Chapter 434

"Properly handling the blood supply and morphology of soft tissue is merely the first step of mangled extremity debridement surgery. This does not violate the principles of trauma treatment. But it requires us to make a new interpretation on the basis of those treatment principles."

"Excise all inevitably necrotic tissue, strive to preserve more 'non-necrotic tissue'!"

Fang Ziye continued turning to the next page, which bore the time window for lower limb necrosis: "Limb arterial vessel occlusion with severe ischemia for 4-6 hours can result in necrosis."

"The above statistical time results are the time window derived by our many trauma surgery predecessors after experiencing hundreds of thousands or even millions of limb necrosis patients."

"This time serves as a very appropriate objective standard for judging the occurrence of limb necrosis."

"However, after understanding this absolute standard, we should deeply understand whether, if our human body tissues have suffered severe ischemia and then intermittently regained blood supply, such an 'intermittent' time window can be extended."

"Even, could it allow the 'time window' to reset, winning us more surgical time?"

Fang Ziye's voice was neither passionate nor did he deliberately design hooks to drive the audience's suspense; he simply narrated in an unhurried, straightforward manner.

But don't forget one thing: Fang Ziye had allocated his Basic Theory points to Level 5.

When theory reaches a profound level, it is hard to be directly discovered, and hard to directly play a reversing role in clinical practice; it is just that such depth of theory allows Fang Ziye himself, within basic theory, to explain profound concepts simply and easily navigate the various basic principles of common disease types.

"During the debridement surgery process, we should understand several concepts. First, crush syndrome; second, whether tissue is necrotic, whether tissue is in a pre-necrotic state; third, cell lytic necrosis caused by violent compression is immediate and irreversible, while local state disturbance caused by ischemia is adjustable."

"Therefore, during the debridement process, we must analyze them one by one. First, crush syndrome is common in prolonged compressive trauma; its essence is rhabdomyolysis."

"There is a key point here: prolonged tissue compression leads to calcium ion overload-mediated cell damage, resulting in cell membrane damage, leakage of intracellular contents, and reperfusion injury after entering the blood circulation."

"Therefore, this portion of tissue absolutely cannot be preserved, but should be excised promptly..."

"Furthermore..."

Fang Ziye did not elaborate in detail on the meticulous operation methodology, but only spoke of principled, conceptual things.

A speaker's sharing must also have a sense of priority; first, what you show others is not high-end technique or new operations, but to make others understand what exactly you are doing, what you have done, and what the results are after doing it.

Among the audience below, only an extremely small number of people knew that what you are doing is mangled extremity limb salvage surgery; this technique is theoretically feasible, and only an extremely small number of people have derived it.

If you don't make others understand the theoretical feasibility, then it lacks promotability, and it is also hard to attract others' interest.

Of course, what these people most want to see is still what kind of results you have produced.

Fang Ziye used three minutes to flip through six pages of PPT, roughly describing clearly the theoretical details to note in mangled extremity debridement surgery, and then began elaborating on the results.

"The second key step of mangled extremity surgery is still to follow the principles of trauma management: restore blood supply, use various methods to restore blood supply."

"Patent blood supply is the key to limb survival, and also the prerequisite condition; if the blood supply of the affected area and the distal perfusion of the affected limb cannot be restored, then the consequences are catastrophic, and severe cases can lead to patient electrolyte disturbance or even death."

"Methods of restoring blood supply are not the main content of this session's sharing."

"Next, let's look at the final results of the three groups of cases our team has done recently."

Fang Ziye's PPT turned to page 15, and the before-and-after comparison images of Yan Chu's first debridement surgery appeared before everyone.

The first image was a fresh mangled extremity, skin torn open flesh gaping, blood and flesh dripping, placed on the left side.

The second image was scarred skin; although scar tissue pulled in a patch, that foot with 'poor appearance' was not gone, but was actually reattached beneath the fair lower leg.

Moreover, the image content showed the lower limb suspended, representing that after surgery the patient's affected limb not only survived but also recovered a certain degree of active movement.

Accompanying the visual impact of the images was Fang Ziye's narration, each word and sentence unhurriedly spreading through the venue via the microphone: "After nearly six hours of effort by our team, this case of 'standardized lower limb mangled extremity' was successfully concluded with limb salvage surgery."

