Chapter 184

Wu Guo Nan and Xue Tao had already disinfected both of the patient's lower limbs; Li Junfeng of Joint Surgery had arranged for Xu Yanlin to complete the preoperative disinfection, while Wang Zhongxing held up the patient's legs with both hands.

The current surgical plan for this patient was bilateral lower limb amputation, bilateral upper limb limb salvage surgery with amputation as backup; they had also discussed with Liu Chaodong outside the possibility of amputation.

But Director Wu Guo Nan's team alone could not perform so many operations, and since the patient's identity was special, they had invited a director from Joint Surgery to help; this Director Li Junfeng of Joint Surgery was an orthopedic doctor inclined toward hand surgery, though now assigned to work in Joint Surgery.

Because the patient's body was quite sturdy, a pair of legs was not light.

Seeing this, Fang Ziye first put on a pair of sterile gloves, asked Huang Yu for one leg, letting Huang Yu switch between left and right hands to take turns as a buffer.

Xue Tao went directly to wash his hands with Li Junfeng, and the two continued saying something midway.

Xue Tao turned to ask Li Junfeng: "Director Li, that is to say, this patient can actually avoid amputation, it's just that no one dares to perform this operation now?"

Li Junfeng glanced at Xue Tao, his gaze and tone strange: "Xue Tao? Why are you asking this? Don't stir up trouble."

"This patient's condition itself is quite special, and his identity is also special."

Xue Tao was clearly from Orthopedics; if he were to meddle in vascular surgery matters, and on this patient at that, Li Junfeng would absolutely not allow it.

Wu Guo Nan also gave Xue Tao another look.

Xue Tao hurriedly explained: "No, Director Li, I was just curious and asked casually. I certainly won't rashly perform limb salvage surgery."

"I'm not from Vascular Surgery myself; since Director Peng said amputation, it must be very difficult to save the limb."

Then Xue Tao added: "Director Li, Ziye is also a Senior Resident Physician; limb amputation belongs to authentic Level II surgery. I'll let him go on stage, and I'll be the assistant—is that okay? It won't delay the patient's condition."

"What do you think?" Xue Tao wanted to do Fang Ziye a favor.

Amputation was simple, belonging to Level II surgery; Fang Ziye happened to be able to do it. And amputation was actually not difficult.

"It's fine; you just tie off the artery later. Right now, the most important thing is to solve the blood loss problem caused by vascular damage." Li Junfeng reminded him of the key point.

Li Junfeng wasn't particularly clear about Fang Ziye's background, but whoever performed the amputation, it was done. It was just that Li Junfeng's rank was higher than Wu Guo Nan's; he was the Administrative Director of Joint Surgery, on par with Zhang Mingcan.

The current situation was:

Amputation was not difficult, limb salvage was difficult. And Wu Guo Nan knew that even if Zhang Mingcan or Old Director Hong Du were called, they might not be as reliable as Li Junfeng in saving both upper limbs.

What was life-threatening about the patient now was multiple traumas and severe blood loss; hemostasis, blood transfusion, intake greater than output—that was the key.

But after hemostasis for too long, the blood in the arteries and veins would all coagulate; if amputation were not performed, the muscles of the four limbs would gradually necrose, and by then, creatinine produced by muscle dissolution, etc., would also be life-threatening.

So, this amputation could actually be divided into two steps.

Tie off the artery, stop bleeding, emergency risk avoidance to save life.

Then amputate, save life!

Amputation could even be done slowly six hours later; it wouldn't matter, it wouldn't burden the body.

"Good!" Xue Tao nodded.

The disinfection drapes were finished quickly, and then Fang Ziye and Wang Zhongxing went to the sink outside the operating room to wash and disinfect their hands.

Wang Zhongxing smiled bitterly: "Ziye, encountering such an emergency, you're really lucky."

"One doesn't encounter one in years."

Fang Ziye only smiled with pursed lips; he was pondering, if limb salvage were really performed, would it be more suitable to add points to Vascular Incision? Or to add points to Thrombectomy? Or add both?

