Chapter 489: Another Level 6 Medical Skill, the Meaning of a Doctor
"Doctor Yang, let me ask you, why do we deliberately leave some peritendinous tissue when we harvest the transplanted tendon?"
Zhou Can threw this question to Yang Zhi.
"To better stabilize the tendon?"
Yang Zhi obviously didn't quite understand either.
According to common thinking, some peritendinous tissue should be reserved when removing the tendon to facilitate suturing and fixation.
"Let me ask you, what is the function of tendons?"
Zhou Can asked instead of answering.
"It helps the limbs complete the movement! For example, the flexor and extensor tendons of the fingers, their function is to help the fingers complete the flexion and extension movements."
Yang Zhi gave the answer without even thinking about it.
Who among those who study medicine doesn’t know the function of tendons?
“Why can the finger flexor and extensor tendons help the fingers move?”
Zhou Can asked further with a smile in his eyes.
"This... isn't it because they help the fingers to flex and straighten by contracting or relaxing?" Yang Zhi became less and less confident as Zhou Can asked his question.
"Dr. Yang's answer missed the point. If the tendon wants to help the limbs move, it must first ensure that it can slide smoothly and freely. If the bones are deformed or the muscles are atrophied and tightened, they may not be able to slide normally, and the activity function of the corresponding parts will be affected. Therefore, when I separate the plantar tendon, I deliberately leave some tissue around the tendon in order to allow the transplanted tendon to slide flexibly."
Zhou Can was in a good mood, so he patiently explained the secrets of the operation to the two of them.
These surgical knowledge are not easy to learn from books, but are valuable experiences .
"I see! I've learned something!"
Yang Zhi and Pu Dingdong nodded repeatedly, both feeling that they had benefited a lot.
The two of them followed Zhou Can to perform surgery and often learned a lot of valuable knowledge.
It's not just about surgery. Sometimes some rescue experience and ideas for solving problems can benefit them greatly.
"Remember, after the distal end of the transplanted tendon is fixed, its reliability must be tested on the spot. If a problem is found, the cause must be found and solved immediately. Don't be careless and ignore it when a problem is found, and directly suture the incision. This will directly lead to the patient's inability to restore the finger function after surgery."
Zhou Can warned the two of them.
What is a good teacher?
A true teacher is one who can teach by example, and teach morality, experience and skills.
He tested the fixed plantar tendon and it was fine.
Only then were the cuts on the fingers sutured one by one.
Two medical assistants were not asked to perform the operation because it was a delicate operation that required extremely high technical skills.
Neither Yang Zhi nor Pu Dingdong could meet this requirement.
Next, he placed the wrist in a neutral position and pulled the free tendon ends to bring the fingers into a flexed position 15° greater than the functional position.
Then the flexion of each finger increases from the radial side to the ulnar side.
It's easier said than done, but there are many things to pay attention to when doing it.
For the dynamic muscle, it is necessary to sew a traction line on its tendon, and then pull the tendon to test the sliding amplitude until it meets the requirements.
In addition, it is also required to use an injection needle to pass through the skin horizontally and pin it under a large tension state. The two tendons are temporarily sutured and fixed, and the fixed needle is pulled out. Then the wrist joint is palmar flexed 40°, and the fingers should be able to fully straighten. When the wrist joint is placed in the maximum dorsiflexion position, the fingertips should be within 4cm of the palmar transverse line.
After the test, all passed, and a smile appeared in Zhou Can's eyes.
Transplanting hand tendons mainly requires patience, the surgical operation needs to be extremely precise, and all tests during the operation must be in place.
Never try to cut corners.
Also, after the tendon length was determined, the proximal end of the free tendon was anastomosed to the flexor digitorum profundus tendon.
When doing tendon anastomosis, he used the Pulveraft braiding method to fix the retained superficial flexor tendon and the transplanted plantar tendon, considering the difference in thickness. If the tendons used were the same size, it would not be so troublesome and the conventional suture method could be used directly.
[Suture skill experience points +1, +1... Bonus experience points +10. ]
[Ligation experience +1, bonus experience +10. ]
As he continued to sew, his experience points increased rapidly.
Suturing has long been promoted to level six, while ligation is still a little behind, but will be there soon.
He was very eager to be promoted to level six in ligation surgery as soon as possible.
Because suturing and ligation are a pair of close comrades-in-arms, inseparable.
It is definitely not okay to only be good at suturing but weak at ligation. In some difficult surgeries, if the ligation is too weak, it will seriously lower his surgical level.