"However, this is not over; in the first image, we can clearly see that the patient has a large segment of tibial nerve damage."

Fang Ziye used a laser pointer to indicate the distance of the tibial nerve stump in the frame: "At least about eight centimeters of defect, this obviously cannot be primarily sutured."

"All teachers can also see that these soft tissues, after experiencing debridement, have fresh cut surfaces on the superficial layer of all muscles; under the condition of nerve damage and local motor function loss, muscle adhesion of the foot and ankle is bound to exist."

"Next, let's look at two sets of functional physical examination videos."

Fang Ziye flipped to the next PPT; the subtitle was very plain, simply named "Stillness and Motion".

However, the first silent short video was the physical examination of Yan Chu's active and passive foot and ankle function.

"No sensation? None."

In the video, a white coat poked Yan Chu's sole with a needle tip: "No pain?"

"No pain." The little girl's voice came through.

"Passive movement obviously restricted, foot and ankle and below muscle adhesive rigidity."

Fang Ziye did not explain, but opened the second video; the video opened with the same foot, only the other side's morphology was slightly fuller and rounder.

The video opened with the white coat poking the sole again: "Any sensation?"

The little girl's foot withdrew: "Like a little mosquito bit me."

"Move it. Plantarflexion."

The little girl plantarflexed 5°.

"Dorsiflexion."

The little girl dorsiflexed about 8°, and the ankle joint's internal and external rotation, foot inversion and eversion, although not up to a normal person, these functions have all recovered.

And one can clearly see the muscles bulging unevenly under the scar skin during contraction this time.

At this point, Fang Ziye said: "The content we are sharing today only involves limb salvage surgery, so unrelated topics we will temporarily not discuss; if all teachers, seniors, colleagues..."

Fang Ziye had only spoken halfway when someone below, I don't know who, rudely blurted out a high note.

"If you're not gonna say it, why the hell did you play a video? Fishing for attention?"

Obviously a person with a rather explosive temper.

Seemingly unknown who it was, but after the scolding started, people sitting left, right, front, and back turned their heads and bodies, surrounding him in a layered circle, with this Big Brother encircled at the very center.

Fang Ziye and the Conference Host both saw him, but Fang Ziye paid no heed, continuing: "If interested, we can discuss in detail after the meeting or have another opportunity for detailed exchange later; this is a conference after all, time is limited."

"Today our topic is 'Standardized Mangled Extremity' limb salvage surgery treatment; other unrelated topics will not waste everyone's time."

"Next, let's look at the second case our team did; the difficulty of this case is far higher than the first one..."

Duan Hong actually also saw the person who blurted the high note, but at this moment he only felt this person had clear eyebrows and bright eyes, exceptionally pleasing to the eye.

In a trendy phrase: dig a pit and don't fill it, live ten years less; Fang Ziye's move is purely asking for a beating.

Naturally, Fang Ziye is a standard scholar; he knows every small lecture only converges on one topic, and during the topic process, without any PS traces, he simply and brilliantly foreshadows the next small lecture's content.

Actually, publishing papers also depends on whether the Editor is interested in your research direction and content; if you happen to suit his taste and catch his curiosity, then your subsequent submissions will become relatively much simpler.

If the preoperative phase was just laying the groundwork, then once the second case arrived, it was purely a "showing off" segment.

Fang Ziye had already finished laying the groundwork for what mangled extremity is, what "standardized" mangled extremity is; the first mangled extremity patient not only had limb salvage surgery completed, but the salvaged limb was more than just a "display piece"!

It could actually recover some function — this was truly a bit staggering to hear.

With this thought in mind, everyone in the conference venue was anticipating: could this second patient with thigh mangled extremity also have the limb saved, and after saving the limb, could function also be reconstructed??

The former was inevitable, because this was personal understanding of mangled extremity limb salvage surgery, but the latter was not necessarily so.

Once the femoral nerve and sciatic nerve are damaged, the difficulty of reconstruction is extremely great; in this world, there are too many patients with sciatic nerve dysfunction who are plagued by it, suffering intractable pain, even paralyzed in bed.

Fang Ziye said: "This patient's surgical time was twice that of the first mangled extremity surgery."

"One very key reason was that he had a hip joint injury; secondly, he had bone defect, and the primary insertions of many muscles had no anchor point……"

"The debridement surgery for this hip joint injury took our team nearly seven hours, and the subsequent closure and shaping took another two to three hours."

