top student at medical school

Chapter 179 How many bones have you knocked?

Trauma surgery focuses on debridement and hemostasis. This is only a partial emphasis.

This does not mean that incision and suturing are unimportant.

The organic combination of debridement and incision can actually evolve into bone grafting, which is different from osteotomy as a direct specialty evolution of incision.

Clinical practice places varying degrees of emphasis on different basic skills, not because they are considered important, but because these basic operations can evolve into many important components of specialized technical skills.

For example, the reason why the debridement technique is required to carve three-dimensional characters in the training room is, to a certain extent, to lay the groundwork for bone grafting and debridement.

Otherwise, what's the point of simple debridement if you're using it on fracture defects or irregular fractures?
Flexibility and adaptability are required.

Bone grafting, a procedure that is more detached from basic skills than trauma surgery, is closest to the ideal state. It means that you take bone in the shape that corresponds to the extent and form of the bone loss after the fracture.

However, such a design usually only exists in theory.

In clinical practice, bone strips are the most commonly used raw material for bone grafting.

Whether it's artificial bone or autologous bone, the raw materials used for extraction are mostly designed in long strips, which are then spliced ​​together or subjected to pressure grafting.

Of course, are there any more advanced artificial bone materials?
Yes, there is such a method: 3D printing. The bone defect is printed based on its exact structure and then directly implanted. This is an advanced material variant of artificial bone, requiring both 3D printing technology and techniques for manipulating artificial bone materials.

Corresponding to 3D-printed artificial bone materials is autologous bone harvesting, which allows for the extraction of raw materials that most closely resemble the shape of the bone defect, based on the specific condition of the defect.

The principle is simple, but the operation is extremely difficult.

Surgeons who can perfectly and accurately extract bones that are specifically adapted to human bone are usually one or two of the most core professors or associate professors in a group.

In most cases, minor procedures like bone harvesting are used by the attending physician for practice.

Take Shen Tao as an example. He is currently in the practice stage of bone harvesting in the group. He needs to improve his fine skills step by step. He needs to design exquisite bone harvesting procedures using human iliac bones, fibulas, and other materials that can be used as raw materials for autologous bone transplantation, and then translate the design drawings into practical skills.

Unfortunately, Shen Tao is still in the initial stage of training in the second training room of the Orthopedics Department of the People's Hospital.

This also led him to believe that Fang Ziye was a promising talent when he saw that Fang Ziye could complete the bone removal procedure in the shape of a square cuboid from the very beginning of his exposure to bone removal.

At that time, Shen Tao felt that Fang Ziye's basic vocational skills were within an acceptable range.

But how come Fang Ziye suddenly appeared all of a sudden after such a short time?

You said you were only good at research, and your clinical skills were just average?

Who the hell said that?
Who spread the rumor?

I want to kill him—

Oh, it's Zhang Mingcan. Never mind then.

Shen Tao's rich inner world is something that most people cannot understand.

Only Wu Guonan, who had occasionally undergone autologous bone harvesting, felt the same shock as Shen Tao at this moment. After all, he was the chief surgeon of the team, and he was responsible for all the difficult and complicated surgeries in the group.

If you are not in your position, you will not seek your government.

Associate chief physicians like Xue Tao, who, when faced with difficult and complicated cases, would simply smile indifferently at Director Wu Guonan, would never appreciate the value of Fang Ziye's technique at this moment.

"It's quite beautiful." Xue Tao moved his very thick eyebrows, his tone full of appreciation, like a great master who had been sweeping away the world, calm and composed.

Wang Zhongxing picked up the fresh, bloody bone fragment that Fang Ziye had taken out, compared it with the bone defect, and exclaimed in amazement: "It's almost there. Although there's still a slight difference, it's still very good."

Fang Ziye remained calm and composed. After completing the procedure, he asked the scrub nurse, "Bone wax."

Fang Ziye could actually improve his bone-harvesting skills by adding more points, but there's absolutely no need for that!
As I said before, as long as your skills are sufficient, there's no need to pursue perfection. Just improve your level to the maximum extent possible within your current scope and be worthy of your current status.

Knowledge points are precious and hard-won, with countless uses, and Fang Ziye doesn't want to waste even a single one.

After bone harvesting, bone defects will appear in the original bone, but the location is not critical and it does not bear any force.

But it is still necessary to stop the bleeding.

The scrub nurse, who didn't quite understand what Xue Tao and Wang Zhongxing were doing, naturally didn't find anything intriguing about it. She simply handed over the bone wax, her brows furrowing, and said in a sweet tone, "Dr. Fang, just a little bit is enough."

Looking at the three innocent-looking children, who resembled Teletubbies, Shen Tao felt a little melancholy.

Sometimes, the more you know, the more you realize how vast the world is; the more ignorant you are, the less afraid you are, and the less awe you feel.

Shen Tao didn't know what to say, so he looked at Wu Guonan, who had a similar reaction to him: "Director Wu, let's start the bone grafting. This autologous material is good, so we don't need to suppress the bone grafting."

"Yes!" Wu Guonan nodded.

Wu Guonan actually knew more than Xue Tao, because Wu Guonan's focus in the department was on hand surgery.

In the field of hand surgery, there is a relatively high-end specialty procedure called bone flap transplantation.

Bone flap transplantation is actually a more advanced variation of bone harvesting, and it is most suitable for the treatment of bone defects, osteonecrosis, and other conditions.

"Next time, we can have Ziye try a pedicled bone flap procedure. I'm sure he can manage it if he understands vascular incision." Wu Guonan chuckled softly, then looked at Fang Ziye with a more serious expression.

Bone flaps differ slightly from autologous bone grafts.

