The hospital is too busy, so I'm going to join the army and become a top soldier!

"Zheng Lian, how about I help you?"

Zheng Guoliang turned around.

His first reaction was to refuse!

"No!"

"You've barely even been on a proper operating table a few times, how can you possibly help me?"

The attending physician on duty next to him also frowned.

He had just learned from Zheng Guoliang that Shen Yan was a new recruit who had just joined the army this year.

He's still a freshman at Fu-Hsin University School of Medicine!

How could a medical student who hasn't even finished all the basic medical courses want to participate in such a difficult limb replantation surgery?

Is this a joke?

Shen Yan did not argue about her academic qualifications.

He placed the image directly in front of the lightbox, pointing to the location of the amputation of Han Dayong's right forearm.

"The injured person suffered a complete amputation of the middle and lower segment of their right forearm."

"The cross-sections of the ulna and radius are irregular, with some fragmentation and contamination, but the main skeletal structure can still be preserved."

"The flexor and extensor muscle groups were completely torn, and some muscles were subjected to mechanical compression. However, the severed limb was preserved in time and has not yet become completely inactive."

"The real difficulty during the surgery won't be the bones and tendons."

"It's the blood vessels!"

The attending physician's expression changed slightly.

Shen Yan continued:

"Both the radial and ulnar arteries have extensive contusions."

"Some blood vessels may appear normal on the surface, but the inner lining may already be torn."

"If only the part that is obviously damaged is removed and then an end-to-end anastomosis is forcibly performed, thrombosis can easily form at the anastomosis site after blood flow is restored."

"Even if the surgery is completed on the surface, the arm still can't be saved!"

The attending physician on duty became completely serious.

Because Shen Yan's assessment was exactly the same as what he had been worried about!

Do not!

Shen Yan explained it even more clearly than he did!

Zheng Guoliang did not immediately agree.

After all, diagnosis and surgery are two different things!

"So, what are your plans to do?"

Zheng Guoliang asked directly.

Shen Yan glanced at the time.

"We can't wait for the experts now."

"The wounded soldier was injured at 9:12 a.m., and it had been more than two hours since he was taken to the military hospital."

"Although cryopreservation can extend the replantation time for severed limbs, there is a lot of muscle tissue in the forearm."

"Low-temperature storage does not mean that delays can be indefinitely allowed!"

"If we wait another four or five hours, the damaged muscles, nerves, and blood vessels will become even more inactive."

"Even if the experts arrive by then, there's no guarantee that replantation will still be possible!"

The atmosphere outside the operating room was even more oppressive.

Time is the biggest problem right now!

The hospital has the equipment, and the operating room is ready.

Unfortunately, none of the experts who are best at limb replantation are available!

Shen Yan continued to explain her surgical plan.

"Once the surgery begins, not everyone can focus on treating the wounded soldier's remains."

"We must split into two groups."

"One team deals with the remains of the wounded, while the other team cleans up the severed limbs."

"Debris was cleaned on both sides, and arteries, veins, nerves, tendons, and major muscle tissues were identified and marked."

"This will minimize the surgery time!"

The attending physician on duty nodded subconsciously.

Simultaneous debridement of both groups is a common method for complex limb replantation.

However, the hospital's specialists are not available today, and the staff on duty lack experience in independently performing such complex replantation surgery.

Just now, everyone's attention was focused on whether or not to wait for the expert.

Instead, they didn't immediately arrange for simultaneous processing of both groups!

"The bone fragments need to be cleaned of contamination and bone fragments that cannot be preserved."

Shen Yan continued:

"Based on the images and cross-section data, my initial assessment is that it needs to be shortened by one to one and a half centimeters."

"This makes it easier to achieve stable fixation and also reduces tension during anastomosis of blood vessels, nerves and tendons."

"Once the bones are stabilized, repair the major tendons and restore blood flow as soon as possible."

"The radial and ulnar arteries cannot be forcibly brought together and anastomosed."

"If the vascular defect is too long after debridement, prepare an autologous vein for bridging in advance!"

At this point, Shen Yan pointed to the location of the blood vessels in the image.

"After the arteries recover, it is also necessary to ensure sufficient venous return."