"Of course, for an injury at this location, a relatively easier point to handle is that the vessels are relatively singular — just the anastomosis of the femoral artery and popliteal artery; to complete a primary limb salvage surgery, the difficulty is not vascular patency, but rather to handle the soft tissue well……"

"This is his postoperative image; it can be seen that the lower limb morphology is intact, the skin defect still exists, but with secondary flap transplantation surgery, bone defect transplantation surgery treatment, etc., it can be solved relatively well."

"I estimate all you seniors are very curious about his final state at discharge."

Fang Ziye pulled the same trick of digging a pit and not filling it again, directly putting up the image of the patient "on crutches" walking out of the department.

There was no video, but in the image, the patient himself was leaning on a crutch, both feet on the ground, affected limb stepping forward, healthy side bearing weight — this already explained everything.

"This is our team's second mangled extremity limb salvage surgery; the limb salvage result is still gratifying……"

When Fang Ziye spoke here, he discovered that several unfamiliar old men had squeezed in behind the door; Zhongnan Hospital's Xiong Zhizhang and Old Professor Wen Dongfang were among them, and the other few, Fang Ziye couldn't name.

But these people's arrival did not interrupt Fang Ziye's continued sharing.

Flipping through the PPT, he began sharing the third group of mangled extremity's "road to counterattack".

When the PPT reached page 29, it was about to enter the finale.

Fang Ziye's PPT was not long overall, only thirty-six pages, the last page still being the curtain-call thank-you-for-listening line, equivalent to only seven pages of content left.

After Fang Ziye showed the third mangled extremity patient's discharge outcome, the people below started cursing and grumbling, swaying left and right……

Even on the lecture podium, Fang Ziye could hear bursts of abusive cursing.

"Have some shame?"

"Act like a human being?"

"Any quality at all? Digging pits and not filling them, not mentioning a single key word, but saying a whole basket of unimportant stuff."

"Lecturing some actual dry goods……"

Fang Ziye just pretended not to hear.

It truly wasn't that Fang Ziye had no quality; it was simply that time was limited.

At this kind of academic exchange conference, who would take purely technical content to lecture on stage? If you really lectured technique, with limited time, you'd just get through an opening before it's the next person's turn……

That would be truly miserable.

Those who understand can understand Fang Ziye, but that doesn't stop those who understand from cursing in the audience……

After Fang Ziye put up the next PPT slide, it was destined that this lecture's explanation entered the finale: "takehomemessenge (core takeaways)."

"Based on our team's experience, we cautiously make some summaries here. If one wants to do mangled extremity limb salvage surgical treatment, it is suggested to first confirm the diagnosis well."

"1. Start by contacting mangled extremity limb salvage surgery from lower limb mangled extremity."

"According to our team's experience, surgical time for mangled extremity at the lower leg and below is roughly concentrated in five to eight hours; if it is thigh mangled extremity, then about twelve hours are needed; if it is cross-joint injury, surgical time extends to about sixteen hours."

"2. Currently our team has not performed limb salvage surgery treatment on upper limb mangled extremity."

"Because when the team privately preset surgical time and surgical procedure, considering that hand functional complexity is dozens of times that of the foot, surgical time might extend to twenty-plus hours or even longer, which requires a super-large team's coordination."

"3. The core focus of mangled extremity limb salvage surgery is debridement; the theoretical focus of limb salvage surgery lies in blood supply."

"Still the same old talk: the direct core of emergency trauma is debridement surgery ensuring integrity and viability of local soft tissue envelope. Blood supply patency is the prerequisite condition for body tissue survival."

Three sentences, each paired with an image, and this arrived at page thirty-two.

The clamor below gradually calmed, watching the stage seriously.

Although the key information Fang Ziye gave was purely theoretical stuff, the core of every disease type is still theory as the skeleton support; operation is just the on-the-spot performance repeating the theoretical skeleton support.

Things that don't hold up in theory — wanting to operate them into existence — that's impossible.

For example, perpetual motion machines — there are always people who think they've invented a perpetual motion machine.

Fang Ziye continued flipping open page thirty-three at a steady pace.

Page thirty-three is the subsequent outlook for mangled extremity treatment.

