Chapter 202

These one thousand-plus Knowledge Points actually came from a questionable source.

Because according to Fang Ziye's previous probability assessment, if he simply performed two fracture surgeries, at most he would only get a hundred-plus Knowledge Points, sweeping the field, that was all.

However, pre-operatively, Fang Ziye independently performed a Manual Reduction Technique in the Emergency Department, creating a hematoma; as the condition worsened, Fang Ziye completed the Hemostasis Technique, and the Knowledge Points obtained were of a completely different nature.

Fractures are not fatal.

An active hematoma is a fatal disease type, and the Vascular Anastomosis and Hemostasis Techniques inherently had not-low Knowledge Points.

Therefore, the Hemostasis Techniques from two surgeries, one Vascular Anastomosis, and two Manual Reduction Techniques for fractures allowed Fang Ziye to earn as many as nine hundred-plus Knowledge Points; added to his previous savings, the balance reached 1233.7!

Such a result matched Fang Ziye's earlier guesses and calculations.

That is to say, since the disease situations differ, if one deliberately conceals medical history or uses other small maneuvers during medical treatment to worsen the patient's condition, then treats it, it can definitely maximize the Knowledge Point gains.

Fang Ziye is not stupid; he has had this line of thinking and speculation for a long time.

It's just that this path is not proper; Fang Ziye never thought of developing in this direction.

If he hadn't encountered these few people in the Emergency Department who were themselves not proper, who wanted to use the hospital to delay the time before the police took them away, and if Director Zhang Mingcan and the others hadn't given hints, Fang Ziye wouldn't have done this.

Naturally, Fang Ziye wouldn't be arrogant about it either.

Thinking Knowledge Points from an improper source should be stashed away and not used — stash them at the bottom of what trunk? Using them is the truth.

Twelve hundred Knowledge Points — if they could have some effect in Huang Kai's surgery, Fang Ziye wouldn't hesitate; he could even clear out the whole warehouse!

After Fang Ziye spoke, Director Hong Du and Zhang Mingcan, who were standing at the observation positions, moved aside, clearing the way for Fang Ziye to Deng Yong and Duan Hong.

"What are you meddling for?" Deng Yong's gaze instantly sharpened.

He felt Fang Ziye was now purely stirring up trouble for no reason.

But Fang Ziye was only making a suggestion at this moment, so Deng Yong didn't flare up; his tone was still decent.

Moreover, seeing that the speaker was Fang Ziye, even Professor Duan Hong swallowed a mouthful of saliva, his Adam's apple rolling up and down twice on his chubby neck.

A protective feeling arose: "Ziye, the current situation is quite complex; if not handled well, it could worsen the condition further."

Hearing this, Fang Ziye slightly avoided his Master Deng Yong's admonishing gaze, looked at Wu Xuanqi with a very steady gaze, and said in a low voice: "Master, Teacher Duan, I feel my Manual Reduction Technique should be on par with Senior Brother Wu."

"One rotational reduction shouldn't delay much time, so I want to try; it also shouldn't cause irreversible consequences — at most it would just repeat Senior Brother Wu's operation just now."

"Of course, it's also possible I'm overestimating myself and misjudged Senior Brother Wu's Manual Reduction skill, but I feel that given an opportunity, on the premise of guaranteeing no major mistakes, it's still worth a try."

Fang Ziye didn't step on others to elevate himself, directly stepping on Wu Xuanqi to rise; however, he immediately pulled him out as a cushion in the first instant.

Because time couldn't be wasted; the earlier he persuaded them, the earlier he could operate, the earlier subsequent steps could proceed.

Time is precious; at this moment, only by pulling Wu Xuanqi out could it be more persuasive.

Of course, in his heart, Fang Ziye actually didn't hope Wu Xuanqi would get angry because of this.

Wu Xuanqi immediately said: "Master, Junior Fang's Manual Reduction Technique should be better than mine."

"At least in theory it is so."

"In operation, it won't cause secondary injury or more severe injury; wasting a few minutes to try to preserve the patient's urinary system function and reproductive system function, I think it's worth it."

Wu Xuanqi very seriously emphasized the four words "reproductive system."

Meaning: Master, don't forget, this Teacher Huang lying here — he has no "after" (future/family) left.

If he is rescued, he might suffer the pain of losing wife and daughter for a while, unable to bear living; but if he is to have some hope of living on, then.

Actually having reproductive function is very important.

If he has already lost fertility, and also lost his own wife and daughter, how would he live? He might only live for his parents.

