The Godfather of Surgery

After consultation, the patient's daughter and son-in-law agreed to the operation.

However, the patient refused the operation, clamored to go home, quarreled with his daughter in the ward, and threw the stainless steel cup for drinking water on the ground.

Although my daughter can't help but get angry and lose her temper occasionally, but only occasionally, there is always an outlet for the backlog of negative emotions.

The usual complaints are just venting of emotions. There are five old people above the couple, and the pressure is so great that they can hardly breathe.

In any case, she took good care of her father. She shaves his beard, wipes his body every day, and washes his hair every few days. The food in the hospital is not very good. The hospital feeds my father.

Daughter is a small jacket, this time is the best manifestation.

Like coaxing a child, the daughter patiently explained to her father that she should cooperate with the doctor for treatment, so that the recovery will be faster and less money will be spent. If you give up the operation and go back this way, the infection will spread to the whole body and cause sepsis, and then you will need to stay in the ICU. Spending is dozens of times as much as it is now. If you don’t spend money at this time, you will spend a lot of money in the future, and some things can’t be avoided.

The patient was clamoring not to have surgery, clamoring to go home, and giving up treatment, because he was unwilling to spend his daughter's money. If the surgery failed, he would be a bottomless pit, and he would bring a heavy financial burden to his daughter. .

No one wants to live away from their family with stinky rotten legs.

Even the grandson treats him as a monster and is unwilling to approach him, so he can only curl up on the bed in the rental house every day, and has to be taken care of by his wife.

During this hospitalization, the daughter was afraid that her mother would be overworked and would suffer from complications, so she refused her mother to come to the hospital to take care of her father, and asked her to take care of the child at home.

After her daughter's persuasion, stubbornness will only increase the trouble for the child, and the patient agrees to the operation.

As for the amputation, the patient was not surprised, let alone unacceptable. As long as he could say goodbye to this bad life, the amputation was nothing.

If he can really use the prosthesis to return to normal life, he is very eager, and he is eager to share some housework for his daughter, such as helping to buy vegetables and take care of the children.

Those who have lost will cherish them more, and those who have experienced pain will know how important health is.

This operation is not difficult.

The test is to be serious, to pursue perfection in every detail, in order to achieve the greatest success rate.

The effects of uric acid crystals on the body are very extensive. It does not only affect the joints, and joint pain is only the mildest manifestation.

Uric acid crystals can also affect blood vessels, causing hardening of the arteries and causing problems in vital organs such as the heart, kidneys, and brain.

Before the operation, Yang Ping repeatedly studied the blood supply of the bilateral lower body. The destruction of blood vessels by uric acid crystals resulted in the sclerosis of the arteries of the lower extremities, and the stenosis of some arteries. Finally, the amputation plane was determined to be on the knee.

Because the blood supply of the calf is already very poor, there are huge gout nodules in the knee joints on both sides, the knee joints have been severely damaged, and the function is seriously impaired. Actively raising the amputation plane to the knee will not only ensure that the amputation stump has a higher probability of healing, but also At the same time, it solves the possibility that the damaged knee joint will explode in the future.

In many cases, surgeons are prone to have good fantasies about the outcome, which can make doctors more conservative in their decisions.

For example, when a traumatic orthopedic surgeon treats some skin with retrograde avulsion, the inexperienced doctor sees that the flaps are intact, and always imagines that they can survive, so they like to suture in situ, but this backfires. Necrosis, the patient finally needs a second surgical skin graft.

Experienced doctors never have any illusions, and decisively perform reverse skin grafting on the flap. One operation is successful, avoiding the patient's second operation, and avoiding skin removal from other parts of the body.

The same is true for this patient. The doctor is prone to fantasies, the plane is lower, and the knee joint is preserved, but the reality will always exceed the doctor's expectations.

Judging from the state of the blood vessels, Yang Ping felt that he should be more active, give up his fantasy, make a drastic move, and amputate the entire calf that looked fine from the knee.