"If blood is only allowed to enter but cannot flow back smoothly, the severed limb will quickly become bruised and swollen."

"The surgery can still fail!"

The attending physician on duty looked at Shen Yan with a completely different expression.

This is definitely not as simple as just reading a few steps in a textbook!

Shen Yan not only knew how to replant severed limbs.

He even considered how to arrange surgical personnel, how to shorten the ischemic time, and the possible problems of vascular defects and venous return!

Zheng Guoliang continued to ask:

"What about the nerves?"

"The median nerve, ulnar nerve, and radial nerve branches must be identified and marked during the debridement process."

Shen Yan did not pause at all.

"If the nerve ends can be aligned in a tension-free state, then the perineurium or epineurium can be repaired."

"If the defect is too long, we cannot forcibly pull it in order to suture it directly; we must consider nerve transplantation."

"But the top priority right now is thorough debridement, bone fixation, and restoration of blood flow."

"Neural repair determines future function."

"Vascular reconstruction determines whether this arm can survive!"

Zheng Guoliang stared at Shen Yan.

"What if, after the vascular anastomosis is completed, blood flow is established but there is no perfusion?"

"First, check the anastomosis for twisting, stenosis, and obvious leakage."

"Further investigate vasospasm, thrombosis, and whether the transplanted blood vessel is in the wrong direction."

"If the arteries are open, check the venous return."

"If a thrombus has formed at the anastomosis site, it must be removed immediately, the thrombus cleared, the severed ends of the vessel repaired, and the anastomosis repeated."

Shen Yan spoke with great seriousness.

"We can't continue just because we're reluctant to give up the time spent on the earlier steps, hoping to get away with something less!"

The corridor fell completely silent.

The attending physician on duty was at a loss for words.

These things all seem to be available in professional books.

However, when faced with complex injuries, they can quickly connect all the knowledge to form a complete surgical plan.

This is something an ordinary medical student simply cannot do!

Even he, the attending physician, was not as skilled as Shen Yan!

Compared to Shen Yan, he seemed to be the one who was like a green recruit!

Shen Yan continued:

"The restoration of blood flow does not necessarily mean the surgery was successful."

"Seventy-two hours after the surgery, it is essential to closely monitor skin color, temperature, capillary reaction, and swelling."

"At the same time, be alert for arteriovenous crisis, infection, tissue necrosis, and compartment syndrome."

"The replantation was successful, but it's just a matter of keeping the arm alive for now."

"Whether sensory and motor functions can be restored in the future depends on nerve repair, tendon adhesions, and subsequent rehabilitation training!"

Zheng Guoliang remained silent.

He originally thought that Shen Yan had only learned limb preservation and on-site first aid.

It's only now that I realize this kid has developed a complete system for understanding limb replantation!

From preoperative assessment to personnel arrangement.

From bone, tendon, blood vessel and nerve repair to postoperative vascular crisis and functional rehabilitation.

There are almost no obvious omissions!

"Are you really capable of keeping up with the surgery?"

Zheng Guoliang asked the question one last time.

"able!"

Shen Yan did not avoid his gaze.

"I'm willing to take legal responsibility!"

This sentence reminded Zheng Guoliang of all of Shen Yan's performance since he joined the army.

Rescuing comrades suffering from sudden illnesses and accurately diagnosing comrades with heatstroke.

And today, when faced with a complete amputation injury at the car track, the calm and professional on-site handling was remarkable!

Shen Yan has never boasted about saving people!

I would never joke about the lives of my comrades!

Most importantly, they have no time to hesitate any longer!

Because Han Dayong's arm can't wait!

Zheng Guoliang finally gritted his teeth and made a decision.

"good!"

"Come up on stage with me!"

"First, act as an assistant, responsible for handling severed limbs and identifying blood vessels, nerves, and tendons!"

"If your technique doesn't meet the requirements, I'll make you stop immediately!"

Shen Yanli answered with a straight posture:

"yes!"

The team immediately began preoperative preparations.

Change into surgical gowns, put on masks and caps, and disinfect hands.

When Han Dayong entered the operating room, he had already been anesthetized.

The anesthesiologist is closely monitoring his vital signs.

The severed limbs were also brought into the operating room and placed next to another instrument table.

