Doctor's Life Simulator

Chapter 61 You Daren's Shock and Surprise, Breaking Through the Bottleneck
The patient's situation is also very complicated. The patient is a male, a farmer, 46 years old. Due to the disturbance of consciousness caused by a traffic accident, the skin defect on the back side of the ankle joint of the foot is accompanied by the Achilles tendon and the calcaneus bone is exposed.

When first admitted to the hospital, the patient was confused, pale, cold limbs, painful, and anemic.Irregular damage to the entire ankle, the skin was torn off, and bleeding was protracted.

After further physical examination, it was found that the blood supply of the avulsed skin was poor, the capillary reaction was not obvious, the ankle artery was exposed, broken, retracted and blocked, the pulse of the dorsalis pedis artery was difficult to touch, the blood supply of the distal toes was absent, the color was pale, and the skin was warm. Low, the toe belly is deflated, and the capillary response disappears.
Analyzing the patient's condition, You Daren and Wu Youtu also looked solemn, but the youngest Qin Lang looked calm.

Before the operation, the skin flap has been designed, and Doppler ultrasound detection and marking have been performed on the part of the blood vessel.

"Doctor You, Doctor Wu, let's start then."

After Qin Lang finished speaking very calmly, he began to concentrate on the operation.

On the contrary, You Daren and Wu Youtu were slightly nervous and stared at Qin Lang intently.

Since the design of the skin flap has been determined before the operation, Qin Lang started the first step very quickly, incision!

With the perfect incision technique, Qin Lang found the design point very accurately. The axis line of the flap is the line connecting the navicular tuberosity to the medial midpoint of the first metatarsal head.From the front to the head of the second metatarsal, from the back to the bottom of the front edge of the medial malleolus, from the dorsal side to the midpoint of the front edge of the medial malleolus and the inner edge of the (full mother) toe.

Seeing Qin Lang's operation, You Daren was slightly surprised: "This little doctor Qin's hand strength is well controlled and stable, especially the skill of holding the knife."

Wu Youtu on the side wasn't too surprised, after all, he had worked as an assistant with Qin Lang several times, so don't cut it, don't worry about it.

Soon, Qin Lang quickly completed the incision of the entire flap, and the incision area was very precisely controlled at 11cmX9CM.

You Daren's eyes lit up: "This is basically the theoretical maximum incision area, this little guy really dares to cut, limit the incision! Admire."

With Qin Lang's operation, You Daren has changed his mentality, and even, in Qin Lang's operation, he still has some insights and gains.

Wu Youtu on the side watched quietly, but felt that Qin Lang's incision technique was as perfect as ever.

As for the extreme operation, what is it?

After all, there is a specialization in surgery, and Wu Youtu is not very good at free flap transplantation, and he is not as obsessed and meticulous in surgical techniques as You Daren.As for these theoretical limit data, they are even less sensitive.

Next, Qin Lang continued to make an incision on the north side of the flap. With the dancing of the tip of his knife, he avoided arterial variation very precisely and carefully dissected and separated.

Watching Qin Lang's operation, You Daren was once again amazed: "Use the larger arteriovenous veins as the vascular pedicles, and adjust the flap incision line at any time according to its running direction. This kid really has aura!"

"Doctor Xiao Qin, did you really just start learning free flap transplantation?"

You Daren continued to watch Qin Lang's operation in disbelief, while Wu Youtu on the side watched Doctor You's reaction from time to time, speculating about Qin Lang's level.

"It seems that Xiao Qin is still very quick at getting started. A person as picky as Dr. You can't find any obvious mistakes. You can teach me."

Then, seeing Qin Lang begin to move retrogradely, You Daren's eyes lit up:
"The width of the pedicle fascia is exactly controlled at 2cm, this kid is really confident."

Generally, according to his habit, in this case, in order to prevent the cutting from being too small, it will always exceed the theoretical value, plus human error, usually around 2.2cm.

"Hey, what is this kid doing?"

Wu Youtu couldn't understand what Qin Lang did next.

Wu Youtu looked at You Daren, who also looked puzzled, a little confused.

"Qin Lang, what are you doing?"