Wu Xuanqi didn't persuade Duan Hong first; instead, Professor Deng Yong tilted his head toward Fang Ziye and ordered: "Scrub in, get on the table!"

"Good!" Fang Ziye immediately took off running.

He had his ears pricked up all along, waiting for orders.

At this time, there was no room for argument.

If either Duan Hong or Deng Yong still disagreed with his suggestion, he wouldn't open his mouth again to waste time.

Because time is too precious, not allowing a single bit of waste.

Fang Ziye thus exited the operating room door, washed his hands for the fourth time, then walked into the operating room and put on a surgical gown for the fourth time.

At this time, Fang Ziye's hands were slightly red; this was from disinfectant irritation.

In a short time, massive disinfectant soaking would cause the skin layer and fat layer of the hands to shed and thin; further irritation would make the skin become red and moist, even slightly painful.

However, at this moment, not only did Fang Ziye himself have no time to attend to it, others even more so.

During gowning and gloving, the people on the table weren't idle either; they switched to other non-critical operations.

By the time Fang Ziye cleared his Knowledge Points, the Manual Reduction Technique instantly reached the terrifying proficiency of Level 4, 3521.4/5000!

You must know, from Level 3 to Level 4, the required Knowledge Points are less than 600!

Three thousand five hundred points are enough for Fang Ziye to add points to about six Level 4 skills.

Proficiency is never wasted; the higher the proficiency, the more proficient — this point, Fang Ziye believes without doubt.

In his heart he thought silently: Kai Ye, I've already exerted my maximum capability, and didn't even waste any extra Knowledge Points; fortunately, earlier to get Pang Hong in sooner, I also added points to Manual Reduction.

If even like this, your artery still can't be saved, then that is Heaven's will.

I'm still young; I can only have this much capability.

Upon the operating table, after Wu Xuanqi yielded his position to Fang Ziye, Fang Ziye finally got a clear look at the terrifying wound at Huang Kai's pelvic position, lower abdomen, and right lower limb!

To describe it as a complete mess, blood and flesh blurred, bone and flesh separated in large chunks — not an exaggeration at all.

Of course, the blood and gore is actually still manageable; the most critical thing now is that after the comminuted pelvic fracture, some bone fragments are embedded, wedged into other tissues.

While the pelvis needs reconstruction, other tissues — blood vessels, nerves — also all need to be preserved.

The complexity and difficulty of this surgery even exceed the most difficult surgery Fang Ziye has witnessed in years at Zhongnan Hospital.

No other reason.

Mangled Extremity, Osteotomy Correction, Neurovascular Injury, Pelvis, Lower Limb Reconstruction — any one of these is a disease type at the ceiling of top-level trauma surgery diagnosis.

When the injuries are comminuted, even top experts like Professor Deng Yong and Professor Duan Hong working together are of no avail.

Because once certain disease types become comminuted, it is not something that can be solved simply by having more doctors handle it jointly.

Now, the bone fragment that needs reduction and realignment is a piece of ilium.

This piece of ilium has plunged directly deep into the pelvis; its edges are sharp, the root is interlocked, one part is squeezed together with the sacrum and the left bone, while another part is embedded right into the muscle, slicing through it.

The flat surface of the sharp edge grazes past multiple blood vessels, and some sharp edges have even cut through vessels; it is only because the proximal and distal ends of the artery and vessels have been clamped that there is no internal spurting of blood.

Similar bone fragments are not few in number.

The current priority is to extract it from between the bony interlocks while simultaneously pulling it out from inside the muscle.

Fang Ziye's master Deng Yong described the task concisely: "At present, the fragments inside the muscle layer can be left alone, but the main point is that you must use your hand, through a suitable method and force, to gradually pry open the interlocks of the ischium and the sacrum."

"And the arc cannot be too large; you can look at the positions of the sacrum and ischium."

"It must be strictly controlled within a 6mm range of motion; the force cannot be great, but neither can it be small, because once the force is insufficient, the rebound force will snap this iliac fragment!"

"If it ejects, that could be the end."

"So, even when finishing, you can only unload force slowly; do you have confidence?"

Not okay to start.

And once started, it is not okay to stop again.

Fang Ziye put on another pair of gloves to ensure absolute sterile principle, but two layers of gloves would make Fang Ziye's tactile sense even duller.

Fang Ziye took a deep breath: "I can try; if I cannot hold on, I will say so myself."

Only at this moment did Fang Ziye understand why the 'stop' Wu Xuanqi had spoken of earlier was so urgent, so decisive.