Page thirty-four is suggestions for team personnel allocation for mangled extremity standardized treatment.

Page thirty-five is a feedback on the shortcomings of the mangled extremity surgeries the team has currently done, pointing out where current surgeries can be optimized.

Page thirty-six, thanksforyourattention!

"Thank you all teachers, seniors, colleagues for listening; the above is what I brought to share about some cases our team has been doing recently. Looking forward to all teachers' criticism and correction; there are still twenty minutes left!" Fang Ziye's voice was still continuing when he was interrupted.

Duan Hong picked up the microphone and interrupted, saying: "Everyone, which content from so many speakers in the morning session's second half are you most interested in? Next is the Q&A interactive session. Me personally, I first request Doctor Fang not to step down; I have a few questions to ask."

Fang Ziye tilted his head to look toward Duan Hong's direction; all three hosts were eager to try, very obviously having a bellyful of questions they wanted to raise.

However, while Fang Ziye was still tilting his head, a familiar voice from the surround speakers spread and invaded into Fang Ziye's ear canal: "Conference Chairman, now is the Q&A session; according to the second half's speaking order, questions should start sequentially."

"According to this conference's agenda arrangement, each speaker only needs to answer at most five questions, which means that we audience members can ask each speaker five times, right?"

"I personally am very interested in the topic shared by Director Han Xianlong in the second half's first session; don't know if I have a chance to consult Han Xianlong face-to-face?"

Deng Yong stood up, very actively and enthusiastically displaying his thoughts.

At the same time, next to Deng Yong were Han Yuanxiao, Yuan Weihong, Vice Professor Chen Fang, and the newly arrived Liu Huanglong, all eager to try.

Everyone held notebooks in hand, obviously having registered quite a few questions, intending to grill the previous speakers with full force and drag out this Q&A session.

Deng Yong's buttocks stuck out, and Duan Hong knew what shit he was pulling.

Eyelid lifted, brows knitted: "Deng Professor, this is an academic conference venue; shouldn't it be listening to everyone's opinions and ideas?"

Deng Yong spoke openly and generously: "Academic exchange lies in fairness and freedom, not in the so-called opinions of the majority."

"If academia follows the crowd, then there is no academia to speak of. If academia reveres the mainstream, then there is no innovation or hundred flowers blooming."

"And, whether according to the speakers' order of appearance, or according to seniority and ranking, there should still be a first-come, first-served principle." Deng Yong finished speaking with a smile.

He pointed directly at Fang Ziye: "You, this young whippersnapper who doesn't know the rules, when did you book this entire podium?"

After hearing this, Fang Ziye immediately went with the flow and walked to the very center of the podium, in front of everyone, bowed, then transformed into an obedient, well-behaved student, holding his computer, and exited from the side.

Fang Ziye ran away again! ~

Everyone at the scene erupted into an uproar.

Isn't this too shameless?

When Duan Hong still wanted to say something, Deng Yong stood ramrod straight: "Conference Chairman, I want to start asking questions now, I can't wait any longer."

Duan Hong was helpless.

He could only let Deng Yong speak.

Then Director Han Xianlong had no choice but to stand up, receiving the attention of everyone present, forced to perform.

Deng Yong asked a question that was irrelevant to the main point, but very difficult to answer.

"Director Han, when your team was doing micro-innovation on the research project, what was the clinical foothold you based it on?" After Deng Yong finished speaking, his face was full of anticipation; the Oscars owe him a statuette.

How to answer this? Micro-innovation on clinical projects in prefecture-level city hospitals — do they really rely on a clinical foothold? Just like mangled extremity injuries, which have certain blind spots, clinical blind spots that almost no one in the world currently does, were squeezed into by Deng Yong's team and others.

But once the question is out, there must be an answer, regardless of whether the answer is good or bad.

Han Xianlong hesitated for over ten seconds before cautiously replying: "Professor Deng, our team's innovation was mainly based on the hope of reducing surgery time and accelerating patients' postoperative rehabilitation."

"But the actual situation doesn't seem to be quite like that, does it?"

"According to my understanding, you only increased the quality, but the surgery time and postoperative hospital stay weren't specifically highlighted — is it that you didn't do the statistics?" Deng Yong asked.

At this point in the scene, some people could see Deng Yong's purpose.

