Chapter 7: Don't Struggle in Vain (Asking for Favorites, Asking for Follows)

Time flows like water; in a flash another two days passed, and it was Friday.

Monday and Friday are Teacher Deng's surgery days.

Afternoon, 3:42 PM. Of the seven surgeries in our group, after Teacher Deng resolved four major ones with consummate skill, the remaining three relatively minor surgeries were each assigned to a separate station.

The remaining three relatively minor surgeries were each assigned to a separate station.

With many people in the group, Associate Professor Xie can hold his own; basically all surgeries he can do, and even for the high-difficulty surgeries Teacher Deng operates on, he can barely prop them up, only his proficiency and technical mastery are not as good as Teacher Deng's.

Taking the last medium-difficulty pelvic fracture open reduction internal fixation surgery into his hands, he called a Doctor and his own Master's student, and opened the station.

Yuan Weihong took a small-segment bone defect; Qin Geluo Attending Physician chose a simple fracture open reduction internal fixation surgery, and also brought people to find an operating room.

Yuan Weihong's teacher-student trio on the same station!

This is the strength of a surgical team in a top-tier major hospital: gathered they are a single dragon, scattered they are stars filling the sky; as long as there are enough operating rooms, opening four surgeries at any time can be done.

At this moment, Fang Ziye stood at the lead surgeon position, Yuan Weihong was temporarily at the assistant position, and Jie Han was at the second assistant position helping out.

After the sterile sealing film was applied to the leg, Yuan Weihong used toothed forceps to mark the surgical incision point by point, then drew an arc, and tossed the kidney dish in front of Fang Ziye.

"Follow this line, start cutting." Yuan Weihong already knew from his youngest student's mouth that Fang Ziye's current incision technique had passed the rubber cutting stage in the training room.

But he hadn't witnessed it personally, so he wanted to take a good look at Fang Ziye's current basic skills.

Fang Ziye didn't stand on ceremony either, muttering: "Thigh anterior, subcutaneous fascia layer is about 4mm, first cut depth controlled at about 3mm can avoid cutting fascia layer vessels, reducing blood loss."

This is the benefit of strictly practicing according to standards in the training room; flexibly applied in clinical practice, it allows quick getting started.

Fang Ziye held the knife pen-style, entered vertically, moved in an arc, exited vertically.

One cut down, clean and decisive, not the least bit muddling.

Yuan Weihong wiped the wound surface with a dry cotton pad; bloodstains were only a minimal amount, the wound was still fairly dry.

Yuan Weihong then knew Fang Ziye's current skill was indeed somewhat deeper than before; the previous Fang Ziye, when making incisions, either had inaccurate arc positioning deviating from the preoperative design, or uneven depth locally breaking vessels, causing massive oozing.

"Electrocautery, electrocoagulation function, cut!" Yuan Weihong signaled Jie Han to use forceps to spread the skin outer incision while handing the electrocautery to Fang Ziye.

The electrocautery has electrocoagulation and electrocauterization two functions; electrocauterization is purely for hemostasis, electrocoagulation is for cutting.

Fang Ziye was not led into Yuan Weihong's trap; he turned his head: "Circulating Teacher, adjust the electrocautery current. 40!"

If he really cut at that setting he'd be an amateur; Fang Ziye has always been cautious and steady, impossible to perform resection at 60mA.

Yuan Weihong sniffed his nose; he originally planned to probe whether Fang Ziye's temperament had become arrogant after his capability improvement, but failed to probe it.

After skin incision, what needs exposing is the subcutaneous fascia layer and fat layer; these two layers cut with electrocautery can achieve hemostasis during the cutting process — this is the flexible application of electrocoagulation hemostasis.

Fang Ziye finished them one by one, reached the deep fascia layer, then stopped, put down the electrocautery, and honestly handed over authority.

Next step is about muscle exposure; Fang Ziye's basic skills haven't reached that deep yet, so he temporarily doesn't touch it. He picked up two S retractors, handed one to fellow trainee Jie Han, held one himself, and very tacitly went to take the suction device from Yuan Weihong's hand.

The meaning goes without saying.

Teacher, I cannot order you to operate, but I have already prepared as an assistant.

Yuan Weihong said nothing, picked up a hemostat to clamp the deep fascia layer, after a pointed knife opened a small opening he proceeded with blunt dissection; after the muscle layer was spread, he switched to a large S retractor.

After exposing the femur, the bone defect segment was seen. Then having Fang Ziye excise the scar tissue around the bone defect for debridement...

Then harvesting the ipsilateral fibula with vascular pedicle and transplanting it over, shaping with titanium mesh, a series of operations complex and exquisitely subtle, making Fang Ziye and Jie Han both greatly envious...

But a ten-thousand-zhang high tower rises from level ground; Yuan Weihong's operations also started from incision, suturing, debridement and such.

