery department? Let me tell you, don't try to recruit people from me, otherwise I will ask the dean for review." Director Bi looked nervous and guarded Director Hua like a thief.
Everyone knows that there is a shortage of doctors in orthopedic surgery, especially excellent young surgeons.
"Look at how stingy you are. If I really wanted to poach him, would he be stupid enough to do it in front of you? But then again, your general surgery department is really strong, with many talents and outstanding young people. There are endless numbers of doctors, which is really enviable.”
Director Hua looked at Ouyang Cheng, his eyes clearly showing his love for talents.
This made Director Bi even more nervous.
If limb salvage surgery had not been performed by an orthopedic surgeon, I would have been reluctant to invite Director Hua over.
Every time I come here, I always think of young doctors in general surgery.
Guwaii has always wanted to work hard to become bigger and stronger, and it is also taking the elite route in recruiting talents.
I heard that the Orthopedic Surgery Department has at least five vacant residency slots, which are reserved for poaching at any time.
To be able to enter the eyes of the director of China, he must at least have a good character, strong skills, and be young.
"Let's go over there and sit and chat. We can just leave it here for them to clean up." Director Bi quickly brought Director Hua to the wall some distance away from the operating table.
There are four round stools for doctors to sit and rest.
"I think the new recruit in your department, Li Jingsheng, is also very good! Our general surgery department actually needs a doctor who can perform bone reduction. The speed of progress he just showed is even more amazing. I have been practicing medicine for almost 40 years. I have never seen any doctor make progress as fast as him."
Director Bi and Director Hua are actually the same.
Good stuff all the way.
They all want to recruit outstanding young doctors when they see them. Only when the department becomes stronger can it take on more hard work, can the efficiency increase, and can everyone's income increase.
And as a department director, you will become famous and receive high honors.
For example, if the Orthopedic Surgery Department, under the leadership of Director Hua, becomes one of the top orthopedic surgery departments in the country, everyone will praise Director Hua for his achievements.
"How can I put it this way? It feels like looking at other people's wives and always feeling more beautiful and exciting. Li Jingsheng is relatively good, but it's not as exaggerated as you said. You saw the blood vessels he had anastomotic just now, and they were leaking blood. How high do you think his level can be?"
Director Hua belittled Li Jingsheng calmly.
Don't be afraid of thieves stealing, just be afraid of thieves missing you.
Li Jingsheng was worried about the most powerful surgical department in the Second Hospital, which was definitely not a good thing.
The general surgery department is really looking for people, and the orthopedic surgery department cannot stop them.
The weight and voice of both parties are not at the same level.
Cardiac surgery and neurosurgery combined cannot shake the status of general surgery, which shows how strong it is.
It can only be said that every hospital has its own powerful departments.
The General Surgery Department of the Second Hospital was severely shamed by the General Surgery Department of all hospitals.
"I like young doctors who have great potential but are not very good at the moment. Such people don't have the stinking habit of being arrogant and are easy to train. Aren't you envious of the many outstanding young doctors in our general surgery department? How about I exchange one with you? ?”
Director Bi should be about ten years older than Director Hua.
It is said that ginger is spicier when it is old.
This is really the case.
Director Hua's little thoughts cannot escape Director Bi's eyes.
"Change Ouyang Cheng to me?"
Director Hua looked calm on the surface, but in his heart he would definitely not agree.
Li Jingsheng is the second signature of the Orthopedic Surgery Manual Reduction Clinic, and he has shown extraordinary talents and abilities in the diagnosis of difficult cases and surgical operations. This kind of young doctor will definitely become the backbone of the department in the future. How can Director Hua be replaced?
"Ouyang Cheng, Director Hua wants you to develop in the Department of Orthopedics, and he will focus on training you. Do you want to go?"
Director Bi was even more outrageous and directly asked Ouyang Cheng who was suturing.
"Is this... true?"
Ouyang Cheng seemed a little moved.
There are many experts in general surgery, and there are not many outstanding young doctors like him.
If you want to get ahead, you need to endure for many years.
Some people would rather have a phoenix tail than a chicken head. Ouyang Cheng felt that only by becoming a chicken head could he have a chance to become a phoenix.
"Ahem...I'm just kidding you, Director Bi." Director Hua felt embarrassed.
He is the head of the department, so he would never agree to something like this.
Not to mention taking one Ouyang Cheng, even if you give him ten, there is no way to replace Li Jingsheng.
"I know that you, Director Hua, never do business at a loss. In addition to Ouyang Cheng, I will add another outstanding young doctor to you and give that little plum to our general surgery department."
Director Bi already knew it, and now he was just teasing Director Hua.
"If I want to replace him with someone else, I can agree. Li Jingsheng is the doctor in our Orthopedic Surgery Manual Reduction Clinic. He can't be replaced. He can't be replaced. He can't be replaced!"
Director Hua shook his head in denial.
The two parties were just like friends, joking around and trying to trick each other's background in the department.
In this round of confrontation, Director Hua has already lost.
Even a fool knows that Li Jingsheng is the most important among the young orthopedic surgeons.
"By the way, after the injured person is cured, he should be arrested and sentenced, right?"
"It's not clear yet. He's injured so badly. He won't be able to get out of bed for two or three months."
"It's true that good people don't live long, and the harm is left for thousands of years! He was rescued after being so seriously injured. Who knows if he will harm others again next time he gets better?"
"How can we doctors have so much control! This matter can only be left to the law. I heard that the city is planning to hold a medical skills competition. The venue seems to be Qiaobang Hospital, and the director has given us the task. Now that these department directors are here, what are you going to do?"
Director Bi changed the topic, obviously unwilling to talk more about this patient.
Because he knows Director Hua's character and has a strong sense of justice.
The two men's views in this regard are completely different.
Director Bi believes that doctors only do what doctors do and don’t care about anything else.
When Director Hua faces some gangsters, he will bring his personal feelings to bear, and even affect medical decisions.
For example, in this patient's case, if Director Bi had not asked for mercy, Director Hua would have really talked to the family. The patient's leg was too badly injured and the limb could not be saved, so amputation was recommended.
Of course, the final decision-making power in this matter lies with the family.
The family insisted on salvaging the limb, but the doctor could not refuse.
It’s just that family members will largely listen to the doctor’s professional opinion before making a judgment. So no one can say what the outcome will be.
"Skills competition is a good thing. It allows everyone to understand the strength and new technologies of other hospitals. Our orthopedic surgery department has not decided on a candidate yet."
Director Hua said bluntly.
(End of chapter)
