Chapter 348

"Ziye, you go out and discuss with the patient's parents, ask them if they agree to the choice of secondary nerve suture."

"My personal understanding leans more toward the idea that primary simultaneous suture of nerves and vessels would instead lead to postoperative functional loss."

"Mangled extremity nerve damage is not comparable to the regular nerve transection caused by sharp instrument injury. Suture tendons and vessels first, ensure survival first……"

"What do you think, Wei Ge?" Liu Huanglong did not show off the pride belonging to a professor, but discussed politely with Yuan Weihong.

Yuan Weihong pursed his lips and sniffed his nose at the same time: "Professor Liu, currently for mangled extremity limbs, according to incomplete statistics, the survival probability is only thirty to forty percent, the rest all ended up with amputation surgery."

"Therefore, such statistical results actually have no statistical significance."

"Relatively simple mangled injuries should actually be categorized into crush injuries; purely mangled injuries, conservatively estimated, temporarily have less than ten percent limb salvage probability."

"More prefecture-level city hospitals and top-tier Grade-A hospitals, when encountering mangled injuries, the preferred treatment is primary amputation, reducing the patient's number of surgeries and economic burden……"

"Considering survival first is indeed the first step forward. I heard that in hand surgery, some patients choose secondary nerve suture, and based on functional defects, further optimize surgical plans such as nerve transposition and nerve grafting?"

Yuan Weihong is not completely ignorant of hand surgery, but if it comes to playing high-end treatments in various sub-specialty fields, his cognition is actually relatively blank.

This is like all being programmers, but actually every programmer's relative strengths differ, absolutely cannot be generalized.

"Then I'll go out and talk to the patient's family first. Previously what I discussed with them were only the two options of limb salvage and amputation surgery." Fang Ziye nodded, withdrew his steps and retreated backward.

At first Fang Ziye did not know Professor Liu Huanglong would one hundred percent take the stage, so of course he could not give the patient's family overly high expectations; if prior expectations were higher than the final surgical result, Fang Ziye would inevitably be in a whole lot of trouble.

Now Professor Liu Huanglong has his own unique understanding; this understanding is a knowledge gap that even top professors of trauma surgery lack. Since he raised it as a suggestion, Fang Ziye could only go talk to the family again.

Informed consent, one of the most basic medical principles, no matter how hot-headed one gets, in non-emergency risk-avoidance situations, it must be fulfilled.

……

Fang Ziye took off the sterile surgical gown, removed the sterile mask, after going out first washed his hands at the sink, then twisted his neck and waist, heard a few cracking sounds, felt the stiff joints slightly relax, then walked toward outside the operating room.

After calling the girl's parents to the intraoperative consultation room through the broadcast, Fang Ziye explained the situation suggested by Professor Liu Huanglong.

The parents outside, besides being anxiously worried, were certainly also inquiring about their daughter's treatment hope and possibility through various connection networks, just what results did they get?

Fang Ziye's words were undoubtedly a life-saving straw.

The girl's father had already arrived, dressed appropriately and generously, formal attire shirt, only at this moment his hairstyle had been rubbed by him into an exceptionally messy state, Adam's apple bobbing, mouth dry: "Doctor Fang, you mean to say, my daughter's current damage, can now be anticipated a bit, keep the foot's form, but whether function can recover, only the next surgery can tell?"

"Correct!" Fang Ziye nodded.

"Such a choice will require a second-stage surgery, increasing the child's surgical burden, but there should be more recovery probability. Naturally, the economic burden will also relatively increase…"

"After all, it requires secondary anesthesia…"

Fang Ziye's voice was interrupted by the man, very decisively: "Doctor Fang, you don't need to deliberately remind about the economic problem. As long as it's not an astronomical figure, several hundred thousand or a million like that, we can all afford it."

"Even, under certain permissible conditions, you can preferentially choose better ones, for example imported suture needles and threads, machinery or materials and such, these are all acceptable."

"If, during surgery, you can temporarily invite some expert consultation fees, we are all willing to undertake them……"

The man, using the most unadorned tone, using the most "powerless" form at this moment, embodied his fatherly love.

Before surgery, according to the girl's mother's account, one could imagine the girl's family circumstances were not bad.

Han City locals, and moreover able to afford art student expenses, go to private lessons, family circumstances would not be too poor.

Fang Ziye continued to explain: "The fees certainly won't be as high as you say. Naturally, everyone's situation is different. Perhaps tens of thousands of yuan is nothing to you, but our hospital, including myself, have encountered situations where tens of thousands needed multiple families to pool together, borrow money, etc."

"We doctors have the obligation to inform. Actually, the current treatment is not completely an economic problem. Nor is it a problem of inviting consultation experts."

"Actually, your daughter's such situation, in our Eastern Han, even within the trauma surgery field worldwide, belongs to a refractory disease type……"

"Inviting experts over to do surgery, that requires a very mature surgical technique, experts having certain confidence to pull off the surgery, only then is there a chance to complete limb rescue through remote technical assistance."