Once the wound was truly exposed, the actual situation was more serious than what imaging and external examinations showed.

Mechanical parts cause more than just cutting.

The muscles, blood vessels, and soft tissues near the fracture site all showed varying degrees of contusion!

Some parts of the tissue appear to be relatively intact.

But it has actually lost its activity!

After examining the wound, the attending physician on duty looked even more grim.

"It's more serious than we anticipated!"

"Even with the experts present, this would be an extremely difficult surgery!"

Zheng Guoliang did not respond.

He directly followed the plan that Shen Yan had just proposed and divided the personnel into two groups.

"We're dealing with the wounded and their remains!"

"Shen Yan is in charge of severing limbs!"

"Mark all blood vessels, nerves, and tendons immediately after identification!"

Upon hearing the instructions, the operating room nurse couldn't help but glance at Shen Yan.

Let him handle the severed limbs independently?

Will this work?

"start!"

Zheng Guoliang has no time to explain!

The surgery officially began.

Master-level knowledge of limb replantation is fully activated!

Shen Yan picked up the instruments and began to treat the severed limbs.

The operating room nurses, who had initially been suspicious, quickly realized something was wrong.

Shen Yan's hands were so steady, it was impossible for him to have never been on the operating table before!

His performance at this moment was just like that of a veteran expert who had been immersed in the operating table for many years!

Soon, he identified all the important structures one by one!

The devitalized tissue that needs to be removed is accurately cleared.

Muscles and soft tissues that still have preservation value are completely preserved.

He did not expand the scope of the debridement in pursuit of speed.

Similarly, no part that had already lost its vitality was left behind just because people couldn't bear to part with the organization!

Shen Yan would clearly mark each blood vessel, nerve, or tendon he identified.

There were no unnecessary movements throughout the entire process!

The attending physician on duty would occasionally look up and glance at it.

The more I looked at it, the more something seemed off.

Shen Yan's movements were too practiced!

Let alone freshmen.

Even attending physicians who have long participated in limb replantation surgeries with experts may not be able to quickly identify tissues and clean wounds in such complex fracture surfaces!

Zheng Guoliang has also been paying close attention to Shen Yan.

He was prepared to call a halt at any time.

After looking for a long time, I couldn't find a chance to speak at all!

Shen Yan did not make any mistakes.

They can process severed limbs even faster than they can process the remains of wounded soldiers!

Shortly afterward, Shen Yan completed the initial cleaning of the wound.

"The severed limbs have been removed!"

"The extent of damage to the radial and ulnar arteries has been marked!"

"The major veins, median nerve, ulnar nerve, and tendon ends have been identified!"

The attending physician on duty fell completely silent.

Is this guy really here to be an assistant?

Why do they look more like the surgeon than the others?

After the wounds on both sides were cleaned, the group reassessed the bone damage.

The fracture ends of the ulna and radius were contaminated and slightly fragmented.

Some of the bone fragments are no longer of any value.

Zheng Guoliang looked at Shen Yan.

"1.5 centimeters?"

Shen Yan reconfirmed the soft tissue and vascular defects.

"1.5 centimeters is the most suitable."

"Continuing to preserve the damaged bone will not only affect fixation, but also increase the tension on the vascular and nerve anastomosis."

"Shortening it any further will affect the length of the forearm and the subsequent functional recovery."

Zheng Guoliang nodded.

"Treat it as 1.5 centimeters!"

The bone fracture ends have been repaired.

Then alignment and fixation are performed.

The severed right forearm was finally reattached to Han Dayong's arm!

But this is only a connection in the bones; blood flow has not yet been restored!

Nearly five hours have passed since Han Dayong was injured!

The cycle must be rebuilt as soon as possible!

The attending physician on duty assisted in treating the major tendons.

Zheng Guoliang then sat down in front of the microscope, preparing to perform the most crucial vascular anastomosis.

Once the blood vessels were actually started to be freed, the problem reappeared.

The damage to the radial artery was longer than expected!

After the contusion and endometrial damage were removed, a significant defect appeared between the two ends.

It is simply impossible to achieve tension-free fitting directly!

"Prepare to take a vein!"

Zheng Guoliang did not hesitate.