Yang Ping also carefully evaluated more than 40 gout nodules all over the body, and finally, he decided to remove them all.

During the amputation operation, Yang Ping did not inflate the tourniquet, the tourniquet was just a spare.

Because during the operation, Yang Ping wanted to observe the real blood supply of the limbs. His scalpel cut through the skin, subcutaneous, deep fascia, and muscles. He wanted to observe the oozing blood in each layer of tissue, which was the most reliable way to judge blood supply. This method is more reliable than any preoperative vascular imaging examination.

He tried to cut the skin on the lower part of the calf to verify his judgment. He hoped that he had made a mistake and hoped that the skin oozing blood would be obvious.

However, regardless of the skin, fascia or muscle, there is almost no obvious blood oozing without a tourniquet, and there is still a large amount of pus in the muscle space, which is spread from the ankle joint.

The preoperative judgment was correct, and the limb must be amputated from the knee.

Yang Ping closed the incised calf with a sterile medical membrane, changed the gloves and scalpel, and re-applied the upper knee and lower thigh. The scalpel incised the skin, and the standard tongue flap was formed.

Bright red blood began to ooze out from the edge of the flap. Yang Ping was not in a hurry to stop the bleeding. He was looking forward to this effect.

"The blood supply of the skin is better, and the bleeding is more obvious." Song Zimo's tissue forceps clamped the subcutaneous tissue and gently lifted the flap.

Yang Ping's aggressive and bold amputation plane judgment is very accurate.

"The choice of the amputation plane is very suitable." Yang Ping was relieved at this time.

At this time, oozing blood is the hope of successful surgery. The faster the oozing blood, the greater the hope.

The scalpel continued to incise the deep fascia, cut off the muscles surrounding the femur, cut off the blood vessels and ligated, and cut the nerves with a high-level sharp knife, and finally reached the center of the femur.

The chainsaw cuts through the femur, and the thigh is severed from the knee, leaving the patient's body as a free, independent object that no longer belongs to the patient.

The isolated limb was removed from the operating table and put into a transparent plastic bag. Zhou Can put it away and sent it to the pathology department after surgery. In principle, any tissue or organ removed from the human body must undergo pathology. examine.

Pathological examination of the residual limbs is completed, and the final destination is to be sent to the crematorium for incineration. Everything has a processing procedure and cannot be done arbitrarily.

Yang Ping smoothed the femur section with a bone file, and smeared bone wax on the bone section to stop bleeding.

At this time, rinse the operation area again, rinse repeatedly, remove some lime-like uric acid crystals, drill holes in the bone end, suture the muscle, wrap the bone end, and use the drill hole at the bone end to fix the bone end to form a good stump muscle Pads, so that the prosthesis will be more resistant to shock and wear in the future.

Finally, the deep fascia and skin were sutured, a negative pressure drainage tube was placed, and the amputation on one side was completed.

It is hard to imagine that in Europe long ago, in the wild age of medicine, amputation was very simple. Some even cut off the limbs at one time with a guillotine, and then pressed the limbs into boiling hot oil to scorch them to stop the bleeding. The severed ends of the limbs squeaked in the boiling oil, and the patients were in excruciating pain, and some died directly from pain shock.

Even if the physical fitness is strong, the pain and subsequent infection will cause many amputees to die.

In Europe at that time, how crazy and barbaric surgery was, we can't imagine in modern times.

Contemporary Chinese medicine is much more humane, and Hua Tuo's Mafosan and surgical techniques already have the prototype of modern surgery.

After completing the amputation on one side, Yang Ping continued the amputation on the other side. The amputation was completed on both sides, and the stumps of both limbs were wrapped with sterile dressings and bandages.

The huge gouty nodule at the left elbow joint was incised, and the lime-like substance inside was exposed, and the large curette scraped it out in clumps.

If this kind of thing is placed in one place alone, it will definitely be considered as high-purity lime powder.