"So, invite experts? The significance won't be very large. No one will agree. We also can't find suitable candidates……"

This needs to be explained clearly: it's not that Zhongnan Hospital is tsundere, but that you can't find suitable people.

Whether it's Jishuitan or Magic Capital Sixth Hospital, West China Hospital such orthopedic top-tier hospitals, there also won't be professors willing to come thousands of miles in the name of 'consultation' surgery, taking high appearance fees, finally just doing an amputation surgery, taking money and leaving.

No diamond drill, don't take on porcelain work. Disease types that can't be handled, spending money is useless.

"Then, let's proceed according to Doctor Fang's choice first. Try to make it as good as possible. If really can't make it good, no matter what, she is still our daughter."

"Did our best." The man responded.

Fang Ziye nodded.

The intraoperative surgical details changed, but actually did not change the 'limb salvage surgery' major surgical direction. As for specific surgical techniques, surgical details.

Damn, such a disease type, doesn't even have a standardized treatment plan, where would there be a mature surgical technique?

Can you tell me what the first generation photolithography machine is called?

Therefore there is no modification of surgical method, and no need to re-sign.

Fang Ziye again rushed back……

Only on the way back to the operating room, Fang Ziye slightly slowed his steps.

Based on some things Professor Liu Huanglong informed today, let Fang Ziye re-recognize the current surgical technique architecture, or say, a disease type's treatment advancement history.

Principles were long written in textbooks, same as saving lives.

Save life first, treat disease later.

Similarly, mangled injury treatment, save limb first, preserve function later.

Before antibiotics were discovered and put into use, before debridement and suture technique was thoroughly developed, limb trauma, all were handled by amputation to preserve life.

Before vascular surgery developed maturity, before arterial thrombus extraction surgical technique was developed, lower limb arterial thrombosis, all were amputation to preserve life.

Before limb replantation surgery developed maturity, amputated limb treatment, was stump suture to preserve life.

Before tumor resection surgery, also called lesion debridement resection surgery developed maturity, orthopedic tumor patients, were also amputation to preserve life.

Every new disease type in medicine, at the beginning none had a corresponding mature surgical technique to handle them. At that time, all relied on the most unadorned basic skills to handle, with preserving life as foundation.

So speaking, actually facing new disease types, everyone is equal. What everyone relies on are not high-end cutting-edge exquisite surgical operations, but surgery's most basic basic skills to correspond.

Then step by step develop out the corresponding specialty surgical techniques for new disease types, mature surgeries.

Of course, facing new disease types, it is also unequal.

Professors' basic skills, at least core basic skills, generally are more badass than ordinary doctors. So, when they handle new disease types, they are also more at ease, have greater fault tolerance space.

Based on this, Fang Ziye looked again at the two Level 5 skills on his panel, and his mood became relatively relaxed.

Debridement Technique Level 5, Suture Technique Level 5.

These are the two most basic basic operations in surgery; when facing unknown disease types, the potential they can unleash is enormous.

And once such a disease type can have a mature treatment plan pushed forward, the benefits it brings to the patient, and to the developer himself, are also enormous.

Naturally, if vascular anastomosis and nerve anastomosis and other specialized operations belonging to hand surgery — if the proficiency of specialized operations currently maturely applied in hand surgery could also reach Level 5 — it would certainly yield even better solutions for mangled extremity management, and allow even more composed handling.

But there's no way; knowledge points are limited.

However, even though they're limited, and can't be rushed to Level 5, Fang Ziye still chose to add points to nerve anastomosis and other operations, bringing them to Level 4 proficiency.

Although nerve anastomosis was taken over by Professor Liu Huanglong, that doesn't necessarily mean Fang Ziye won't have a chance to operate; what if Professor Liu Huanglong thinks highly of his suture technique basic skills, and lets him participate in suturing one or two nerves — wouldn't that be even more knowledge points?

Plus, Fang Ziye has another enormous foundation!

Closed Reduction Technique Level 5.

This is a proficiency level that many, many trauma surgery professors cannot reach; therefore, this time when he goes back, after suturing the blood vessels and prioritizing revascularization of the limb stumps, the potential he can unleash when he then manages the fracture remnants is also boundless.

Professor Duan Hong sent a mangled extremity case to Zhongnan Hospital some time ago, actually because he valued his closed reduction technique level; later he didn't send any more, probably because that mangled extremity patient's recovery wasn't very good.

The limb survived, but not well enough; same as Huang Kai in Enshi, currently in a hemiplegic state — the limb is alive, merely a decorative limb.

And this time, Fang Ziye can cooperate with Professor Liu Huanglong, who excels at handling hand surgery nerve disease types; perhaps they can unleash unimaginable potential and long-term potential.

(Chapter End)