It was probably to shorten the questioning time Fang Ziye would have to face later.

The Q&A session was only twenty minutes total; in the second half there were five speakers total. If the first four each answered five questions, Fang Ziye wouldn't have to go up.

……

At 11:54:47, Director Han Xianlong finally sat back down trembling with trepidation, with a slight cold sweat on his forehead.

When he handed over the microphone, he only felt a sense of having survived a calamity.

Han Xianlong had never thought that the micro-innovations he did actually had so many not-so-good details that could be picked at; if really targeted by someone with ill intent, doing projects like this would very likely be spinning a cocoon to bind himself.

However, once the topic reached here, Deng Yong and Han Yuanxiao both sat down!

Yuan Weihong and the others also didn't question the subsequent speakers anymore, handing the entire Q&A session over to Duan Hong.

Deng Yong naturally had to pave the way for Fang Ziye, but the way of paving the way wasn't to let Fang Ziye avoid being questioned, but to show everyone: don't go too far, everyone has an elder or two.

Ask the questions that should be asked, don't deliberately make things difficult for people...

Fang Ziye, leaning against the wall, smiled faintly upon hearing this.

The scene of Deng Yong and the others sitting down side by side simultaneously was deeply engraved into the depths of Fang Ziye's heart.

The benefits of integrating into a team lie not only in the team's assistance and resources, but also in many, many other things — for example, giving you more solid confidence, letting you not be bullied at critical moments.

Duan Hong's voice rang out once again, interrupting Fang Ziye's thoughts. Fang Ziye turned his head to look in Duan Hong's direction. Professor Duan also symbolically asked the audience again if anyone else had other questions for the subsequent speakers, and the whole venue fell deathly silent.

After this, Duan Hong said: "No one has questions? Then I have a few questions, I'd like to consult with Zhongnan Hospital's Doctor Fang Ziye."

Being called on, Fang Ziye could only walk forward a few steps from the crowd again, leaned diagonally against the left side of the second row, and took the microphone handed by the staff.

Smiling ingratiatingly: "Teacher Duan, please ask, but please don't ask anything too difficult."

The differences in status, influence, connections, resources, etc., between himself and Duan Hong were completely not on the same level.

These things all have to be slowly accumulated by oneself, not achieved overnight. If you have such capability, these things will immediately gather around you.

Fang Ziye's preemptive show of weakness did not cause everyone's discomfort; on the contrary, they felt that Fang Ziye, from his previous lofty superiority, returning to the human world, was just an ordinary youth, with all his joys, sorrows, angers, and pleasures on full display.

He also has people he fears, and people he respects.

Duan Hong's first question was very stimulating: "Doctor Fang, what is your position in your team?"

"In surgery, what is your position?"

Duan Hong knew Fang Ziye was the lead surgeon.

But others didn't know Fang Ziye was the lead surgeon, and the surgical record didn't write it either, so Fang Ziye very naturally replied: "Teacher Duan, you're asking a question you already know the answer to."

"I'm just a student who recently graduated with a doctorate, currently only a resident physician, so naturally I'm an assistant."

Duan Hong immediately asked a second question: "Hmm, not bad."

"It's just, for your team's first case, who in your team was the lead surgeon? How did you think to pursue the mangled extremity research direction?" Duan Hong directly brandished a giant saber over three thousand meters long.

Who was the lead surgeon for Yan Chu's mangled extremity limb salvage surgery?

Duan Hong, Deng Yong, Qi Qiaowen!

No Fang Ziye; at that time, Fang Ziye's debridement technique was just a little brother.

Fang Ziye was able to go on stage because Duan Hong promoted him, letting Fang Ziye go on stage to perform the fracture closed reduction technique.

This question was very difficult to answer; at least Fang Ziye needed to think for a few seconds.

During the time Fang Ziye's gaze met Duan Hong's, the sound system transmitted the low muttering of Deng Yong and Yuan Weihong, as if they were about to stand up and take the blame on their own heads.

After hearing a few syllables, Fang Ziye hurriedly interrupted: "The lead surgeons for the first mangled extremity limb salvage surgery were Professor Deng, Professor Duan, and Professor Qi."

"The reason for considering moving toward the limb salvage surgery topic was that after the three professors discussed it together, they felt there was a certain probability of limb salvage, so they tried to carry out the first limb salvage surgery clinically."