Not encountered, or don't know, whatever.

Since encountered, and his Knowledge Points balance was still not small, then temporarily add points to use them.

The meaning of storing Knowledge Points wasn't just this?

So, simply, Fang Ziye directly found the corresponding Specialty Basic Skill of Vascular Surgery.

Vascular Incision, Thrombectomy, Vascular Anastomosis...

Over a thousand Knowledge Points, just disappeared like that.

This was Fang Ziye's largest consumption so far.

When walking back in, Fang Ziye found that this patient's condition was indeed very terrible, yet at the same time terrible, it was also very fortunate—

A knife in the right upper abdomen, estimated to have stabbed directly into the liver. The edges of the wound were neat, should be quite easy to repair.

The edges of the wounds in the jejunum and ileum were also neat; it seemed the attacker had not been very cruel to stab and then stir around.

If really done like that, then it would probably be truly hard for even immortals to save—

But even so, an extremely pungent smell still emanated from the abdominal cavity.

The intestines were broken; that smell was enough to make one feel like dying.

Making Fang Ziye involuntarily frown...

When Fang Ziye and Wang Zhongxing washed their hands and walked in, they saw Li Junfeng already cooperating with an unknown brother from Joint Surgery, performing exposure of the brachial artery of one upper limb.

Wu Guo Nan and Xue Tao, the two of them, temporarily teamed up, performing surgery on one lower limb.

After Wang Zhongxing and Fang Ziye came in, Wang Zhongxing immediately took over Xue Tao's position; the four people split into two teams, respectively starting to find arteries and stop bleeding.

Because amputation was required, after directly finding the brachial artery and femoral artery, they could first temporarily tie them off.

Fang Ziye changed into a sterile surgical gown and wandered around beside Xue Tao.

Wu Guo Nan turned and said: "Xue Tao, you take Ziye to do the other side first; Femoral Artery Exploration and Ligation is just a simple Level II surgery, part of amputation; you two completing it shouldn't be difficult, right?"

This was actually just an exposure technique, also called incision.

But actually, Vascular Exposure Surgery and Vascular Incision were two different surgeries. Vascular Exposure Surgery was a vascular professional basic skill under incision, while Vascular Incision was a Vascular Surgery specialty skill.

One was basic, one was truly at the specialty level, truly needing to operate on specialty disease types.

Fang Ziye nodded, Xue Tao smiled, and stood at the assistant position.

Femoral Artery Exploration was just a Level II surgery, also part of amputation; this was naturally not difficult; Fang Ziye, as long as he had some anatomy experience, just needed to follow the anatomical structure.

Ligating the artery was even simpler; just tie it off with silk suture.

Blood vessels were like water pipes, but not completely like water pipes; the similarity was that both could pass liquid.

The difference was that water pipes could be on the body surface, while blood vessels were generally buried deep inside the body, especially large arteries, rarely having superficial courses.

If a water pipe had a break, one could first stop the water, then slowly find the hole; but blood vessels could not, the total switch of blood in blood vessels was the heart; if it stopped beating, the person was gone.

Therefore, the proximal end of the blood vessel needed to be found quickly, then compressed to control the bleeding.

Xue Tao said: "Ziye, you do the manual compression hemostasis first, I'll expose the femoral sheath first, once it's exposed, I'll hand it over to you."

Fang Ziye nodded.

Then Fang Ziye's right hand slowly tore open the gauze while his left hand went to the abdomen, palpated flatly for a moment, then pressed down deeply and tightly!

This was on the body surface, performing compression hemostasis according to the vessel's course!

It came naturally from anatomical knowledge, not a particularly profound skill.

Manual compression hemostasis, applied intraoperatively, is another level entirely, not the same.

But compressing the more proximal end of the arterial rupture like this could reduce the bleeding volume to a large extent.

Because the patient's blood pressure wasn't high, plus Fang Ziye's compression, after Fang Ziye lifted the gauze, the oozing was surprisingly not much!

At the same time, Fang Ziye temporarily consumed about 500 Knowledge Points, adding points to the downstream skill of Hemostasis Technique, Pressure Hemostasis, bringing it to Level 4.

