medical simulator

Whether it was Zhou Cheng or Du Yanjun, no matter what, they were only fighting for a place in the hospital, and there was no competition with Luo Yun.

Even if they are admitted to the hospital, it does not belong to their peers and still does not constitute competition.Luo Yun's attitude was naturally relaxed, and he looked at Du Yanjun and Zhou Cheng.

He found that Zhou Cheng was very calm at the moment, and he was not very excited because he got the second assistant position. Instead, he looked at Du Yanjun with slightly guarded eyes, with helplessness.

Yes, Zhou Cheng's face was full of helplessness, and Du Yanjun's eyes were full of guard, which was fleeting.

Of course Zhou Cheng was helpless, because in fact, from the beginning of this operation, Zhou Cheng felt that he had a sense of control over the operation process from beginning to end, and with perfect skills, he could do better than Cai Dongfan .

Just like the choice of surgical approach, at least Zhou Chengcheng will not choose the combined anteromedial and anterolateral approach, but will choose the LL approach.

During the operation, Zhou Cheng would not stop and stop like Cai Dongfan. This is just a simple V-shaped tibial plateau surgery.

After Zhou Cheng watched the medial open reduction and internal fixation in the first half, he knew that Cai Dongfan's level was probably proficiency, not even proficiency.Even after seeing Cai Dongfan's surgery, he still won't get any improvement.

Instead, it made Du Yanjun wary of him, and Zhou Cheng naturally felt innocent and helpless.

But on the bright side, Zhou Cheng still said: "Thank you Teacher Cai, thank you Teacher Luo."

Cai Dongfan let him take the second assistant position, and Luo Yunrang was grateful for this position.

Cai Dongfan remained silent, and continued to choose the next operation. Cai Dongfan just felt that although Zhou Cheng was only a regular trainee, he was at least a junior doctor brought by him, and he was also a "registered student". too much.

Including the same for Zhang Zhengquan in the future.

This is what I should do as a superior doctor and a teacher. Today, Zhang Zhengquan was dismissed to let Du Yanjun take the stage more, which is indeed a bit unkind.

But there was no way, Du Yanjun was his student, and he wanted to fight for the opportunity to stay in the hospital. As a teacher, he could only help him.If Du Yanjun could stay, it would be a closer relationship than Luo Yun.

A true master-student relationship.

However, the next step is to deal with the lateral platform of the tibia. The lateral bone fracture is not like the medial side where there are too many and strong muscle insertion points, so there is not much muscle traction, and the displacement of the fracture is within a relatively normal range.

Cai Dongfan, as the chief physician, after exposing the broken end of the fracture, used bone peeling to apply a little pressure, and then restored the split fracture to a better position. Because external pressure can be applied, even temporary fixation with Kirschner wires is not enough. No need to fight.

The outer steel plate was also hit directly.

At this time, the reduction and fixation of fracture treatment principles have been completed, but this is not over yet.

The entire operating room must have a surgical process and rigorous thinking.

Next, it is natural to return to the tibial plateau classification itself.

Tibial plateau fracture, type V of Schatzker classification: bicondylar fracture involving medial and lateral plateau splitting, combined with vascular and nerve injury, this type accounts for 12.0% of tibial plateau fractures!

This is a classification in the strict sense, and the definition is written like this, but in fact, whether the blood vessels and nerves have really been damaged has to be explored during surgery.

The nerve that is most likely to be injured is the common peroneal nerve. The fibula is on the outside of the tibia, so the place that needs to be explored is the outside of the tibial plateau, the common peroneal nerve and blood vessels near the head of the fibula.

This is the basic operation!

Common fractures are caused by violent trauma, and the exploration of tendons, nerves, and blood vessels during surgery is part of the basic operation.If it is an open fracture, it is even more necessary to explore.

In the simulator, Zhou Cheng once failed to master the exploration technique systematically, resulting in undiscovered damage to blood vessels, non-union of fracture ends after surgery, and avascular necrosis of bone.

To Cai Dongfan, this kind of operation was nothing more than an extremely simple matter.

The Chief Physician is rated, if he can't even do a good job, then the Chief Physician is too good.

The operation ended without any disturbance, and Zhou Cheng did not have too many outstanding performances after the treatment on the inner platform, and Cai Dongfan and Luo Yun did not deliberately require Zhou Cheng to have an outstanding performance.

After the operative surgery is over, however, there is one more step.

That is stitching.

While taking off his clothes, Cai Dongfan said, "Luo Yun, don't step down yet. Later, Zhou Cheng and Du Yanjun will sew up the wound on one side. Watch it."

"After internal fixation of this kind of tibial plateau fracture, because of the intervention of the steel plate, the suture should be more rigorous."

After finishing speaking, Cai Dongfan took off his clothes completely, then picked up the mobile phone on the storage table, stepped on the sensor door of the operating room with his foot, and went outside, probably to the lounge or smoking room of the operating room .

