medical simulator

Qin Ming and the others didn't respond at all, which meant that this was beyond their knowledge system.

Is surgery easy?

It's not simple at all. In every place, it's the best that comes from the natural parents. No matter how you repair it, it can't reach the level of the natural. This is an objective fact.

Even these structures in the thumb cannot be completely restored. It is already quite difficult to fully understand and apply them flexibly.

Hearing this, Lu Bin clicked his tongue a little, and asked, "Doctor Zhou, what do you mean? To replace the lack of joint capsule and tendon sheath through transposition or transplantation of tendons? Is it difficult?"

Zhou Cheng continued: "It's not easy, it's human-made, our thumb, and a metacarpophalangeal joint, I'm going to explore the aponeurotic structure inside later, and see if I can wear it a little longer. past the tendon."

"You can't create something out of nothing, so you can only make the best use of it." Zhou Cheng continued to observe the remaining structures while thinking about contingency strategies.

Thoughtful, Lu Bin silently helped at the side, then took the tweezers from Qin Ming's hand, and carefully assisted Zhou Cheng, his tone filled with excitement: "This is another extraordinary operation. Ah, Qin Ming, Yang Tao, you need to read more and think more."

This must be a good thing again. In fact, the thumb deformity has no serious impact on the patient. However, if the patient's own functions can be restored to the greatest extent through surgery, this surgery will not be easy.

Seeing Lu Bin and Zhou Cheng cooperate with each other, Zhang Zhengquan didn't intend to sell him, and he was also relieved.

Lu Bin is sensible, which means that he should avoid explaining unnecessary things to Zhou Cheng. It's fine if Lu Bin says it. Zhang Zhengquan also has other considerations.

ten minutes later.

Lu Bin asked, "Doctor Zhou, are you planning to do tendon transplantation? Or are you planning to do transposition?"

At this time, both methods can be chosen, and both can achieve the effect, but it is difficult to explain which one is better. it is good.

After the operation, the patient lost part of other functions, but it is great to be able to replace more directional functions and complete basic hand operations.

"Our thumb has the highest mobility. On this finger, transposition is impossible. I thought about it. Let's do a transplant. The extra extensor hallucis longus tendon is still there. works."

"It's really not possible, let's see if we can take it from other parts." Zhou Cheng continued to lower his head, slowly resting the exposed extensor hallucis longus and flexor hallucis longus tendons before hesitating a little.

Zhou Chengcheng chose to cut off the proximal end of the flexor hallucis longus tendon, but left the distal insertion point.

Lu Bin quickly saw what Zhou Cheng meant, his scalp tightened, and he asked, "Doctor Zhou, this flexor hallucis longus is very limited in length. After you cut off the proximal end, there will be two sutures, or will it be sutured?" In the middle section, it is easy to cause the risk of fracture after surgery."

Lu Bin was puzzled.

Generally speaking, most of the tendon transplantation is done at the insertion point. At the insertion point, one end is fixed through the fixation of the tendon and bone, and then the entire shape is deformed. Only a single suture is required, so the risk will be reduced. a lot of.

When it comes to a surgery, no matter how delicate the pre-operative discussion is, the details during the surgery cannot be perfected. Instead, it is decided temporarily based on the actual situation and the level of the surgeon.

In line with the basic theory, but also adapt to the situation, this is the truth.Instead of admitting to the rules.

"It's okay, as long as the tendon is sutured well, the risk of rupture is not high. Moreover, the natural muscle insertion point will be more conducive to mobility, but it is out of shape in the middle, just a leveraged structure." Zhou Cheng talked about his inner considerations.

Lu Bin's words are naturally correct, the risk is high.

But Zhou Cheng's words are also true, the income is high.

And the risk, to a certain extent, can be made up for through suturing techniques and postoperative rehabilitation guidance!

Lu Bin stopped pushing, but turned his head to Qin Ming and said, "Qin Ming, you have time to check the relevant literature. I think it might be good to write a case for this patient."

case is a case report.

Qin Ming nodded immediately: "Director Lu, I think so too."