Knowledge Points are meant to be used, Fang Ziye couldn't care about that much right now.

The result was that Fang Ziye actually grabbed the proximal end of the femoral artery before Wang Zhongxing.

"Silk suture!"

His right hand turned into a mud-eel-grabbing posture, cleanly and neatly pulling out a section of the femoral artery from inside. Thumb and index finger pinched it tightly.

Then he switched to the thumb and index finger of his left hand, which had been compressing the femoral triangle, pinching tightly!

Pulling slightly outward, then immediately taking the two pre-prepared silk sutures, quickly looping them around the vessel, tightening and tying them into a slipknot (refer to shoelaces, tighter than shoelaces).

Only then did he release the femoral artery! He flicked the vessel stump slightly, saw no bleeding, and let out a long breath of relief.

Xue Tao's side hadn't even prepared the scalpel and other instruments yet.

Looking back, he saw Fang Ziye had already finished suturing, just waiting for him to cut the thread.

Xue Tao then said: "Release the compression pressure first, let me see if there's any other bleeding."

Opposite, Wang Zhongxing's brow instantly twitched, discovering Fang Ziye had actually operated ahead of him, his hand movements couldn't help but speed up slightly.

But this rash speed-up caused Wu Guo Nan to fail to catch the arterial stump in time!

Instantly, the artery began spurting blood!

Spurting high!

Then spraying down, one part even shooting directly onto the lens of Joint Surgery Director Li Junfeng's glasses.

Naturally, Li Junfeng didn't move a muscle, just said sternly: "Circulating, wipe the blood, let me step down..."

He didn't blame Wang Zhongxing.

No one wants an intraoperative accident, but some disease types just spurt blood.

Xue Tao, cooperating with Fang Ziye, was still looking for other vessel openings, seeing this scene, he immediately reached across the operating table, directly using thumb, index, and middle finger together forcefully, grabbing the contralateral femoral artery stump.

Steady, accurate, ruthless!

The spurting blood stopped immediately.

But the sprayed blood droplets now kept falling, landing on the OR floor and on everyone's heads and shoulders.

Even so, everyone only glanced at Wang Zhongxing's direction, saw no more bleeding there.

They didn't leave, but treated this scene as unseen and continued the surgery.

They weren't affected by bloodstains in their vision, didn't need to step down like Li Junfeng.

Getting sprayed with a little blood during surgery, what's there to fear? As long as the scalpel isn't at the neck, the patient has no infectious disease, the surgery that needs doing still gets done.

This is the composure a surgeon routinely should have.

Wu Guo Nan immediately pressed down, stopping the massive hemorrhage, and had Wang Zhongxing take over the compression position, soothing softly: "Don't panic, surgery must be done slowly."

At the critical surgical moment, Wu Guo Nan wasn't even willing to waste time cursing.

Just completed the three-person compression relay operation not so tacitly.

On Fang Ziye's side, after Xue Tao finished cutting the thread, he yielded the lead surgeon position to Fang Ziye.

Tone brief: "Ziye, role swap."

Role swap means lead surgeon and assistant exchange roles, but don't exchange positions.

Fang Ziye nodded agreement, took the scalpel and toothed forceps Xue Tao handed over, and began the surgery.

Xue Tao took the chance to blink, then lifted his neck, eased his posture, and when he moved his gaze back to the surgical field, he didn't look well at all.

In just a short while, he saw Fang Ziye had opened the wound, clearly exposed the femoral artery injury, and was still 'playing with' the adjacent femoral nerve and accompanying femoral vein...

Actually checking if those two things were injured.

But this practiced technique instantly turned Xue Tao into a baffled monk.

MLGB, surgery's happening right now, you're flipping things around like this.

No, when did I grow taller but my hands aren't enough?

Xue Tao couldn't figure it out, and didn't dare to touch.

Just then, Xue Tao saw again, Fang Ziye's vascular clamp seemed to have become a spirit, prying from who knows where, seemingly pulling out the internal great saphenous vein from the wound, and after relieving the wound's compression, blood gurgled out.