Ligation surgery advances slowly, mainly because it is difficult to earn large experience value rewards.
The most common reward is 10 experience points.
Furthermore, it is possible that experience points may be awarded ten times for suturing, but only once for ligation.
This is why the experience value of this medical skill lags far behind that of suturing.
But don't worry too much, in various surgeries, suturing and ligation are used very frequently. Almost every surgery, no matter how big or small, will use them.
According to the current progress, it shouldn't be long before ligation surgery can be promoted to level six.
Soon, he completed the anastomosis of the two tendons.
[Anatomosis experience +1, completing extremely difficult tendon anastomosis, reward experience +1000. ]
The difficulty of anastomosis is mainly reflected in two aspects. First, the transplanted plantar tendon and the retained superficial flexor tendon are of different sizes. Second, the operating platform of fingertip anastomosis is small, which requires extremely delicate operations.
In addition, the corresponding effect needs to be achieved after anastomosis to ensure the recovery of hand function.
The technical points and difficulty involved are so great that even the average chief surgeon would probably feel daunted.
The patient underwent two operations in a Class-A hospital in another province but was not cured. This shows how difficult this operation is.
[Congratulations on your anastomosis skill being promoted to level 6. Your current experience value is 1/1000000.]
Another medical skill was successfully promoted to level six.
In addition to being happy, Zhou Can found that he was no longer that excited and his mentality remained relatively calm.
It’s like after getting a monthly salary of 10,000 yuan several times, when you get it again, it won’t seem like a big deal.
He has already advanced to level 6 in many medical skills, and his mentality is becoming more and more calm. Now he is aiming for the higher level 7.
I thought it would take at least five to ten years to advance the first medical skill from level five to level six.
Unexpectedly, in less than two years, many medical skills have been promoted to level six.
This was something he had not expected.
In the past, when his surgical skills were only at level 4, the surgeries he could perform were actually quite limited. He mainly observed many difficult surgical tasks.
At that time, earning 10 extra experience points as a reward would make him happy for a long time.
Now that his medical skills have almost all been upgraded to level five or above, the range of difficult surgical tasks he can challenge is becoming wider and wider. This also gives him the opportunity to earn large amounts of experience points as rewards.
At the highest point, I even earned 10,000 experience points as a reward.
Although it has only happened once so far, it is enough to make him extremely excited.
According to experience, if there is a first time, there will be a second time, a third time...
It is very difficult to earn a single experience value reward of 10,000 now, that's because he knows his own level is limited and does not dare to challenge some extremely difficult surgical tasks.
As many surgical skills were promoted to level six, especially advanced medical skills, this gave him the confidence and ambition to challenge more difficult operations.
I believe that by then, a single reward of 1,000 experience points, or even 10,000 experience points, will become commonplace.
Just like now, it is very common to get 10 or 100 experience points as a reward at a time.
The higher his medical skills level, the more powerful the diagnosis and treatment tasks he will be able to handle. It may take him a lot less time than he expected to be promoted to level seven.
At this moment, the tendon anastomosis has been completed, and the newly promoted level 6 anastomosis technique is not needed in this operation.
However, he believed that in the next operation, the sixth-level anastomosis would definitely bring him a surprise.
Some difficult matches can be attempted now.
Including nerve anastomosis, which is recognized as the most difficult.
I believe there will be new breakthroughs.
He himself was gifted in neural anastomosis.
I still remember that when he took the regular training recruitment exam, his anastomosis skills were still very poor. However, after anastomosis of the mouse tail nerve, he was able to restore some of the mouse's nerve functions.
He stunned everyone on the spot. He beat all other candidates, whether they were PhDs or masters, top students from famous overseas universities, or geniuses from top domestic universities.
Nowadays, the anastomosis technique has been promoted to level six, which is the level of a chief physician. I can’t imagine what kind of effect he will achieve by anastomosing the patient’s nerves now?
Zhou Can has always wanted to repay Dr. Xu's kindness.
How to repay?
Giving a sum of money is a bit too low-level.
And Dr. Xu would definitely not accept it.
The best way to repay Dr. Xu is to help the patient who suffered a medical accident recover his health.
As long as Zhou Can can really do this, the patient and his family will regard Zhou Can as a benefactor. At that time, their hatred towards Dr. Xu will gradually decrease.
If Zhou Can finds a suitable opportunity to plead for Dr. Xu, he should be able to help Dr. Xu get rid of the invisible shackles he has been wearing for many years.