The attending physician on duty immediately began preparing a suitable autologous vein.

After the vein is removed, it needs to be bridged to the radial artery defect.

Zheng Guoliang sat in front of the microscope and took a deep breath.

Insert the needle and pass it through the blood vessel wall.

Pull out the needle and tie a knot!

The first injection was successfully completed!

The second injection also did not cause any obvious problems.

But as the stitches gradually increased, Zheng Guoliang suddenly stopped.

He discovered a slight twist at the edge of the blood vessel!

If the suturing continues, the anastomosis is very likely to become narrow!

Even if blood flow is restored with difficulty, blood clots can easily form!

Zheng Guoliang's forehead was already covered in sweat.

The nurse quickly wiped it off for him.

"The direction is wrong."

Zheng Guoliang's voice was somewhat deep.

"It has to be torn down and started all over again!"

The attending physician on duty's expression changed.

Dismantling and rebuilding means wasting even more time!

Han Dayong's arm had been without blood for nearly five hours.

Every minute of delay reduces the success rate of replantation!

Even if you don't remove it, the surgery will still fail!

Zheng Guoliang began removing the stitches.

Microvascular anastomosis requires extremely stable finger control.

His theories and foundations are sound.

What truly limits him is his lack of experience in performing complex microscopic anastomosis!

Under prolonged high pressure, his hands could no longer maintain the most stable position!

Shen Yan stood to the side, seeing all the issues clearly.

"Zheng Lian".

"Let me try."

Zheng Guoliang paused.

"No!"

This time, his refusal was even more decisive than before.

Treating severed limbs and performing microvascular anastomosis are two completely different things!

The latter directly determines whether the arm will survive!

Shen Yan did not back down and insisted on speaking.

"The direction of the transplanted vein needs to be readjusted."

"During the anastomosis, the posterior wall of the blood vessel was not fully expanded, and slight entrapment occurred after the third suture."

"If this continues, the anastomosis will narrow by at least one-third!"

Zheng Guoliang raised his head.

Shen Yan even noticed the problem under the microscope?

"Can you really do it?"

"able!"

Shen Yan's answer was very direct.

Time is passing by, second by second.

There's no point in waiting any longer!

Zheng Guoliang stared at Shen Yan for a few seconds before finally stepping aside.

"You start with one end!"

"Stop immediately if there are any problems!"

"yes!"

Shen Yan sat down in front of the microscope.

At this moment, his master-level experience in limb replantation was fully integrated into his hands.

Re-trimmed the edges of the blood vessels.

Adjust the vein graft segment.

Confirm the direction.

The needle is inserted, and the needle pierces the blood vessel wall once again!

Tie a knot after putting the needle out!

The entire movement was steady and gentle!

There is no unnecessary pulling.

It did not cause any new damage to the vascular endothelium!

The first injection is complete.

The second shot!

The third shot!

The sutures are evenly distributed around the anastomosis.

The vascular intima is neatly aligned!

The attending physician on duty stood to the side, increasingly shocked as he looked.

This is hardly a trial.

This is clearly an expert who has performed countless microvascular anastomoses!

Zheng Guoliang was equally stunned.

He was prepared to call a halt at any time.

But once Shen Yan started operating, he couldn't find any reason to stop it!

This surgery was so well-done that it was recorded and presented as a classic case study at a conference!

After finishing, Shen Yan checked it carefully again.

"Blood flow can be opened!"

The clamp slowly loosened.

Fresh blood quickly flowed through the reconstructed radial artery!

There was no obvious leakage at the anastomosis site.

The pale skin of the severed limbs began to regain its color little by little!

The attending physician on duty subconsciously opened his eyes wide.

"It's connected!"

"Blood flow has really returned!"

Everyone in the operating room breathed a sigh of relief.

Zheng Guoliang looked at Shen Yan, his eyes filled with shock!

I was originally the chief surgeon.

Shen Yan was just an assistant who went on stage to help.

How come at the most crucial moment of the surgery, the positions of the two people seemed to have completely reversed?

In addition, a big question arose in Zheng Guoliang's mind.

Where did this kid learn such skills?

How come they seem even more capable than me?

Did he also have some kind of medical genius?