Those years when I hung up and upgraded in the hospital

Chapter 41 This is the confidence (please collect and read)
There is no need to discuss the prone position for Achilles tendon rupture. This is something that most surgeons will know, whether they are trauma surgeons or not.

After Director Long Quan asked Fang Yun to perform the surgery, he did not provide any other explanations or help choose the incision.

Fang Yun took the initiative and said: "Director Long, then I will make the medial incision of the Achilles tendon and start the exploration according to what is recommended in the textbook?"

Long Quan nodded: "Take the electric knife."

The electrosurgery has positive and negative electrodes. Although this hospital is small, the most basic electrosurgery is still prepared, otherwise it will be quite troublesome to stop the bleeding during the operation.

Fang Yun was not polite. He knew in advance that the Achilles tendon had completely ruptured and the proximal end of the Achilles tendon had retracted. Fang Yun directly made a large hole on the inside of the Achilles tendon, about 12cm long!

At this time, don't be afraid of making the surgical incision larger. Make the incision larger with one knife to facilitate the retraction of the retracted Achilles tendon during the operation.

As the saying goes, the arm cannot twist the thigh, but to twist the Achilles tendon muscle to retract, it also requires a lot of strength. At this time, if you make a small opening for aesthetic reasons, it will make you doubt your life.

Fang Yun didn't have high proficiency in Achilles tendon suturing, and Long Quan and others didn't do much research on it. They just followed the basic plan and there was nothing to worry about.

The skin on the inside of the Achilles tendon only has the skin layer, subcutaneous layer and fascia layer, and no muscle coverage.

Moreover, Fang Yun also knew that the blood supply of this part of the skin was not very smooth. Therefore, based on this skin characteristic, he should not do it to show off his solid basic incision skills.

If you use an electric knife to directly cauterize the skin a few times to cause local blood supply to become necrotic, then delayed healing or non-healing of the wound after surgery may be waiting for you.

Similar things are also common during calcaneal fracture surgery.

This is the theoretical category. Fang Yun had nothing to do before, so he could only read books. Reading books meant reading these things.

After sharply incising the skin, subcutaneous tissue, and tendon sheath of the Achilles tendon, the skin flap and tendon sheath were turned to the outside and directly covered with a sterile saline pad to absorb the oozing blood.

"Will the electric knife bring blood?" Long Quan told Du Linquan after he came on stage.

But Fang Yun raised his head and suggested: "Director Long, the wound of this operation is not very big, otherwise the bleeding will stop during the operation. The patient did not lose much blood, so we just used temporary pressure to stop the bleeding."

"It is best to preserve the local blood supply before suturing to stop bleeding after the operation. After Achilles tendon rupture, the wound is prone to non-healing."

Without high proficiency, Fang Yun could only use various methods to reduce the probability of postoperative complications.

After all, Fang Yun still vaguely remembered that after Achilles tendon surgery, the chance of fistula occurrence and infection due to delayed or non-healing of the wound was as high as about three percent.

Avoid as much as possible.

"Okay, I listen to you, you are the chief surgeon." Long Quan asked Du Linquan to put the electric knife aside first.

After being exposed, Fang Yun immediately observed the ruptured stump of the Achilles tendon, which was attached to the calcaneus. The stump was torn.

"Director Long, this patient has a complete rupture about 2.5cm above the insertion point of the Achilles tendon. The rupture is oblique and the proximal retraction is greater than 5cm. It is a tear-type Achilles tendon rupture."

"Shall we use the Bunnell silk suture method?" Fang Yun suggested.

Before coming, Fang Yun told Longquan that bunnell sutures for Achilles tendon rupture are divided into steel wire sutures and silk sutures.If the insertion is avulsed, wire suturing is used, similar to reconstruction.

If the tear is in the middle, use silk suture.

"Okay, you continue."

"Bring two vascular forceps, let's find the retracted end of the Achilles tendon!" Long Quan ordered a junior doctor in the hospital who was also serving as a device nurse.

The other party immediately handed over the hemostatic forceps.

After Fang Yun and Long Quan took over the hemostatic forceps, they again determined the proximal end of the Achilles tendon rupture, such as the brush border, which was very similar to the tearing rupture mentioned by Yun Qiang.

After sorting it out one by one.