This is Cai Dongfan's right as the chief physician and the top doctor leading the team.

For the rest, Luo Yun looked at Zhou Cheng and Du Yanjun's two pups, and said, "Du Yanjun, you sew the inside, Zhou Cheng, you sew the outside."

"Tour, prescribe two 2-0 and 1-0 antimicrobial microjoe."

Antimicrobial Micro Joe is a common name for a stitch with a needle.

2-0 and 1-0 are the diameter of the suture, also called the model.The inner part of the skin needs to be stronger, so 1-0 sutures are used to suture the subcutaneous tissue, and the surface of the skin requires smaller scars, so 2-0 sutures are used.

Because the steel plate is added, the tension of the skin is relatively high, and the sutures below 3-0 are easy to break and rupture the wound after the operation.Of course, if the subcutaneous suture is good, you can also choose cosmetic suture.

But the beauty line of cosmetic sutures is not cheap.And it's not covered by health insurance.

Except for children and girls who love beauty, basically they will not deliberately ask patients if they need cosmetic sutures, unless the patients themselves ask for it.

Soon, the circulating nurse brought the sutures to the table.

For skin suturing, one 2-0 suture on one side is definitely enough, but for subcutaneous suturing, the periosteum, muscle layer and subcutaneous layer are sutured, and one suture is probably not enough.

Zhou Cheng and Du Yanjun each held a pair of tweezers and a needle, and waited for the stitches to come.

Du Yanjun looked at Zhou Cheng with a smile on his mouth, but his eyes were fixed.The reason why I dare to laugh is because there is a mask that blocks it, and the reason why my eyes are not clear is because I don't want to be too obvious.

For surgeons, suture is the foundation of the foundation, and the level of suture also has a level.Although Zhou Cheng came to the department earlier than himself, but with one more year of experience, the level of suturing may not necessarily be better than his own.

Chapter 15 The Aftermath Continues

It was not the first time that Du Yanjun met Zhou Cheng, nor did he just know Zhou Cheng, so Du Yanjun had seen Zhou Cheng's stitching level before.

Du Yanjun actually wanted to say, Brother Zhou Cheng, although my teacher gave me the opportunity on purpose, I fought for it. Although I entered the clinic later than you.But my level may be more solid than yours.

This is actually the real reason why my teacher is willing to give me the opportunity to be the chief surgeon.

This is a very normal self-comforting psychology. It often occurs when you have left a different relationship, or obtained something by chance, and you will find some objective reasons that you think you have. Advantage.

To put it simply, it is obvious that I got in by virtue of connections, but in fact I don't admit it, I actually got in by strength.

You can't compare to me in terms of strength, I don't rely on relationships...

It is definitely not because I am a student of my teacher that I can easily obtain the qualification of the chief surgeon.

It's the same psychology.

Zhou Cheng also couldn't figure out what Du Yanjun was thinking, otherwise he might have laughed happily.

Because if Du Yanjun is not a graduate student, if he is not a student of Cai Dongfan, he usually has a lot of opportunities, and Zhou Cheng can understand his level.

Now that Zhou Cheng is holding the needle holder, he is still a little bit embarrassed.

I wondered in my heart, should I intentionally close the stitches later, so as to save some face for Du Yanjun.

Then he sighed with emotion, and thought to himself, I'm sorry, Yan Jun, we are doctors, and as doctors, we have to be responsible for the patients.Bring out your best level.

The sutures are opened one by one.

The hand washing nurse gave Du Yanjun the stitches first, because she also knew that Du Yanjun was Cai Dongfan's graduate student, and he might be able to stay in the hospital in the future.Give yourself first, which is as it should be.

This is a very normal way of thinking.

After Du Yanjun got it, he devoted 120% of his attention to the stitching, because he wanted Zhou Cheng to relieve his burden of being the surgeon later.

However, Zhou Cheng was more casually waiting for the arrival of the second suture.

Then after Zhou Cheng got it, he even used the needle holder to make a little gesture. After all, after getting the perfect skill from the simulator dungeon, Zhou Cheng hadn't used it once.

Luo Yun holds the thread scissors in his right hand and the vascular forceps in his right hand, ready to cut and hold the thread for Zhou Cheng and Du Yanjun at any time, one to two, and he can handle it in time!

The reason for supporting the thread is that when the level of suture is not enough and the tension of the subcutaneous tissue is relatively high, it is easy to loosen after the first knot is tied. .

Of course, those with good suturing skills can complete the stable operation of the support thread by themselves after the single knot is tied without the need for thread support.

Soon, Du Yanjun finished the first knot before Zhou Chengcheng started sewing.

Luo Yun pressed the vascular forceps up, clamped it, and couldn't get the teeth.

When supporting the thread, the vascular clamp cannot be attached to the teeth, because the vascular clamp must be loosened quickly before the second knot is tied.After the upper teeth, the suture time will be delayed. Another reason is to avoid clamping the soft tissue. The clamping after the upper teeth is very tight, and the cells of the soft tissue are pinched to death...

