Chapter 481 Earn a wave of bone experience points, level 6 incision
After opening the chest wound, it can be seen that the remaining sternum is obviously infected and discolored.
As osteomyelitis progresses, bone necrosis will eventually occur.
The incidence of this disease is extremely low.
In particular, hematogenous osteomyelitis is extremely rare and is a very difficult disease to treat in the field of orthopedics.
Postoperative infection of the sternum is a common cause of this disease.
After Zhou Can completely removed the sternum and completed the debridement, he took a rib from each side to reconstruct the chest wall.
It is to place two ribs horizontally on the chest cavity.
[Bone-breaking joint experience +1, Bonus bone-breaking joint experience +100. ]
For such a difficult bone joint, a hundred experience points as a reward is not much.
However, compared to only earning 1 Bone Synthesis Experience Point at a time, this is already a rocket-like improvement speed.
At present, his skill in fractured bone union is still at level four, which is the attending level.
If you want to be promoted to deputy director, you still have to work harder.
Mainly because he usually performs surgeries, there are very few orthopedic patients. He can't handle difficult ones, and he can't earn much experience points for easy ones.
There is no way around this, we can only accumulate little by little and then make a breakthrough.
In almost all surgical skills, level 4 and level 5 are an important watershed. Before level 5, you can only slowly persevere.
Basically all surgeons have become successful this way.
Once promoted to level 5, that is, associate chief physician, you have made it. At this point, you can participate in various major surgeries and have the ability to attempt to complete some difficult orthopedic surgeries.
Although orthopedics only treats a few bones, it is known as the most profitable department in surgery, so you can imagine its importance.
Even if you only master hand surgery, you can do very well.
In fact, if you master any of the orthopedic surgery branches, including hand surgery, foot surgery, joint surgery, lumbar spine surgery, and bone trauma surgery, you can become an orthopedic surgery expert that major hospitals will be eager to hire.
Income and status will be very good.
China has a long history of traditional Chinese medicine, and ancient medicine and martial arts are actually inseparable. In particular, injuries, internal injuries, and external injuries are closely related to martial artists.
Ordinary people usually get sick, but only those who practice martial arts like fighting and killing, and getting injured is almost commonplace.
Broken limbs or broken ribs require treatment from traditional Chinese medicine.
Therefore, when it comes to treating bone injuries with traditional Chinese medicine, even today when modern Western medicine is at its peak, traditional Chinese orthopedics still stands out from the crowd.
Which hospital is the best at bone setting?
It must be Chinese medicine!
For sprains and fractures, Chinese medicine is still needed.
The most common way for Western medicine to treat fractures is to insert steel nails. A splint can be placed with more than ten or twenty steel nails. Not only is the cost extremely horrible, but the patient's bones will also be riddled with holes.
Of course, these days, whether it is Chinese medicine or Western medicine, a good doctor is one who can restore the patient's health.
Western medicine is not completely useless in the field of orthopedic surgery.
For correction of bone deformities, traditional Chinese medicine traction can be of some use, but the effect is far inferior to that of Western medicine.
For example, Chinese medicine has almost no way to treat severe scoliosis, while Western medicine can directly perform surgery, cut off one or two vertebrae, and then provide necessary exercises to eventually turn the patient into a normal person who can stand up straight.
In addition, the treatment of bone cancer is also dominated by Western medicine.
After Zhou Can reconstructed the patient's sternum, he began to quickly free the bilateral pectoralis major muscle flaps.
What are you doing?
These muscle flaps are used to fill the missing sternum, and then the pectoralis major muscles on both sides are sutured together to achieve the purpose of soft tissue reconstruction.
After doing all this, a drainage tube was placed in the chest wall incision, the cavity was sutured and closed, and the operation was finally completed.
Zhou Can let out a long breath.
Performing this operation brought him a lot of medical experience points. In addition to fractured bone joining experience points, there were also experience points for incision, suturing, hemostasis, anastomosis and other medical skills.
Whether it is removing the sternum or using the free pectoralis major muscle flap to fill the missing pectoralis muscle, it is an absolute technical job.
It has been of great benefit to his own surgical growth.
"Well, as long as the patient receives enhanced antibiotic treatment after surgery, he should be able to recover quickly. If he gets infected again this time, it will be troublesome and there is basically no solution."
Zhou Can added that this was to remind Director Xueyan to strengthen the patient's postoperative care.
For every bad patient who comes back for surgery twice, there will be one less chance for surgery.
Open chest surgery is extremely harmful to patients.