This reduction — or rather realignment — is not merely a matter of reduction force technique, of which muscles to stretch as force-transmission structures for leverage; it is a matter of control over force, of mastery over amplitude, which must be extremely good.

Moreover, the force must be evenly distributed.

Another layer of meaning in his own master Deng Yong's words was that he also must not break the ischial residual segment or the sacral residual segment.

If they break, it is the same principle as the iliac fragment being crushed and rebounding, causing multiple vascular injuries.

Pressure is not nonexistent, but Fang Ziye felt it was still worth a try!

Wu Xuanqi and Fu Qianjin, who had come up to assist, both yielded their positions to Fang Ziye.

Fang Ziye stood beside his "Teacher" Duan Hong, took a deep breath, then carefully extended his hand, slowly touching and probing the contents of the surgical field.

This is intraoperative physical examination, a rather specialty-specific application of physical examination technique.

Sometimes, during the course of surgery, no auxiliary examination — MRI, CT, or any other — can provide the needed information; only physical examination can obtain it.

"It is an irregular fracture; the fracture fragment thickness is insufficient, it belongs to a very thin sharp sheet, and the pressure and anti-bending force it can withstand are not very large."

"So we must be even more careful!" Deng Yong said.

Fang Ziye did not reply, just seriously performed the simple physical examination, probing, but not moving in the slightest, perceiving the shape and tissue structure, but not deeply.

This is the ease-of-use level of Level 4 Physical Examination Skill.

If he could operate without gloves, the effect might be better, but that is impossible.

Forty seconds later, Fang Ziye raised his head, placed both hands between the ischium and the contralateral sacrum, and said: "Master, Professor Duan, I am going to start exerting force; when you extract the iliac fragment, try to direct force toward the perineum, toward the contralateral knee joint, which may allow easier extraction of the fragment from inside the muscle."

"At the same time, Master, the direction you are in may need hemostasis." Fang Ziye had no way to confirm whether the fragment had lacerated the anterior abdominal wall artery or the intramuscular artery, so he gave this reminder.

"Then let's begin!"

"Wu Xuanqi, you prepare to take over at any time." Deng Yong said to Wu Xuanqi.

Still not trusting his own student, but if it were not for the reason Wu Xuanqi had explained, he would have immediately ordered Fang Ziye off the platform; at your age, you don't need to worry about these things.

You are not like Wu Xuanqi, who is an older doctoral student.

"No problem, there's a vascular surgery teacher here." Wu Xuanqi said.

And at this moment, Fang Ziye noticed that Nie Mingxian, who had previously said he could not go up, had now violated protocol and gone up.

Although he did not utter a word, staying in the assistant's position, Fang Ziye still noticed him.

Seeing this, Fang Ziye felt a chill in his heart, but dared not speak it aloud.

It was even impossible to say anything; Wu Xuanqi hadn't even called his name, so why not play the fool?

As for why Nie Mingxian did not go up for Zhang Yu's surgery before, but went up for Huang Kai's surgery now, Fang Ziye did not think or pursue the reason further.

Soon, Fang Ziye began to exert force.

From shallow to deep, slowly.

The rate of force increase cannot be too great, because force differential may cause the osteophyte to be snapped, causing irreversible damage; therefore sustained force differential absolutely cannot change rapidly!

"Steady. Steady. Steady." Fang Ziye silently elaborated in his heart.

In the stage of microscopic force control, what is needed is steadiness.

Seek progress within steadiness; first seek steadiness, not progressing is also acceptable.

Everyone in Orthopedics held their breath, but the General Surgery operation continued, only they also tried to yield as much space as possible to the Orthopedics people.

That is, Wu Xuanqi.

Beside Wu Xuanqi, Professor Duan Hong pushed his buttocks back, pulled his abdomen in, to avoid bumping into Fang Ziye's elbow.

His abdomen was five centimeters from Fang Ziye's elbow, but his upper body, his hand, the bone holder in his hand, still maintained their proper positions.

Maintaining such subtle movements is also extremely taxing.

But at this time, no one could help him; he could only rely on Professor Duan Hong himself to strive to maintain.

And right at this moment, in the blink of an eye!

Both Duan Hong and Deng Yong saw that in Fang Ziye's hands, the residual ends of the ischium and sacrum were separated apart; the clamped iliac bone instantly lost its support, one end slid down slightly, and continued to stay interlocked.

Seeing this, Professor Duan Hong was about to move, the bone holder moved down two centimeters, then stopped.

