From small clinic to medical empire

Chapter 5 Difficult spells
Compared with inpatient surgery, outpatient surgery has lower requirements in all aspects, but standard operations are still required.

After signing the informed consent form with the patient, Shi Xiaoya has also prepared the surgical instruments and the operating room.

Zhang Zifan and Liu Jianming disinfected their hands together and put on disposable surgical gowns.

With the help of the nurse, Xiao Nan had already changed her clothes and lay down on the operating chair. Shi Xiaoya covered her with a towel and covered her eyes, and then focused the bright shadowless lamp on her maxillofacial area.

It could be seen that the patient was a little nervous at this time, Xiao Nan firmly grasped the armrest, and asked, "Uncle, can I choose general anesthesia? If I don't know anything, I won't be afraid!"

Zhang Zifan picked up the povidone-iodine cotton ball with tweezers, and said in a calm voice, "Don't be nervous, you won't feel any pain under nerve block anesthesia, you may feel a slight discomfort, but it's not that serious, don't worry."

With that said, Zhang Zifan began to disinfect the patient's operation area.

Contrary to the cognition of many people, the inside of the mouth does not belong to the body. Like the intestinal tract and nasal cavity, it belongs to the outside of the body in the medical sense.

Moreover, there are a lot of bacteria in the oral cavity. In terms of magnitude, it is the same as the anus, which is a huge hotbed of bacteria. Oral surgery, like hemorrhoid surgery, belongs to the three types of contaminated incisions.

The mouth is so dirty, which is why there is a clear clinical relationship between gum erosion and bacterial endotoxin-related myocarditis.

Combined with the surgery at hand, this characteristic of the oral environment will lead to a sharply increased risk of postoperative infection.

Once the deep part of the alveolar is infected, it will cause serious complications such as dry socket, osteomyelitis of the jaw, and osteonecrosis of the jaw, which will make the patient feel miserable.

Therefore, Zhang Zifan was very careful about the disinfection of the surgical area, trying to ensure that no dead corners were left and no secondary contamination was caused.

In fact, this alone is still not enough to ensure that patients do not suffer from severe infection and inflammation.

If it was when he was working in the First Attached Hospital, Zhang Zifan would definitely ask the nurses to set up a temporary venous access for the patient. In layman's terms, he would give the patient intravenous antibiotics, dexamethasone and other drugs to prevent inflammation while undergoing surgery.

But according to the system information, Haoran Dental has no pharmacy or infusion room, and nurse Shi Xiaoya's intravenous injection skills are only F-, so Zhang Zifan knows that this clinic does not have the ability for intravenous infusion at all.

However, Zhang Zifan has already thought of a countermeasure for this, which is to reduce the patient's injury and the risk of infection from the operation itself.

……

Ask the patient Xiao Nan to open his mouth wide, exposing the tip of the buccal fat pad on the medial cheek wall. This point points to the position where Zhang Zifan should block the anesthesia needle.

However, at this time, Zhang Zifan suddenly noticed that a small green dot appeared in front of his eyes, which was particularly eye-catching on the red mucous membrane wall, and there were three small characters "needle entry point" marked beside the green dot.

This is obviously the capability of the system, which is used as a surgical aid for doctors.

However, this is like giving a cheat sheet to a top student in the final exam, which makes Zhang Zifan feel a little speechless. Even if he doesn't have the current A-level surgical ability, he is quite experienced in performing alveolar nerve block by himself.

But it was better than nothing. Zhang Zifan decisively inserted the special needle at an angle of 45 degrees into the patient's mucosa and reached the inner wall of the ramus of the mandible.

Here, where the inferior alveolar nerve and inferior alveolar artery penetrate, no blood was withdrawn. As 2ml of articaine was injected under pressure, the patient's lip and tongue began to become paralyzed on one side.

During the whole process, because Zhang Zifan operated very accurately and quickly, the patient only made a slight hum when the needle was inserted, and then remained calm.

Due to the angle, Liu Jianming did not see Zhang Zifan's wonderful operation. At this time, he was trying to recall his limited experience on stage.

Liu Jianming's surgical skills are only H, and it can be said that he hardly knows any surgery. This is a common situation for stomatologists who lack surgical training all year round.

However, he had rotated in oral surgery during his university internship, so he also knew what he should do as an assistant.

Finally, Liu Jianming finally thought of using a retractor to pull away the patient's quarrel, and used a tongue depressor to suppress the little girl's ready-to-move tongue, exposing the surgical field of vision, and then raised his head and asked, "Director Zhang, what kind of incision do you plan to make?"

Liu Jianming's tone was very respectful, because the more he watched the patient's film, the more frightened he felt. Since "Director Xiao Zhang" dared to try such a complicated operation, let alone be able to come to the stage, at least the surgical technology must have killed him in seconds.

Dr. Liu put his posture very low, Zhang Zifan nodded, and said: "'7' shaped incision, big flap."

"'7' shaped cutout?"

Liu Jianming was taken aback, this "Director Xiao Zhang" is really brave and skilled!

Compared with the "I"-shaped incision and "T"-shaped incision, this kind of incision has less trauma and infection risk, but the disadvantage is also obvious, that is, because only half of the mucosal flap is turned over, the exposed area of ​​the alveolar bone is small. , narrow field of view, will increase the difficulty of surgery.

Zhang Zifan nodded and said, "Well, try to minimize the longitudinal incision to ensure the prognosis."

As he spoke, the sharp receding sickle of the scalpel in Zhang Zifan's hand accurately cut through the midline of the patient's retromolar pad, and then cut the distal buccal mucosa of the second molar with the second cut.

As soon as the experts make a move, they will know if there is any.

The stability of the scalpel was definitely a surgeon's business card in front of his colleagues. Liu Jianming suddenly had a premonition that Old Tang might actually be slapped in the face.

"Spit!"

Zhang Zifan's instructions made Liu Jianming wake up from his distraction, and quickly picked up the saliva suction tube to suck away the blood seeping out of the incision and the accumulated saliva to ensure a clear vision.

"Periosteal stripper!"

This was an order for Shi Xiaoya. She frantically found the periosteal stripper from a pile of instruments and handed it to Zhang Zifan.

After the periosteum stripper was used to separate all the soft tissues, the white alveolar bone was exposed, but in Liu Jianming's view, there was still no trace of the cunning impacted tooth, which was completely hidden in the bone.

However, in Zhang Zifan's eyes, things were not like this at all.

[Infected bone tissue]

【Healthy bone tissue】

[Infected granulation tissue]

【Healthy Connective Tissue】

Once various organizations are contacted by Zhang Zifan, corresponding introductions will be displayed.

Healthy ones are in green, infected ones are in yellow, and necrotic ones are in red.

This is very helpful. In the extraction of bony buried teeth, it is not only the extraction of the buried wisdom teeth, but also the debridement of the infected bone tissue and soft tissue. It is difficult to distinguish only by the doctor's experience. In many cases, they can only kill three thousand by mistake, and it is impossible to miss one and perform an extended resection.

But now with such magical skills, combined with Zhang Zifan's A-level proficient knife skills, he can accurately remove the infected tissue, while retaining as much healthy tissue as possible to reduce damage.

(End of this chapter)