Now the sternum is completely removed and two ribs are taken to rebuild the chest wall, which basically consumes the patient's last bit of "possession". If infection occurs again, it will be the end of the road, and there is a high probability of death.
If this patient is cured, it will be of great publicity significance.
I believe Director Xueyan can definitely distinguish the priorities.
The second surgery was performed on a patient with lung cancer.
This person had a lobectomy three months ago at Fangxin Cancer Hospital.
This is a postoperative recurrence accompanied by distant hematogenous metastasis.
The metastatic sites that have been identified so far include the hilar and mediastinal lymph nodes.
This widespread metastasis has made it difficult to resolve the problem through surgery. To put it bluntly, there is little point in doing another surgery.
The patient is in his prime, and his wife, children, and parents all have a strong desire for treatment. Even if it means losing everything, they are willing to give it a try.
Faced with the family's strong desire for treatment, Deputy Director He was deeply moved and finally decided to take on the operation.
Deputy Director He knew that his surgical skills were limited, and that he had to rely on Zhou Can to have a chance of tackling this difficult problem. So after discussing with Zhou Can and Director Xueyan, he set the surgery date for tonight.
There is one thing that is particularly interesting. The Third Hospital poached so many key doctors and nurses from Tuya's cardiothoracic surgery department last time , but Deputy Director He was not poached.
This surprised both Zhou Can and Director Xueyan.
You know, Deputy Director He has always been a thorough and sophisticated egoist. Even though he bowed to Director Xueyan and stopped competing for the position of department director, he still behaved quite selfishly in his work.
According to common sense, such people can basically be found easily.
Unfortunately, the Third Hospital failed to poach him.
Zhou Can later heard that the day after several doctors in the cardiothoracic surgery department resigned one after another, Deputy Director He became extremely irritable and angry, and broke several cups in the office.
No one knows why he is angry.
It could be that many of his thoracic surgery doctors had been poached, which had increased his work pressure. It could also be that a large number of key staff members had resigned en masse, including some he had personally trained, which had made him angry.
But there is another version.
According to rumors, the Third Hospital poached a deputy chief physician under him, offering him an annual salary of 700,000 yuan after tax, and the poacher was personally recruited by Zhang, the deputy director of the Third Hospital.
The price offered by the Third Hospital to Deputy Director He was only 600,000 yuan, and it was not specified whether it was before or after tax. Moreover, the person who came forward to recruit him was a section-level cadre of the Third Hospital.
The salary is obviously lower than that of the deputy chief physician.
Isn't this a slap in the face of Deputy Director He?
The latter rumor is probably quite true. Otherwise, given Deputy Director He's personality, he is very likely to change jobs.
Of course, since I haven’t verified this, no one knows whether it’s true or not.
For Tuya Hospital, whether it is true or not, it is an indisputable fact that Deputy Director He has worked harder since a large number of key medical staff in the department were poached. The hospital and the cardiothoracic surgery department have benefited from it.
"Doctor Zhou, I'm afraid you will have to be the lead surgeon for this patient's mediastinal lymph node dissection and right lung lobe expansion."
After the second patient was sent to the operating room, Deputy Director He arrived quickly.
Director Xueyan led her team to perform another cardiac surgery. Her surgical skills were already very strong, and having Zhou Can in the same operating room to support her was enough.
For her, Zhou Can’s role in the operation was more often to help her clean up her mess.
When an emergency occurred, Zhou Can quickly took action to rescue.
To put it more clearly, Zhou Can is playing the role that Director Hu played previously.
"No problem, just stand by and guide me during the operation. We young people should do more."
Even now, Zhou Can has a good relationship with Deputy Director He.
But a villain will always be a villain.
He never changed his opinion of Deputy Director He just because he became friendly or even tried to please him. When they were together, he was always extremely humble and careful in front of him.
When speaking, try to say less and do more so as not to arouse Deputy Director He's disgust.
People eat a variety of grains, and one kind of rice can feed a hundred kinds of people.
A department may have dozens of people at least, or as many as one or two hundred people, or even more.
It is impossible to expect everyone to be a gentleman and to be friendly and kind to others.
There are all kinds of people.
Learn to unite these people, and then pool everyone's strength to jointly do a good job in the department's diagnosis and treatment business. This is the vision and bearing, as well as management ability that a manager should have.
Over the past year, Zhou Can's management capabilities have improved significantly.
This also laid a certain foundation for him to lead a larger surgical team in the future, be promoted to department director, or even vice president or president.
The operation began soon.
After opening the patient's chest, he found that the actual situation was more serious than the X-ray showed.
Some tumors are too small to be detected even with the most sophisticated equipment and can only be seen with the naked eye after opening the chest or abdomen.