Zhou Cheng just started to sew.

It's just simple interrupted sutures, nothing fancy.

Moreover, Zhou Cheng's soft tissue suturing technique is also at the perfect level. After strictly mastering the principle of 3 ones, the needle goes in and out very quickly, and then the knot is tied.

After tying the first knot, pull the suture back and fix it to the side where the needle enters. This operation, even the two sutures in the first knot, can form a relatively strong temporary fixation force without assistance Help line.

After the first knot is completed, quickly tie the knot with the needle holder instrument.

After tying three firm knots.

Then Zhou Cheng used his hands and tweezers to lift up the two knotted sutures and waited for Luo Yun to cut them.

And at this time, Du Yanjun's third knot was tied, even a little later than Zhou Cheng's.

Luo Yun was stunned for a moment, and decided to cut the thread for Du Yanjun first, but just looked at Zhou Cheng, not understanding why Zhou Cheng finished the first stitch earlier than Du Yanjun when he got the thread later than Du Yanjun.

The length of subcutaneous sutures needs to be very short, basically two millimeters.

After Luo Yun finished cutting the thread for Du Yanjun, he came to cut it for Zhou Cheng.

Then, while Du Yanjun was sewing up the first knot, Zhou Cheng pulled up two more stitched rabbit ears and waited for Luo Yun.

When Du Yanjun saw this scene, he was a little flustered and almost lost his grip on the thread.

Luo Yun smashed his needle holder with a vascular forceps, and cursed: "Concentrate on suturing, and watch what others do."

Then, while supporting the thread for Du Yanjun, he cut off Zhou Cheng's second stitch.

Du Yanjun tied the second knot in a hurry.

To open again is to tie a third knot, and three knots are necessary to ensure that even if one knot falls off, it is still a dead knot.

Then, Zhou Cheng's hands turned into small motors, and the third stitch was finished, which was more than a little slower.

The corners of Luo Yun's mouth twitched under the cover of the mask, cursing in his heart: You two are deliberately playing with me, right? You are deliberately waiting for me to cut the thread.

This time Luo Yun cut Zhou Cheng's thread first, because Zhou Cheng obviously sewed faster.

When Zhou Cheng saw it, he said, "Mr. Luo, how about I get a pair of scissors myself?"

After Luo Yun finished listening, he looked up at Zhou Cheng who was half a head taller than him.

I was stunned for a while, and asked in a slightly abnormal tone: "Can you do it yourself?"

What Zhou Cheng meant, Luo Yun understood, is that one person completes the operation of suturing and thread cutting, and uses the ring finger to hold the needle holder and the thread cutter at the same time, and then turn one 180 degrees when it is used up, and use the other.

This is a relatively advanced technique that requires hand speed and operational ability.

Luo Yun himself can't do it.

"You can try it." Zhou Cheng didn't finish his sentence.

Because Zhou Cheng disliked Luo Yun for being too slow, and also knew that Luo Yun couldn't just stare at him, so he focused more on Du Yanjun.Du Yanjun is a graduate student, Zhou Chengcheng can only rely on himself.

Du Yanjun also heard Zhou Cheng's words, and he was dumbfounded for a while, and for a while he couldn't even do anything by himself.

When did Zhou Cheng become so powerful? ? ?

Countless question marks approached the door like his old friends.

The hand-washing nurse has seen the operation of suturing and thread-cutting at the same time, but that was when she went out for further studies. In top hospitals, some skilled attendings of general surgery and trauma surgery were forced to develop skills due to lack of manpower.

She was a little curious, could Zhou Cheng do it too?

Also cut the thread to Zhou Cheng.

After Zhou Cheng got the thread cutter, he put one ear through his ring finger, fixed the middle of the thread clipper with his little finger, and fixed the needle holder with his middle finger.

After suturing, the little finger and the middle finger push hard at the same time, swish swish swish, the thread scissors and needle holder immediately rotate 180 degrees at the same time, and when they reach the previous position of the needle holder and thread scissors, they are caught by the middle finger and little finger at the same time.

Cut, click!

Then the middle finger and the little finger exerted force again, and rolled 180 degrees again, as if they were performing acrobatics in their hands.

It seemed that Zhou Cheng was doing acrobatics, as if he was showing off on purpose.But in fact, Zhou Cheng is not even interested in paying attention to other people's stunned expressions. The handle of the needle holder and the handle of the thread trimmer will bump and rub when they are turned.

The sound of guang, chug, guang chug keeps ringing...

Zhou Cheng played by himself, and everyone else, including Luo Yun, became spectators.

Zhou Cheng sewed about five or six stitches. Seeing that no one else was moving, he cut the thread silently and put it down. He looked at Luo Yun with some blank eyes and said, "Mr. Luo, did I block your way?" It’s up to you to cut the thread.”

Zhou Cheng forgot again, Luo Yun doesn't seem to know how to do this stuff.