"Senior Brother Yang also did such a good job in fracture surgery."

"A broken collarbone, it's easy, I can do it too."

"You'll do it in 6 minutes?"

“---”

Song Zimo sat silently on the side.

This guy, how many collarbones do you have to do to make this, I thought he would only replant his fingers.

Many doctors do not pay attention to this point at all, especially when using transverse incision, a knife is cut to cut the cutaneous nerve, and the skin around the surgical site is numb after surgery.

The hemostasis treatment was very well placed, and the bleeding was almost not visible on the gauze. Periosteal detachment is minimized to maximize the protection of blood vessels for fractures.

The second one, comminuted fracture of the clavicle, do not underestimate any fracture surgery, because there will never be exactly the same fracture, so trauma orthopedics is a test of people's adaptability.

The clavicle is not only broken into several segments, but each segment is also divided into anterior and posterior lobes. This reduction of fractures can sometimes make doctors very embarrassed. Some doctors had to end the surgery in a hurry.

Surgery is done and done well are two different things, high-quality surgery, fewer complications, and good postoperative functional recovery.

"It's hard to do!"

Looking at the fragmented bones, even the attending physician with some experience expressed concern.

Lao Han looks at the X-film on the reading lamp - it's really not easy to get.

The surgery has been carried out to reduce the fracture, everyone cheered up, and Song Zimo also concentrated.

See how he copes with this fracture, or how he manages it perfectly.

With Song Zimo's experience, watching Yang Ping deal with the first clavicle surgery, it was not something that could be accumulated by a few dozens of units, he believed that Yang Ping could handle it, but he was curious about how he could cope with it perfectly.

The 1.2 mm K-wire needle, this time the steel needle is thinner.

The vascular forceps carefully clamp the bone block, which is very stable, like holding an egg steadily, which is firmly clamped in the forceps without using too much force to crush the bone. The soft tissues of the upper band, even a little, are gently preserved,

First the big pieces, then the smaller pieces.

Horizontal, longitudinal, oblique, and almost every bone has thin steel needles.

The bones are put together and the shape is restored.

"Wait a minute, how to put on the steel plate, these will interfere with the placement of the steel plate."

Someone frowned.

The steel plate is shaped, and then put it on, this time in front, most of the steel needles avoid the steel plate, and two cannot be avoided, but they just penetrate out of the hole of the steel plate, which does not affect the placement of the steel plate at all.

The insertion position of each steel needle was pre-planned, and the placement of the steel plate was taken into account, and everyone suddenly realized.

The placement of screws, the direction of the screws in each hole is different, and a bone block will be held. Each time a screw is implanted, at least one steel needle is pulled out, and the last screw is implanted, and the steel needle is completely withdrawn.

The fracture is well reduced and firmly fixed.

Lao Han smiled slightly, this treatment is old and spicy. In the past, in order to solve the problem of interference between temporary fixation and ultimate fixation, he spent a lot of effort on research, and it seems that this kid also spent a lot of effort on research.

Song Zimo is satisfied, there is often a lot of effort behind simple things.

In other words: one minute on stage, ten years off stage.

The whole process reflects the concept of protecting blood vessels all the time, even if some bones are a little bit of soft tissue, a little movement may be torn off, but they are still protected.

Only the bone with soft tissue attachment can have blood circulation and live bone; And those that are not connected by soft tissues and are completely separated from the body are actually dead bones. Only living bones have the ability to heal, but dead bones do not, so they can only rely on the extension and growth of living bones to replace it.

Fifteen minutes after the operating room was cleaned and disinfected, the third unit was ready to start.

This surgery involves the exploration of the vascular nerve below the clavicle, which is already considered a fourth-level operation.

This kind of exploration is a high-risk surgery.

On the third station, Lao Han was a little worried.

When it comes to vascular nerve exploration, it is no longer a simple clavicle fracture surgery. These stubborn old men in the expert group are not soft at all in the evaluation, and they will pick out the bones in the eggs.

"The tip of the fracture has pierced the vascular nerve under the clavicle, wait for the exploration to be careful, especially the bone fragment, do not move easily. The probe is clear, the bleeding is ready to stop, and then the bone fragment is taken. It is likely that as soon as the bone block is removed, the broken end of the blood vessel will retract, and then the bleeding will be stopped and the chest will be opened, which is troublesome. Lao Han reminded Yang Ping.

Old Han is experienced, he doesn't need to sit here all the time. Sitting here, in addition to seeing how Yang Ping's orthopedic surgery skills are, the main thing is to give Yang Ping guidance in time and ensure the safety of patients.

Reveal a step-by-step, routine transverse incision to facilitate probing of the subclavian vascular nerve.