Fang Ziye said: "Any vascular surgery suture thread? Open a few."

"Yes!" Two circulating nurses answered immediately, though they didn't know which department's lead surgeon wanted it, they just wanted to follow orders, couldn't be bothered to quibble.

Emergency situation, even if an intern doctor asked them to open something, they wouldn't hesitate to ask more.

Ask what, saving one second is one second, this is the quality in rescue and emergency.

Li Junfeng and the others looked at Fang Ziye at once upon hearing this.

This patient is prepped for amputation, why are you taking vascular suture thread?

Including Bone Surgery Department One's Wu Guo Nan.

Fang Ziye said to Wu Guo Nan, "Director Wu, I think we can move the amputation plane slightly lower, which will make prosthesis fitting easier later, and the arterial and venous tears here aren't large, so they can be repaired with sutures."

Although it's an amputation, how much to leave and how much to cut are completely different.

Amputating at the thigh root is amputation, amputating at the ankle is also amputation, but the degree of functional preservation is completely different.

Wu Guo Nan then said, "You handle it entirely, no need to ask me, no need to mind whether I watch or not."

Don't employ those you doubt; once employed, don't doubt them.

It's just an amputation surgery anyway, no matter how Fang Ziye fusses, the result is still just amputation.

Wu Guo Nan then didn't say much more!

Xue Tao secretly gave Fang Ziye a big thumbs up.

With this awareness, Fang Zi's future growth height won't be too low.

Amputation surgery, though cruel, save as much as possible — this is for the patient's good, and what can be done now is probably just this.

Orthopedics people aren't very proficient in vascular surgery; if vascular surgery can't solve the vascular problem, then orthopedics can only try to leave more vessel stumps to compensate.

After getting the vascular suture thread, Fang Ziye quickly sutured the great saphenous vein first; the great saphenous vein only had a small cut, not needing the three-point fixation vascular anastomosis of limb replantation at all, and he quickly repaired the great saphenous vein.

The femoral artery was the same……

After hearing Fang Ziye's words, Wu Guo Nan felt a pang in his heart; if Fang Ziye hadn't said this, he really planned to just amputate at the injury site, simple and crude, but Fang Ziye spoke up like this.

As director, Wu Guo Nan was embarrassed to say his amputation range was even shorter than Fang Ziye's, so he also asked for vascular suture thread and started suturing.

Not deliberately competing with Fang Ziye, just doing this to make the patient better.

But when Wu Guo Nan finished suturing and was about to see what Fang Ziye was doing.

He suddenly discovered something not quite right——

Because Fang Ziye was now operating on the posterior side of the patient's lower leg!

And his movements were proficient——

What is he doing?

Fang Ziye used a round knife to incise the skin, then didn't use a pointed knife to go deep, but used a vascular clamp, as if entering his own home, bluntly dissecting the muscle layer, heading straight for the posterior tibial artery……

One minute later, a pointed knife pierced the posterior tibial artery wall, pulling out a thrombus strip the size of a little finger from the vascular lumen, like pulling a radish, as if a black mud loach……

Very obvious, this was the arterial embolus Fang Ziye found from the femoral artery downstream branch!

He's performing arteriotomy and thrombectomy!

Seeing this, Wu Guo Nan and Xue Tao, as Fang Ziye's assistant, both had their expressions change violently!

Not just once.

Fang Ziye is doing arteriotomy and thrombectomy, how does he know where the thrombus is?

This is the first point.

The second point is, if Fang Ziye now extends the limb salvage range below the knee joint, what are they supposed to do?

Can they amputate above the knee joint, above the elbow joint?

Doesn't this show they're not as good as Fang Ziye?

But if they don't amputate here, what can they do? Do they know how to do what Fang Ziye is doing now?

They don't!

Fang Ziye didn't notice anyone watching him; he had already thrown himself in wholeheartedly.

Perhaps, normally it's very hard to discover vascular emboli. But with Medical Basic Physical Examination Skill pointed to Level 4, it's possible.