Polish the stump a little and cut off the necrotic fiber filaments until they are almost aligned.The patient's foot is placed in extreme dorsiflexion, so that the tendon muscles are in a relaxed state for easy suturing.

"Are there nylon threads or absorbable sutures?" Fang Yun asked after finishing preparations for suturing.

Don't tell him that he really needs to use ordinary silk thread to suture, he will just leave the operation to Long Quan.

Who dares to use ordinary knotted silk thread to suture Achilles tendon? "some."

"How many do you want?" The circulating nurse nodded immediately.

"Let's shoot two. The muscle strength of the Achilles tendon is relatively strong. Shoot for 2-0, not 3-0." Fang Yun explained.

For ordinary tendon suturing, 3-0 is the best, but the Achilles tendon is a large tendon, and 3-0 may not be hard enough. If it collapses after surgery, it will be the end.

After everything was ready, Fang Yun could only use ordinary suture methods to imitate Bunnell's suture method, threading the needle and thread meticulously.

It is not the end-to-end connection of ordinary sutures, but like knitting thread, a grid-like shape is formed between the proximal end and the distal end of the Achilles tendon. During the operation, the thread is not cut.

This is the first time Du Linquan has seen such a novel suture method.

"Director Long, what kind of suture method is this? Is it the 'Bunuo' suture that Dr. Fang just talked about?" Du Linquan seemed to have gained more knowledge.

"Correct."

"Doctor Fang knows a lot of surgeries." Long Quan complimented Fang Yun incidentally, as if he meant something.

Du Linquan understood immediately. After scanning Fang Yun's body, he said with a smile: "Can Dr. Fang add his contact information later?"

Fang Yun said: "Doctor Du, I am only a small attending now, and I am not yet qualified to practice more. If you need it in the future, you should ask Director Long to come."

Fang Yun declined.

It's not that he doesn't like this kind of operating opportunity, but that Fang Yun knows his position very well.

You are not a physician in this hospital, so you dare to practice more. Unless the dean is your biological father, otherwise, don't even think about such nonsense.

Furthermore, Fang Yun only uses Longxian People's Hospital as a springboard, and may not run away next year or the year after. It is not a long-term cooperation, and there is no need to create extraneous matters.

There is almost enough going on inside the hospital.

Du Linquan immediately said: "Doctor Fang is still very sensible, Director Long."

"Doctor Du, it doesn't matter. Doctor Fang will come often in the future, and it's the same. Dr. Fang has just been promoted to an intermediate professional title not long ago, so it's not good to rush to the medical department to register for more practice." Long Quan explained a little, but did not explain. Fang Yun's identity as a follower in the assessment.

But in my heart, I have a higher opinion of Fang Yun.

He is a sensible young man who does not get carried away, has his own persistence, knows his own position, and knows when to stop.Those who are neither arrogant nor impatient have great potential for future development.

I can definitely make a difference in the department.

While Long Quan and Du Linquan were talking, Fang Yun had finished sewing one suture. It was not completely knotted. Instead, he used another suture to reinforce the suture again in the opposite direction of the previous suture method, forming a more stable stitch. Complete grid shape.

Just like woven fabric, the layers are densely woven, and it looks extremely stable. Compared with the ordinary end-to-end stitching or the figure-of-eight stitching variations they have seen, it is more than a little bit more stable.

After sewing, Fang Yun tied four or five knots and then cut off the remaining sutures.

"Director Long, relax your hands and let me check the tension and rebound?" Fang Yun suggested.

The patient is still in extreme dorsiflexion, but Fang Yun needs to check the plantar flexion position during the operation and how stable the sutures are?
As soon as Long Quan let go, Fang Yun performed a few plantar flexion and dorsiflexion operations of the ankle joint with confidence. The suture of the Achilles tendon remained motionless. The weaving of multiple sutures had made the far and near ends firmly Stick together.

Fang Yun then said: "Don't be afraid now, Dr. Du. The patient will still wear a back extension cast after the operation, but within half a month after the operation, the cast can be removed for a period of time to relax."

"I told you not to do functional exercises first, but you can relax for 15 minutes every day to allow the tendons to passively move to a certain extent and prevent adhesions." Fang Yun explained very confidently.

"Okay!" Du Linquan heard this and did not doubt that Fang Yun's words were too bold.

This is the confidence.It comes from Fang Yun’s hard core strength.

Theory is definitely not useless, but will enhance your knowledge.

(End of this chapter)