Zhou Cheng glanced at Lu Bin and Qin Ming, smiled and said nothing, just for this, Lu Bin's scientific research sensitivity is higher than that of Cai Dongfan.

When Zhou Cheng was with Cai Dongfan before, Cai Dongfan never thought about writing articles, but Lu Bin was able to capture this point keenly, and he was quite thinking and sharing.

This is also a kind of scientific research thinking. Although it is a simple thinking, it is also a kind of consciousness.

The reason why Lu Bin attaches great importance to the case is that no one mentioned it when he was in the Ninth Hospital of the Shanghai Magic City. Too lazy to write, no need.

Doing the project directly and publishing RCT articles is the key.

A case is a personal surgical show, and a randomized controlled trial is a sublimation and promotion of a theory, and the footholds of the two will be different.A teaching hospital like Shanghai No. [-] Hospital is already very reluctant to show off its surgical techniques for individual cases.

In this way, another full 40 minutes passed.

Two brand new tendons reappeared in everyone's field of vision, and with the help of Kirschner wires, the patient's thumb also changed from a [-]-degree passive flexion to a straight state.

After reading it, Lu Bin was full of emotion: "Wang Limin, your luck is really good. You met Dr. Zhou. From the current point of view, your thumb is still worth looking forward to after the operation. The quality of this operation is definitely not good. Worse than any professor you'll find anywhere in the country."

"You can achieve this level with us, you have made a lot of money."

What Lu Bin said was a bit exaggerated, but Qin Ming also echoed, "This operation is indeed exquisite. If the anatomical structure can be reconstructed to such a level, the postoperative function will definitely not be too bad."

"And there are no blood vessel and nerve problems, which is worth looking forward to."

"Wang Limin, you must cooperate with the exercise after the operation, otherwise, it would be a pity that Dr. Zhou took so much effort to prepare you for so many basic conditions."

Wang Limin didn't understand so much, but he sounded comfortable with these words, and said solemnly: "Hey, thank you Doctor Zhou, thank you Director Lu and Director Qin, you are all good people."

"Don't worry, I will definitely cooperate, and I will definitely live up to your hard work and hard work. If I recover well after the operation, it will be a good thing for me."

"Thank you, doctors." Wang Limin finally did not forget to thank the others.

The atmosphere in the operating room instantly became much warmer, and everyone felt relaxed.

"You mainly want to thank Dr. Zhou. We can't do this kind of technology." Lu Bin explained, not wanting to steal Zhou Cheng's limelight.

Hearing this, Zhou Cheng was actually quite happy in his heart, and he also thought a little badly in his heart: Director Lu, if you can find ten people all over the world, and you can do this, then count me as the loser ?

This is still Zhou Cheng's conservative smugness. Of course, it's hard to say this, just do it.

Zhou Cheng is still carefully suturing the tendon with microscopic instruments. Zhou Cheng is still using the modified Kessler suture method, which is reinforced one stitch at a time, to avoid tendon rupture or suture rupture after surgery.

"Brother Zhou Cheng, you are really good. Director Lu has said so, so it must be good." Zhang Zhengquan also gave Zhou Cheng a thumbs up, still thinking about whether there is any patent for this new technique, or It doesn't matter if you come up with some special equipment.

Zhou Cheng turned his head to look at Zhang Zhengquan, and said, "Quan Zi, you have to strengthen your professional skills. If you don't study, you won't even be able to capture the key points. Tell me, this operation is good. Where is it?"

"How can you flatter other people in the future?" Zhou Cheng was just giving out to Zhang Zhengquan.

Zhang Zhengquan carefully looked at the operating table for a long time, but he couldn't hold back a word, but in the end, Zhang Zhengquan still said: "The product produced by Zhou Cheng must be a high-quality product, so I can't be wrong about this?"

"Get out! Feed shit in disguise, you're flattering me." Zhou Cheng cursed.

He must activate Zhang Zhengquan's interest in learning, do a good job of teaching theory for him, and make a contribution.

After the reconstruction of the tendon, the joint base of the joint, and the joint trochlea, the operation is not the end, and skin problems still need to be dealt with.

However, this is not a difficult operation for Zhou Cheng. He even has the means to remove scar tissue, let alone such a simple skin transplant.