Because Fang Ziye had not yet said the fragment could be taken, even if he judged it could be taken, he could not operate!

Timely cessation of operation is also a kind of psychological quality, a surgeon's quality.

The primary surgeon decides everything.

Even though Fang Ziye is just a student, right now he is the primary surgeon for the closed reduction, so everything must wait for his arrangement!

Fang Ziye's hands are very steady, his body is also very steady, fundamentally not trembling.

Nor can Fang Ziye be allowed to tremble, because the arc of this kind of trembling could cause osteophyte splitting!

Continue applying force.

Cannot be excessive, and Fang Ziye also slows down the speed of increasing force once again.

Another ten seconds pass.

Finally!

Visible to the naked eye, when the ischium and sacrum separated a distance of roughly 3 millimeters and 4 millimeters, watching as the other vessel stumps had already drawn close to the blood vessels!

"Take!" Fang Ziye says this very lightly, very steadily, expressionless.

Breathing smooth and steady, not excited at all.

Duan Hong and Deng Yong, each holding a bone holder, cooperate with quite tacit understanding to pull the ilium fragments outward, at first it is very smooth, after coming out two centimeters, there is slight interlock!

Both stop again, operation as one, no tendency to clash at all.

"Can still take." Fang Ziye looks at the overall situation, tone still very stable, no fluctuation, as if an ancient well.

"Toward the contralateral knee joint patella direction." Fang Ziye adds one more sentence.

Deng Yong and Duan Hong indeed do not hesitate to slightly add a bit of force.

At this moment!

Finally.

The bone fragment, from inside the muscle, is pulled out, its edge slightly scraping through the muscle layer.

But, as the bone fragment comes out!

Originally the muscle vessel stump was perfectly fine, without any abnormal opening, yet with a *zi* sound, a blood jet spurts out.

The blood jet happens to strike straight toward Fang Ziye's face.

Seeing this, everyone's complexion changes drastically in an instant.

This kind of blood jet, the impact on Fang Ziye at this moment, will cause this surgery to head toward an unknown direction. If at this time Fang Ziye gets scared, that is understandable, after all people all have defensive reactions.

Once the area near the eyes suffers impact, one will instinctively retreat regardless of everything.

At this time, if Fang Ziye releases force once, the rebound of the ischium and sacrum will definitely cause secondary irregular bone fracture during surgery, once fracture fragments fly out, they are simply blood vessel cutters!

The blood vessels inside the pelvis are so rich and dense, comparable to the mesenteric artery.

But, Fang Ziye does not do so.

Timely closes his eyes, then does not move a muscle.

A blood blade on the mask, half on the eyelid.

But Fang Ziye also does not timely release force, instead slowly, relaxes the force in his hands, bit by bit, as if hacked to death by this relatively sustained blood blade!

Deng Yong is delayed a full one second before managing to stuff the gauze-wrapped vascular clamp in his hand into the muscle breach, blocking the gushing blood jet, completing the local packing hemostasis operation.

Many people look toward Fang Ziye's direction.

And Fang Ziye, however, is still slowly breathing calmly, until, a full five seconds later, Fang Ziye slowly releases all force.

Both hands steadily spread slightly to both sides at a certain arc like a crab.

Mouth calmly calls out: "Circulating Teacher, help me remove clothes, wipe the blood on my eyes! I'm going out to wash my face then back on stage."

The orthopedics side's operation does not cause any abnormality in other places.

Right now everyone's attention is on saving lives and their own specialty's operation, who cares about your side's blood jet, unless you spray onto others.

"Okay, coming right over!"

"Go downstairs to wash face." Deng Yong sees Fang Ziye so composed, heart full of relief and appreciation, feels this student of his will definitely become a great vessel in the future.

Similarly, to avoid Fang Ziye making a mistake in busyness, wait a moment directly at the outside sink wash face, so instructs him.

"Wash finish back on stage!" Deng Yong follows immediately, again without hesitation instructs.

No one refutes, also no one dares to refute.

Because similar operations, definitely not just this one time, and this time, is the most critical, after this step is done well, subsequent operations, although can not need Fang Ziye to do, Wu Xuanqi can handle.

But Fang Ziye played such a big role, one more surgery is not excessive right.

"Good!" Fang Ziye leaves.

"Hemostasis." Duan Hong expressionless, instructs Wu Xuanqi.

The gap left by Fang Ziye's departure, quickly filled by sterile surgical gowns, surgery must continue, and still very long...

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(Chapter End)