"Fang Ziye you suture the inner layer, Jie Han you suture the subcutaneous, let me see your suturing techniques, what level each of you is at." Yuan Weihong, like an old bird, feeding fledglings.

Fang Ziye heard this and instantly felt a surge of joy.

Honestly accepting the needle holder and 3-0 monofilament suture, he began steady and solid work.

Suturing, besides requiring operation, a certain basic understanding is needed.

The periosteum layer certainly needs suturing; here continuous suturing can be used, one needle to the end; after suturing, layers remain distinct, periosteal apposition excellent.

Then the deep fascia layer; deep fascia can choose continuous suturing or simple interrupted suturing, and at this time it tests a certain level of skill.

Sutured poorly, it bunches the deep fascia into a lump. Apposed well, it's just like half-layer suturing orange peel, achieving just-right seamless closure.

Fang Ziye has already reached this level.

Muscle layer not incised; Teacher Yuan Weihong took the intermuscular approach, no handling needed.

Then the subcutaneous fat layer; fat layer suturing demands even more full-thickness suturing.

It needs tight apposition but not so tight as to cause local fat compression leading to postoperative fat liquefaction; this has the same clever effect as suturing tofu.

Fang Ziye operated two stitches, the corner of his mouth revealed bitterness, he looked at Yuan Weihong.

Yuan Weihong said: "It's fine, making do works, continue suturing."

Sometimes a local minor operation isn't the optimal solution, but doesn't greatly affect the overall surgery; Fang Ziye just sutured not that well, not that he couldn't complete it, but the level difference is clear at a glance.

At more critical suturing positions, say near the joint capsule, even more exquisite suturing is needed to avoid patient functional limitation.

Fang Ziye honestly followed routine to complete the fat layer; completion degree was truly not high. But reaching the subcutaneous fascia layer and subcutaneous layer, this returned to orange peel suturing style operation.

Fang Ziye gathered his confidence again, finished suturing the subcutaneous layer, making skin apposition very good, with a kind of auntie-smile looking at the achievement like the Doctor senior brothers used to after finishing suturing, looking down on everything.

Pressure shifted to fellow trainee Jie Han here.

Jie Han right now trembling with trepidation, newly arrived, just a department rookie; the only medical skill he relatively mastered was suturing technique.

Depth control insufficient, one stitch deep, one stitch shallow.

Only two stitches down, Yuan Weihong couldn't bear to watch, directly cut the suture knot: "Forget it, you go back to the training room and stay a while longer."

"This wound going back to the ward, we can't answer to the patient and family."

Jie Han as if granted amnesty, handed the needle holder back to senior brother, gaze curious yet expectant, exactly like Fang Ziye two years ago, no difference at all.

Surgery finished, fellow trainee Jie Han responsible for accompanying the patient to the ward.

Fang Ziye took away the massive 4 Knowledge Points, accompanied Yuan Weihong together down to the changing room.

Yuan Weihong silent all the way, Fang Ziye also didn't dare speak, only his eyes flashing with strange colors, as if expecting, yet also afraid.

However, in the end it was Yuan Weihong who couldn't hold back first, turning his head to say: "Although your basic skills have improved slightly now, it's still a bit too late."

"Right now it's already mid-August, less than half a year until our hospital's doctoral admissions."

"If there were still a year and a half, you could still fight for it. But wanting to pass the First Training Room, even if you only face the 'castrated version' requirements that master's students face, it's a bit late."

"Go find a proper job."

Fang Ziye, unwilling to give up, asked: "Master, what are the actual requirements for us master's students to pass the First Training Room?"

Yuan Weihong glanced at Fang Ziye, also extremely unwilling to see him give up, so he simply made him give up completely by stating all the harsh requirements one by one: "Suture the tofu well, the incision technique requires being able to cut the tofu into an eight-faced golden pyramid shape, with distinct tiers."

"The debridement technique requires being able to carve three-dimensional simplified Chinese characters on the tofu, the hemostasis technique requires quickly locating and capturing bleeding points on blood vessels, within twenty seconds, repeating a single point forty times, with a standard completion rate higher than thirty-six times."

Upon hearing this, Fang Ziye felt instinctive despair.

But after thinking it over carefully, he only kept silent, yet his eyes were full of unyielding resolve.

Yuan Weihong turned his head, and after seeing Fang Ziye's gaze, tilted his head to whisper in Fang Ziye's ear: "Tomorrow go run the Finance Department reimbursement board fee, you have a Zone 1 SCI article, you need to study its contents thoroughly."

"You must master it inside out within a month, not a single data point off, remember it all."

"If anyone asks, the author is you, I'm just the supervising teacher, then prepare well for the external hospital's doctoral exam. Did you hear me!"

Fang Ziye froze for a moment, his heart warming.

(Chapter End)