"In May, Professor Deng, Professor Liu, and Doctor Yuan, after experiencing nearly two months of exploration and discussion, performed the mangled extremity postoperative functional reconstruction surgery."

"Throughout the entire process, I was just acting as an assistant." Fang Ziye emphasized once more at the end.

Openly and straightforwardly, he laid out the whole story.

Everyone at the scene, upon hearing this, instantly fell deathly silent.

So that's how the mangled extremity research project came about.

But it seems strange questions have multiplied again.

Why would Zhongnan Hospital list it separately? Why didn't Tongji Hospital and Peking Union Medical College Hospital spin it out as a clinical project?

After Fang Ziye finished speaking, sensing the room fall silent for a moment, he thought carefully but did not voice the rest of his words!

If you're so capable, you do it then — hasn't your Tongji Hospital secretly done mangled extremity cases?

Hasn't Peking Union Medical College Hospital secretly done them too? What's the point of asking these things? Deng Yong also participated in the first mangled extremity case you did.

The content you discussed together — can't each person take it back and do it independently?

If a hospital encounters a mangled extremity case, either amputate, or call Duan Hong and Qi Qiaowen to rush to Zhongnan Hospital for surgery? Would you come on call?

Of course, these words were unnecessary to say aloud.

The surroundings remained silent, yet it didn't make Fang Ziye panic. At this moment, Fang Ziye was glad the speaker was himself.

Fang Ziye is young enough to be shameless enough, so he can acknowledge many teachers — I'm just a doer, I can learn from whoever teaches.

After Fang Ziye finished, Duan Hong's expression eased from shock, then turned awkward: "My questions are done, Director Fu, Professor Qin. Do you have any questions?"

Director Fu is the director of Yi City People's Hospital, also holds a doctorate, currently has the Associate Professor Title, and is also one of the Conference Host members.

Professor Qin is the Director of Orthopedics at the Provincial Central Hospital.

Duan Hong hurriedly passed the questions off.

Don't be fooled by everyone's dead silence now — once they recover from Fang Ziye's candid reply, the "crusade" target will shift.

You, Duan Hong, can't rely on seniority to bully people — the project is public.

As long as others don't steal your data, don't plagiarize your core technology, aren't the ones who kicked you out — then the project isn't surnamed Duan, so why are you sitting here asking these questions?

Want to say this mangled extremity business also has your share, Duan Hong?

Want Zhongnan Hospital to hang your name up?

You're a Director Committee Member of the Trauma Surgery Branch — how can you be such a sore loser?

Duan Hong never expected Fang Ziye would so openly admit it from the start.

And hearing Duan Hong hand over the questioning rights, Professor Qin Yu asked directly: "Doctor Fang, I only want to ask two questions — you just need to answer relatively simply."

"First, for this disease type of mangled extremity, would the team needed be very difficult to build?"

"Before you successfully completed the first mangled extremity limb salvage surgery, roughly how many amputations did you go through?"

Professor Qin Yu's questions were more down-to-earth, closely related to what Fang Ziye shared.

"Currently there's some difficulty — our team's first surgery initially accumulated extremely large manpower; the lead surgeons were Professor Duan Hong, Professor Qi Qiaowen, Teacher Deng Yong, Teacher Yuan Weihong, and others."

"Within my scope of vision, our first operated case achieved limb salvage success, but before that, specifically how many failed — that exceeds my personal knowledge."

"After that, our team successively treated eight or nine mangled extremity cases — currently postoperative rehabilitation is all within the predicted control range! ~"

"I believe if another mangled extremity limb salvage surgery team were to be built, it would be much easier than when our team was first established."

"Current data is limited, lacks statistical significance, so we haven't shared detailed techniques or objective data — precisely to avoid misleading everyone!"

"If our team eventually produces a relatively clear result, explores a feasible mangled extremity treatment plan and process, we will definitely publish it at the first time." Fang Ziye spoke while standing at attention.

After finishing, he put the microphone down, courteous and composed, not nervous, no sharp high-pitched words.

"Hua la la la la! ~"

"Pa pa pa pa pa!"

Everyone in the venue erupted in thunderous applause once again.

Strolling leisurely yet concealing a commanding presence.

Even Duan Hong spoke up once more to praise and explain...

(Chapter End)