At this time, Fang Ziye had already cleared all his knowledge points to below 200.

Xue Tao took a deep breath and asked, "You know arteriotomy and thrombectomy?"

This isn't a question, this is an affirmation.

Fang Ziye was suturing the posterior tibial artery incision where the thrombus was removed, nodded, and naturally replied, "Yes, Teacher Xue, encountered similar before, thought it useful, so learned a bit."

Fang Ziye's words, though spoken very plainly and directly, even with reason and evidence.

While Fang Ziye spoke, several sharp sounds of rubber slippers friction against the ground were clearly heard!

The ones making the sound were Peng Yuanming from Hepatobiliary and Pancreatic Surgery and Li Junfeng, director of Joint Surgery.

They couldn't help but turn their heads over.

After all, Peng Yuanming had just quarreled fiercely with the family outside, why? Because this kind of thrombectomy couldn't be done.

Currently, for this level of precise extensive thrombectomy, those he knew who could do it were Wu Xuanqi and Nie Mingxian; Wu Xuanqi had a task, Nie Mingxian was under anesthesia.

Didn't expect Fang Ziye could do it, this tm isn't bullshit?

Of course, this is the operating room, the operating table, surgery in progress.

All doubts unrelated to surgery are for after surgery; this is a basic principle of surgery, also basic quality.

……

The mouth corner muscles of Li Junfeng and Wu Guo Nan, like myocardium, became integral in nature, simultaneously starting to twitch.

Either twitch or don't twitch, extremely neat and uniform.

Xue Tao lightly stepped back, didn't stand too steady, sprained his lateral malleolus, had pain but not obvious.

He also saw Li Junfeng and Wu Guo Nan intentionally or unintentionally glance at Peng Yuanming, eyes filled with strangeness and complexity……

Big Brother, why don't you come over and see if this is your department's surgery?

Peng Yuanming felt today was definitely his doomsday, first a pile of unlucky things falling from the sky like they cost no money.

Peng Yuanming had to find free time to come take a look.

……

Fang Ziye continued the next step of operation; he first sutured the arterial opening!

Then he released the ligature silk thread, and indeed saw the posterior tibial artery begin to fill, and no blood seeped out afterward.

Immediately, with both hands, he followed the course of the posterior tibial artery from top to bottom, feeling for the artery's pulse!

The course of the femoral artery runs from upper outer to lower inner, while the pulse of the posterior tibial artery extends from behind the child toward the lateral malleolus.

Therefore, Fang Ziye's hand kept probing downward until it reached the dorsalis pedis artery, whereupon he immediately startled himself slightly.

Then, unable to believe it, he withdrew his hand and switched to his left hand to try once more.

He also felt the pulsation of the dorsalis pedis artery!

Now Fang Ziye began to struggle, whispering to Xue Tao: "Um, Brother Tao, it seems, if I'm not mistaken, we might not need an amputation on this side after all, I actually just want to leave it a bit longer."

"But now the dorsalis pedis artery already has a pulse."

"Can we still amputate?" Fang Ziye was sincerely asking Xue Tao.

But upon hearing this, Xue Tao nearly rolled his eyes to the top of his head, his vital signs were gone...

nmb!

Although Fang Ziye's voice was low, the operating room was quiet enough at this moment.

Almost to the point of dead silence, because everyone else's breathing could be heard especially clearly.

However, under such circumstances, Fang Ziye's side said he might not need to perform an amputation.

But actually, Wu Guo Nan next door was already performing an amputation, and even Li Junfeng of Joint Surgery, who originally planned to do limb salvage surgery, after seeing that the condition of the upper limb artery was not good at this moment, thought that since the patient's informed consent signature was for amputation surgery.

It had already shifted from limb salvage surgery toward amputation surgery—

But unfortunately, just at this time, Fang Ziye told them that Fang Ziye's side would not do amputation surgery, switching to limb salvage surgery.

Xue Tao said nothing, and Wu Guo Nan, as director, muttered a low curse at this moment: "I ci ao..."

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(Chapter End)