It is hard to imagine that this substance is produced by the human body itself, and it is this "lime" - uric acid crystals, which makes the patient suffer and suffer.

This gout nodule, dug out "lime", filled a large metal basin. Even the surgeon, who was used to seeing all kinds of strange diseases, was very uncomfortable at this time.

Fatty Liang stared at this sinful "lime" one meter away from the operating table. He had to remember this kind of thing and make his determination to fight gout even more rock-solid.

An intern was leaning against the corner, his face was pale, his forehead was sweating, and he said weakly, "Teacher, I can't do it anymore."

Then leaning against the wall, he slowly slid down. He tried hard to persevere, but his strength did not allow it.

"Help him lie down!" Zhou Can, a roving nurse with sharp eyes and quick hands, threw a surgical gown on the ground and instructed another intern to support him and let him lie flat on the spot.

Nima, who is undergoing an operation and has to rescue an intern. I have seen people who are dizzy with blood and needles, but have never seen uric acid crystals.

Zhang Lin didn't take the stage. Seeing this scene, he immediately participated in the rescue, lying flat, opening the airway, auscultating the heart and lungs, inhaling oxygen, and performing ECG monitoring. A series of operations were quick and clear.

The operation here did not stop, and Yang Ping continued with Song Zimo and Xu Zhiliang.

"Are you okay?" Yang Ping asked while doing it.

They have all seen the big scene, and they still care about this.

"It's fine, I have my heartbeat and breathing, and my blood pressure is relatively low." Zhang Lin took off the stethoscope.

"Replenish fluids and check the blood sugar at your fingertips." Song Zimo helped cut the thread.

"2.4!" Zhou Can's blood glucose meter measured fingertip blood sugar.

"Low blood sugar, don't eat breakfast, push a 50% high sugar." Zhang Lin called Zhou Can.

Now that the diagnosis has been made, the interns will no longer be intervened in the rescue here, and the operation will continue, while Zhang Lin will continue to direct the rescue in an orderly manner.

They are all veterans who have experienced hundreds of battles, and they don't even blink their eyes when they rescue this kind of thing.

"If you don't eat breakfast, you still pay attention to taste surgery. Are there people who haven't eaten breakfast? Those who haven't eaten breakfast and those who can't stand the stimulation should go out." Zhang Lin shouted.

Slowly, the intern wakes up, and the hypoglycemia can sometimes be fatal.

Fatty Liang was on the side, ready for endotracheal intubation at any time. The intern survived the danger and woke up. He put away his intubation equipment.

"Is the operation done?" The first words of the intern woke up.

"It's not over!" Zhang Lin again auscultated his heart and lungs.

"How much have you dug up?" the intern said again.

Still want to watch? The guy who doesn't know who is alive or dead.

"Close your eyes, lie down and rest for a while, and measure your blood sugar again." Zhang Lin stood up.

Xiaosu has covered the stage with a sterile sheet of "lime" - uric acid crystals, and the metal basins for them have increased to five, and the sixth is filling up quickly.

After the gout nodules in several large joints were cut, Yang Ping handed over the operation to Song Zimo and Xu Zhiliang to continue.

The blood sugar of the intern lying on the ground rose to 6.2, and he was out of danger. He stood up by himself.

"Wow, so much, teacher, I still want to see." He stared at the several metal basins covered by sterile sheets on the stage, suppressed the sweat on his forehead, and said curiously.

"Do you have masochistic obsessive-compulsive disorder? You don't think it's too much?" Zhang Lin said in a stern tone.

Song Zimo said while performing the operation, "Let him take a look. Treat it as a desensitization treatment. With so many people around, nothing will happen."

The sterile sheet was slowly opened, revealing pure white "lime" piled high in metal basins.

"Teacher, I still can't."

The intern quickly looked away, the person next to him immediately supported him, his face began to turn pale again, and the first desensitization treatment failed.

"Take your time and desensitize a few more times." Yang Ping had already taken off his surgical gown and rested beside him.