Lu Bin said: "Xuan, you go and get a blade-thick skin remover. The skin grafting is about to start."

Originally, everyone planned to make medium-thick skin, but Zhou Cheng rebuilt it so well that he didn't use medium-thick skin as a fig leaf at all, and it could be treated as a skin defect.

However, Zhou Cheng stopped it: "Director Lu, slow down first. Let's not take the thick skin first, let's deal with the structure under the skin."

Lu Bin let out a cry, and looked at the surgical field with embarrassing eyes: "How should we deal with this subcutaneous structure?"

Zhou Cheng didn't show off too much, and then continued to expand some incisions, just crossing the subcutaneous part of the surgical incision, and from nowhere, a large lump of fat tissue was cut out.

Moreover, after taking out this lump of fat tissue, Lu Bin saw again, Zhou Cheng didn't know where, and pulled out a very thin blood vessel, less than 1mm in size.

Such blood vessels, not to mention finding their broken ends, even if they are usually seen, are called electrocoagulation to stop the bleeding.

After seeing the two blood vessels, Zhou Chengcheng's eyes began to shine.

Then yelled, "Tour, give me the thinnest vascular suture."

At this moment, Lu Bin really understood what Zhou Cheng meant, and his expression was full of astonishment: "Doctor Zhou, you don't mean to connect the nourishing blood vessels of this fat, do you?"

"Well, I think so." Zhou Cheng nodded.

"Because in fact, the best skin grafting is to cover the wound with only skin defects and then cover it with a thin layer of skin. Moreover, we all know that adipose tissue is the source of all evils for us to gain weight."

"However, its cushioning effect, covering and protecting soft tissue, is stronger than any other structure. It can also play a role in supporting the skin." Zhou Chengcheng carefully repeated this basic knowledge to Lu Bin and others.

Lu Bin became numb on the spot.

The truth is this, but on weekdays, who would pay attention to this point?

No, Lu Bin's brain was running again for a while, and then he repeated the operation that Zhou Cheng did today. Damn, I don't know if I don't sort it out. It's a simple osteotomy for deformity.

What did Zhou Cheng do?

Osteotomy, reconstruction of bony structure, incision and suture of sick tendon, tendon transplantation, internal fixation after fracture, and skin grafting. Prior to this, Zhou Cheng also performed a reconstruction of subcutaneous tissue. Then according to Zhou Cheng's idea, a pruning of the subcutaneous tissue was also performed.

A very simple operation was played by Zhou Cheng so clearly that he almost got out of tricks.

"Doctor Zhou, amazing!" At this moment, Lu Bin sincerely admired Zhou Cheng.

He has seen many people with superb skills and good major surgery. He has been to the national orthopedic annual meeting and the provincial orthopedic annual meeting. There is a live broadcast of the operation.

However, like Zhou Cheng, Lu Bin has never seen such a simple surgery done so perfectly and with such attention to detail.

You can see the whole leopard with a glimpse, and you can see the micro!

Zhou Cheng's surgical technique has definitely reached the level of proficiency, because without this level, it is absolutely impossible to derive so much content from such a simple and basic surgical procedure.

Step by step, the principle is simple, but the operation is still superb, and there is a feeling of turning decay into magic.

This is not Lu Bin's own big talk, but after watching Zhou Cheng's step-by-step operation, this is the true reflection of his heart.

Some people's surgery is so unpredictable that you can't even understand it, but Zhou Cheng's surgery, you can understand it, and the principle is also very simple. It is the combination and disassembly of some extremely simple operations, and then every step Done well, even if it's a small operation, Zhou Cheng completes it very delicately.

Therefore, it is not that Zhou Cheng only knows how to perform minimally invasive open reduction and internal fixation of fractures, but because Zhou Cheng simplifies this operation, so it is impossible to see his surgical skills, and he only thinks his operation is miraculous.

And the miraculousness he has shown before is actually the restoration of fractures, which has reached perfection. There is only so much he can perform, but in fact, Zhou Cheng's basic skills and kung fu are far more than that. .