The surgery that Dr. Xu performed that year, as Zhou Can’s status and strength continued to improve, his influence in the hospital continued to grow.
He asked other insiders for some information.
Although he has not been able to view the patient's file yet, based on the details he has learned, he can basically conclude that nerve anastomosis is the most important thing to help the patient recover his health.
Therefore, his anastomosis technique was successfully upgraded to level six this time, which immediately gave him confidence in treating the patient.
Because the patient's status was very noble, and the person behind him was even feared by Tuya Hospital, even if Zhou Can was really able to cure the patient, the family would probably not agree to take the risk.
Just like the imperial doctors in ancient times, they were often scolded by the emperor as quacks and waste.
In fact, it’s not that the imperial physician’s medical skills are poor, but that there are some medicines that they simply dare not use.
All medicines are poisonous to some extent, and strong medicine is needed for serious illnesses.
This is the most basic principle of Traditional Chinese Medicine.
The princes, princesses, and imperial concubines are all from wealthy families and their bodies are delicate. What if a medicine fails to cure the patient, but instead kills the patient due to its toxic side effects, causing the patient's condition to deteriorate sharply? What should they do?
Your head will fall off in a minute!
Therefore, the imperial doctors would rather bear the stigma of being quacks and only dare to prescribe mild prescriptions.
Most of them are prescriptions for tonifying the middle and replenishing qi.
How could his skills be low when he was chosen by the royal family, entered the palace to become an imperial physician, enjoyed the state's salary and support, and treated royal relatives?
The patient who had an accident during the operation by Dr. Xu was no different from a royal relative to ordinary people like Zhou Can and Dr. Xu. Even if Zhou Can was willing to take the risk of operating on him, he might not agree.
I'm afraid this matter will require further consideration.
In short, what we need to do now is to try our best to increase our fame.
This extremely difficult hand tendon transplant surgery was quickly completed.
In this operation, Zhou Can's separation and anastomosis skills were both promoted to level 6. The harvest was beyond imagination.
Through this incident, he deeply realized what it means that good deeds will be rewarded.
When I decided to undergo this surgery, the risk was actually very high.
My heart was beating fast.
Now it seems that it is worth taking some appropriate risks.
The premise is that the family members and patients are not the kind of troublesome people. If the doctor is an ungrateful person or a venomous snake who may bite back at any time, Zhou Can will still adopt defensive medical treatment like most doctors.
Mutual trust between doctors and patients and maintaining a kind heart that can put oneself in the other person's shoes are sometimes really important.
…
Time flies and days go by quickly.
Zhou Can's life and work gradually got rid of the shadow of the killer incident and returned to normal.
Every failure is a learning experience.
Nowadays, when he deals with female colleagues and female patients, he will try his best to avoid causing misunderstandings from their boyfriends or husbands.
Especially when talking about work with married female doctors and nurses, if the door can be kept open, it should be kept open.
If something can be negotiated in a public place, try not to discuss it in the office.
The patient who underwent the tendon transplant surgery had his right hand function mostly restored after a period of hospitalization. To restore more complete hand function, the patient needs to undergo a lot of rehabilitation training.
This is a long process and may take half a year or even longer.
The patient called the hospital to express his gratitude to Zhou Can for his kindness and medical treatment, which helped his right hand regain basic function.
Now, the patient has found a job as a screwdriver.
In his own words, it is great that he can make money and help his hand function recover better at work.
I heard that after this young man regained his confidence, he actually met a girl at the factory who he got along well with.
The two are currently dating, and the girl has no aversion to the boy.
On the contrary, I admire his bravery and tenacity.
If nothing unexpected happens, this young man will not only get a satisfactory job, but also a girlfriend.
Life is like this sometimes, the harder you work, the luckier you are.
As long as you dare to fight and don't give up easily, God may open a new window for you inadvertently.
Zhou Can felt particularly happy when he learned about the changes that had taken place in the patient after the operation.
Being able to help patients overcome their illness, regain their health, and live a happy and fulfilling life is the most meaningful thing for a doctor.
That day, Zhou Can went to work at the hospital as usual in the morning.
He was making rounds in the inpatient ward when a nurse came running over to him in a panic, "Doctor Zhou, Doctor Zhou, there's a patient in shock outside. Doctor Ai, please come over and help with the consultation."
Ellie is a general practitioner in the emergency department and is now in her late 50s.
The fact that he is still just an attending physician speaks volumes.