Below the clavicle, lateral to the vascular nerve, extending to the upper extremities; Inward is the apex of the pleural parietal, which is the apex of the chest cavity and lungs.

If the pleura is punctured, it may cause hemopneumothorax, which requires thoracic surgery.

The exposure of orthopedic surgery is very important, many surgeries have to go through many vascular nerves, and some have to go through internal organs, these vascular nerve internal organs are like minefields, and if you want to reach the destination of the operation, you have to bypass or cross these minefields.

As a result, our ancestors spent a lot of effort devouting various approaches to avoid or traverse these minefields.

The muscles peeled off from under the collarbone, and opened them, and saw the blood vessels as thick as the little finger, as well as the yellow nerves, the blood vessels pulsed rhythmically, and there was a fresh life under the hand.

Once these are damaged, they can be disabling or fatal.

Slow down, Yang Ping held Xiao Wu's hook. Reverence for life is the only way to become a good doctor.

A sharp piece of bone pierced between the nerves of the vessel, surrounded by blood clots. There are many more blood clots than normal fractures, covering the vascular nerve area. Meaning that blood vessels are likely to rupture, and veins are more likely.

"Be careful, the subclavian vein ruptures, and once it is retracted, the incision is to be enlarged, and the thoracotomy is to be opened." Lao Han reminded again.

Prepare ice saline, vascular clips.

Yang Ping stopped the movements in his hand, although he was not nervous, but he could not be rash.

I have practiced countless surgeries for clavicle fractures in the system, but none of the external injuries can be replicated, each person's physique is different, the direction of force is different, the posture of the body at that time is different, and other influencing factors are different.

Therefore, systematic training only gives you a chance to acquire the ability, and the real operation requires improvisation.

Ice saline constricts blood vessels, minimizing the risk.

The metal basin was delivered with ice salt water, and Yang Ping soaked it in gauze, took it out, and poured some on it.

With so many blood clots, in the process of removing blood clots, it is very easy to involve blood vessels, leading to retraction and catastrophic consequences.

Lao Han regretted a little, he shouldn't have chosen such a case, if there was an accident during the operation, he would be rejected by one vote.

Although it is good to give a bad impression to those old men at this time, the safety of the patient is the most important.

"I'm going to brush my hands." Old Han went to wash his hands.

Yang Ping waited for the ice saline to work, holding tissue scissors in his left hand and vascular forceps in his right hand, gently separating the blood clot, from the outside to the inside.

The place where the subclavian vein comes out to form the axillary vein is clearly separated, and the blood vessels are clamped in time. This is not careless, this is just to block its possible bleeding, and there is a possibility of retraction at the proximal end.

Once retracted, it is equivalent to the rupture of the water pipe in the wall, and it is possible to repair it only by demolishing the wall, otherwise you can only watch it leak.

This is beyond the ability of an attending physician, even a genius like Song Zimo would be inexperienced.

Surgical experience is very important for doctors, especially surgeons, so a platform is very important for surgeons.

For example, two classmates, one of whom was smart, had good grades, and was ingenious, went to the county hospital. One often failed, clumsy, and went to a top tertiary teaching hospital. Ten years later, the county hospital can't compare to the top tertiary hospital in any way. Because people do surgeries every day, you may not come across one a year. That's the gap.

The number of cases is the reason why doctors, especially surgeons, are widening the gap.

So even if you are a genius, if you don't reach a certain level, you don't have the authority for this type of surgery, and you can't accumulate and improve.

"We encountered one last time, the blood vessel retracted, the chest was opened, and the blood vessel was found to stop the bleeding."

"I've seen arteries spurting blood here, squirting up to the ceiling."

I have seen the heart palpitations, careful discussion.

The blood clot is lifted little by little, then clamped with a vascular clamp, picked up, and placed in a curved disc.

Song Zimo's body moved forward and clamped the blood clot with a blood vessel, and he practiced for a long time before he could clamp it steadily. Because blood clots are fragile and break with a little force, it is common to remove blood clots with a curette to scrape them off and then push them out in piles.

At this time, if a curette is used, it is easy to break off and retract the blood vessel due to excessive force or pulling.

The vascular clamp can be clamped accurately, but this is a technical job, and not everyone can imitate it.

The blood clot was removed, the blood vessel breach was exposed, and it had been blocked by the blood clot, leaving only a little bit of the connected blood vessel wall.

The proximal end is also sent to a vascular clip.

Ligation is the safest and easiest treatment, but Yang Ping still chose sutures.

Cut off the broken ends and stitch them together easily. The arteries were examined and there were no problems.

The adventitia of the nerve was cut, and Yang Ping opened the adventitia to reveal the perineurium inside, and there was no problem.

Rinse, suture.

Lao Han came in after washing his hands.

The third surgery was completed.