It's everyone, or rather, Zhou Cheng himself, because after he created a highly influential surgical technique, other people have a too rigid image of Zhou Cheng, thinking that Zhou Cheng is a new surgical technique , synonymous with innovation.

But in fact, where there are so many so-called innovations, they are nothing more than the reinterpretation and perfect embodiment of the basic techniques.

Zhou Cheng continued to operate slowly and carefully, step by step!

Finally, after about 10 minutes, the previous gap was closed, and the outer fat surface was polished into what it should have been.

After reaching such a point, Zhou Cheng still sighed: "It's a pity, considering the current medical level in our world, it sounds very advanced, but in fact, during skin grafting surgery, even the folds and horizontal lines of the skin are treated. not come out."

"Oh!~" Zhou Cheng sighed.

Lu Bin trembled all over, and shouted in his heart, what the hell, do you still want to rebuild the stripes and folds?

Horizontal lines only exist on the wrists, palms and interphalangeal joints of human limbs. These are the lines caused by the loose skin caused by our frequent activities.

Who can find specialized striated tissue during TM skin grafting?

You are also too refined.

"Doctor Zhou, these horizontal stripes are not very useful. There is no need to pursue such a perfect beauty." Lu Bin felt that his thinking and philosophy were not at the same level as Zhou Cheng's.

If it is he who performs this operation, the bone is cut off, casually polished, and then the tendon is cut open and a tendon graft is performed. After the operation, the patient's thumb can be straightened, then he can leave you.

How could it be like Zhou Cheng who wastes time doing so many details? If you have this time, go and do another operation, isn't it good?

"That's right."

Then Zhou Chengcheng administered a nerve block anesthesia to the patient's elbow again, and then used a blade-thick skin picker to take a thinner layer of skin near the wrist, and stuck it on the surface of the wound.

Then, after simple suturing, subsequent operations such as covering with oil gauze were not included in the small operations that Zhou Cheng needed to continue.

The operation was only declared over after an hour and a half.

It was also time for lunch at noon, Zhou Cheng, Qin Ming, Lu Bin and others stepped down to eat, and even Zhang Zhengquan did not step down at this time, because as an equipment dealer, he must not be able to leave the operating room in advance to eat.

Although Zhang Zhengquan is the boss, since he is in the current position, he has to do a good job of supporting himself. You are here, it is not quite the rules, and it is not suitable...

Then, at this time, Lu Bin took a serious look at Zhou Cheng and said, "Doctor Zhou, do you feel too busy recently? If you feel too busy, you must communicate with me at any time."

Lu Bin didn't ask about Zhou Cheng's participation in the emergency surgery, not only because of Zhou Cheng's surgery skills, but also because of Zhang Zhengquan's warning, but Lu Bin felt that, like Zhou Cheng now, No need for emergency surgery like that.

This is a teacher, the most basic respect for a teacher is not to let him work for the welfare of his department, but to give him more rest time.

"Director Lu, it's you who have worked harder. I just sit in the outpatient clinic and do surgery occasionally, so it's not tiring." Zhou Cheng shook his head, telling the truth.

He was actually tired too, but this tiredness was not caused by Lu Bin, so naturally he would not complain to Lu Bin.It's just that he wanted to make more things out of his own wishful thinking, and he chose hard.

It can't be said with Lu Bin.

"That's good, Doctor Zhou."

"Before, I still felt that our field of vision was too narrow. To put it mildly, Dr. Zhou, don't be angry. We all felt that you came to our hospital to teach us minimally invasive internal fixation of fractures. type."

"After all, you are the pioneer of this operation, and you need to promote this operation. However, I now find that I was really wrong." Lu Bin told the truth.

If you want to learn more things, you must put yourself and the other party in the right position, and have the right attitude. This is the right way.

Zhou Cheng smiled, a little surprised, to be honest, not only was Lu Bin stereotyped him, but he was also very wary of Lu Bin in his heart.

From the first time I came to the department, I found that the nurses in the department are very good-looking, and with the wine on the wine table, and the little student in purple in the outpatient clinic, she is also a stunner.

Zhou Cheng has never let down his vigilance, which is actually not conducive to the work, but Zhou Cheng can only see tricks.