"The metastasis and spread of his cancer cells are far worse than I imagined!"
Zhou Can looked at the patient's right lung, surrounding tissues, and mediastinal lymph nodes. Based on his experience, he concluded that this was the result of severe infiltration of cancer cells.
Surgeons who have performed autopsies know very well that malignant tumors are often oddly shaped and have bad colors, while benign tumors have clear boundaries and regular shapes.
Just like poisonous mushrooms are often colorful and can be seen at a glance.
Of course, some poisonous mushrooms look simple and clean, but they are still poisonous.
Some malignant tumors may look similar to benign tumors and are difficult to identify with the naked eye.
This is also why after doctors cut off a tumor, they never judge whether it is good or bad based on experience, but send it directly for pathological examination.
In many cases, intraoperative examination is performed.
This usually requires contacting the pathology department before the operation, and then sending the removed tissue for urgent examination during the operation to get the results quickly. If it is benign, normal excision is sufficient.
If it is malignant, an extended resection must be performed, and even further search and cleaning of the lymph nodes may be required.
"I'm afraid I'll have to wear magnifying glasses."
When the circulating nurse heard this, she quickly took out a pair of magnifying glasses and put them on him.
"How is it, are you wearing it?"
The circulating nurse was quite gentle with him.
"Teacher Chang is a top-notch glasses expert. They fit me perfectly. But I always feel a little uncomfortable wearing this thing. Everything seems huge, as if I have entered a land of giants."
Zhou Can's words made everyone laugh.
He was intentionally trying to liven up the atmosphere in the operating room.
There is a tough battle to fight next, and it would be a blessing if we can complete the operation before twelve o'clock.
Fortunately, he is young, and his physical strength and energy are at their peak, otherwise he would have found it difficult to cope with it.
No wonder many people say that the peak age for surgeons is before the age of 35. After the age of 35, basically they can only gradually retreat to the second line and start training apprentices.
The routine surgery part is performed by apprentices, while the key parts are performed personally.
"Scissors!"
Zhou Can took the scissors handed to him by the instrument nurse and cut the mediastinal pleura below the azygos arch. At this time, the phrenic nerve could be seen.
Cut along the back of the phrenic nerve all the way to the front of the hilum.
Then carefully pull the phrenic nerve apart after the cuff, and then clean the fat tissue and lymph nodes from the pericardium side to the lung side...
It's easier said than done, but every step during the operation requires extreme caution.
Even though he knew that Zhou Can was an excellent surgeon, Deputy Director He still watched nervously from the side and helped Zhou Can with some assistance.
Whenever some key parts, important organs, nerves, and blood vessels are involved, Deputy Director He can't help but shout, be careful, be careful.
There are simply too many metastatic cancer cells.
Through magnifying glasses, he could clearly see some papule-like particles.
Those are not ordinary particles, but cancerous tissues that each have the potential to rapidly grow into a huge malignant tumor.
Zhou Can carefully cleaned the cancerous tissues and lymph nodes one by one.
His experience in incision and separation techniques has been increasing continuously.
Because he performed the surgery on important parts such as the pericardium, he was also given a lot of experience points as rewards.
[Incision experience +1, complete high-difficulty resection, reward incision experience +100. ]
[Incision experience +1, complete high-difficulty resection, reward incision experience +100. ]
…
[Congratulations on your advancement to level six incision. ]
This time, I made a lot of money by helping Deputy Director He perform this extremely difficult cancerous tissue removal operation.
In particular, his incision and separation techniques made him a fortune.
You know, it takes a full 100,000 experience points to advance from level 5 to level 6. Even though Zhou Can performed surgeries crazily in the emergency department every day, he still failed to level up.
This time, he unexpectedly earned a large amount of incision experience points as a reward, and was finally successfully promoted to level six, reaching the level of director.
Incision in surgery is actually equivalent to basic anatomy.
Dissection is an advanced medical skill in anatomy.
The ancient butcher Ding practiced basic anatomy to the extreme, and could easily complete the dissection and deboning of a cow.
Zhou Can's incision skills were promoted to the director level, which meant that his ability to dissect the human body had reached an extremely high level. He could dissect any part of the human body easily, just like a butcher cutting up an ox.
In addition, when he cuts any part of the body's tissue, the feedback he gets is clearer.
It is as if there are countless probes on the palm of the hand, which can highly recognize the feedback signals from scalpels and various instruments. The sensitivity is incomparable to the past.
Now, if you ask him to cut a thick stack of A4 paper, he is confident that he can cut as many layers as he wants.