Qin Lang continued the operation and explained: "In order to avoid wound dehiscence due to postoperative swelling, it is necessary to completely remove the scar tissue with poor blood supply and inelasticity in the recipient area."

Hearing Qin Lang's explanation, You Daren was stunned: "Although that's the case, your operation is too meticulous. Under normal circumstances, who can really achieve absolute debridement and remove scar tissue. Rinse empirically and make sure not to place sutures over edematous granulation tissue and friable scar tissue."

After all, very few people can control the strength and angle of the scalpel so finely. Too much is too much. In order to make absolute debridement, other tissues, blood vessels and nerves are injured instead, and the gain outweighs the gain.

However, the next moment, You Daren saw the power of Qin Lang's micro manipulation!
There was a roar in You Daren's mind, as if subverting his previous surgical principles. He has always tried to be safe, so many operations are very rough and imprecise.

For example, for simple sutures, he only wants to be able to heal later, not to open the stitches, not to split, and not to think about the aesthetics at all, even if there are scars, it is just unsightly.

However, Qin Lang's surgery this time allowed him to see another possibility, that is, the fineness of art, in addition to being practical, it also takes into account the beauty of the postoperative healing and the slightness of the scar.

For another example, when choosing to keep the triangular skin at the vascular pedicle, based on his clinical thinking, he will choose to appropriately relax the width of the pedicle to prevent pressure on the vascular pedicle and ensure safety.

However, in Qin Lang's operation, he saw the ultimate control. Each of his cuts was cut at the theoretically optimal position, and the same was true for the subsequent sutures. The stitches of each stitch were uniform and beautiful, and each knot was smooth. It is exactly the same, neat and consistent.

"It turned out that it was still possible to perform surgery like this."

Of course, if you want to do this, you need to control your strength and angle to the extreme, as well as your familiarity with the theoretical value. Every step of the operation needs to be concentrated and careful.

The operation process of the last one flashed in You Daren's mind. At this moment, according to Qin Lang's extreme operation method to replay, You Daren saw many flaws.

"The flap design line can be finer, the incision area can be more precise, and the flap can be separated deeper."

"I see!"

You Daren was suddenly enlightened, it turned out that the free flap transplantation was not bad, it was so meticulous!

[Ding, because of your extreme operation display, You Daren seemed to be enlightened, and began to push it again, reconstructing his surgical thinking, and he broke through the bottleneck. 】

Qin Lang, who was doing the operation on the side, had also come to an end. Hearing this voice, his face showed joy.

Then there is waiting, another breakthrough by Wu Youtu.

Time passed by every minute and every second, and the sound of the system was not heard for a long time.

Finally, the whole operation was perfectly completed.

You Daren was still unsatisfied, and began to look forward to the next operation, and couldn't help asking: "Qin Lang, is this really the first free skin flap transplantation? How did you learn so many detailed techniques?"

Qin Lang said without blushing and heartbeat: "It is thanks to the classic case videos that Dr. Wu found for me before. I watched them many times yesterday, plus Dr. You's actual combat operations before. I mastered it, and I quickly started this operation.”

"Maybe, I have a little talent."

Wu Youtu nodded aside: "Xiao Qin is indeed very clinically gifted, and of course the influence of classic case videos and Dr. You's hands-on guidance are indispensable. Dr. You, how is the operation done for Xiao Qin? I think After finishing it, there are no obvious mistakes and omissions, and the completion is still very good.”

Both You Daren and Qin Lang showed contempt in their eyes:
"Do you really think that for free flap surgery, you only need to have hands?"

[Ding, because your detailed operations and surgical thinking are beyond Dr. Wu's understanding.He just thinks what you've done is okay.Moreover, I feel that thanks to his teaching video, I have provided you with ideas, and at the same time think that the difficulty of free flap transplantation is exaggerated.Or continue to delve into his own field.Because Dr. Wu did not realize the breakthrough.mission failed. 】

The corner of Qin Lang's mouth twitched.

"Qin Lang, don't worry about Dr. Wu, we will continue with the second operation."

You Daren also looked at Wu Youtu with disgust, then looked at Qin Lang with fiery eyes, and said expectantly.

(End of this chapter)