Autologous bone grafts are bone graft materials, consisting of pure bone blocks.

A bone flap is a piece of bone that is removed, but this piece of bone must also contain blood vessels or muscles. A bone flap with blood vessels is called a vascular bone flap, and a bone flap with muscles is called a myobone flap. Its function is to fill bone defects, serve as a bone graft, and promote fracture healing or bone growth. For example, in the surgery of femoral neck fracture, a quadratus femoris muscle bone flap is implanted into the fracture ends, which can play a role in promoting fracture healing.

The pedicled bone flap that Wu Guonan mentioned is actually an abbreviation for pedicled vascular bone flap, which can be further subdivided into pedicled periosteal bone flap and anastomosing vascular periosteal bone flap!
Being professional and being highly professional are actually two different concepts.

Wu Guonan's words caused Xue Tao's face and expression, which had been as delicate as a Teletubby, to slowly stiffen.

Xue Tao was an associate chief physician working under Wu Guonan. Even if he was ignorant, he knew the significance and value of Wu Guonan daring to let Fang Ziye perform a pedicled bone flap procedure.

Wang Zhongxing had a similar expression at this moment, glancing sideways at Fang Ziye.

However, this time, Fang Ziye himself became a little confused again.

Fang Ziye didn't quite understand the design challenges of pedicled bone flaps. After all, Fang Ziye was a master's student in trauma surgery; his understanding of hand surgery was superficial, but certainly not as deep as that of a practitioner.

Orthopedics is much more than just fractures.

Hand surgery encompasses far more than just muscle and tendon suturing and limb replantation.

The surgery then continued.

Wu Guonan and the others all glanced at Fang Ziye, intentionally or unintentionally, with many questions in their minds, but none of them asked directly.

Because it's not time to ask questions yet.

Let's perform the surgery first. On the operating table, performing surgery and treating the patient is the top priority.

Even if questions are asked, they can only be educational or joking in nature. Formal clinical Q&A or gossip are usually left unsaid by people with some surgical training.

Instead of acting like a lunatic on the operating table, asking all sorts of questions.

The surgery continued smoothly.

In cases of pelvic fractures with bone defects, after fixation and bone grafting, a small titanium mesh needs to be wrapped around the bone for further fixation. Because the bone graft material is dynamic, if it isn't secured and bound, the result will be free bone fragments rather than repair of the bone defect.

However, these are all harmless operations. They have a cognitive barrier, but they don't have much practical value. They are custom-made placement operations.

If it were handed over to Fang Ziye, with his Level 3 experience in operating orthopedic instruments, he could handle it, but he might not be as adaptable as Wu Guonan.

Once the fixation is complete, it's time for a visual inspection to assess the quality of the surgery.

Direct vision is what the doctor sees, but the results of fluoroscopy can be shown to patients and colleagues to some extent. Therefore, it is essential to keep a record of the findings.

This is because patients are generally not shown the results in the surgical field to avoid frightening them.

Keeping patients relatively ignorant and not having a clear understanding of the whole process is actually a form of protection against fear.

The surgery has finally come to an end.

The time has come to 12:37 PM.

There was another minor surgery scheduled for the afternoon, which was not expected to take too long. So Wu Guonan and the others went downstairs to the canteen to eat.

Of course, the patient's attending physician, Wang Zhongxing, had to escort the patient back to the ward and write out the medical orders before he could come down to eat. Halfway there, Shen Tao's lips twitched seventeen times, and after agonizing over the question more than thirty times, he finally asked, "Ziye, when you were at Zhongnan Hospital, how many people's bones did Professor Deng Yong and your master actually make you knock on?"

Generally speaking, modern medicine is a process of gradual accumulation.

The operation is the same.

The longer you study, the more skillful and refined your operation will become.

All skills are either learned in the training room or honed on the operating table.

Fang Ziye, at such a young age, has already achieved such profound expertise in bone harvesting. If it weren't for Professor Deng Yong's deliberate feeding, Shen Tao would have been speechless on the spot.

"There are some, but I don't remember the exact number," Fang Ziye said, not trying to be clever.

The procedure has definitely been performed. Since gaining Professor Deng Yong's favor, Fang Ziye has had occasional opportunities to practice minor procedures like bone removal, though he hasn't performed them that many times.

Of course, Shen Tao couldn't possibly keep specific statistics, because Fang Ziye himself hadn't done so either.

Hearing this, Xue Tao swallowed hard and asked, "Teacher Shen, is Ziye's bone-removing technique considered to be quite something?"

Later on stage, Xue Tao noticed that Shen Tao and Wu Guonan's expressions were slightly off.

Shen Tao didn't answer directly, but joked, "Director Xue, I might only have North and South left."

"Damn it!" Shen Tao immediately started rubbing Fang Ziye's hat, clearly very indignant.

"You must be the guardian deity sent to me by Heaven to protect the mountain."

Xue Tao clenched her fists nervously, feeling indignant.

Why is it that Fang Ziye, with his excellent research talent, also possesses such outstanding clinical talent? What window of opportunity did fate close for Fang Ziye?

He began to look Fang Ziye up and down, trying to find a balance.

Good looks are not a closed window.

Neither is her figure.

Could it be that?
Yes, that must be the case!

Xue Tao began to comfort herself.

Wu Guonan could only smile now, and asked, "Dr. Fang, do the people in your hospital's hand surgery department know anything about you?"

After listening, Fang Ziye glanced at Wu Guonan.

"Director Wu, I am a student in trauma surgery, so I am not very familiar with the teachers in hand surgery."

Wu Guonan also has a very good eye.

After a brief conversation, the group arrived at the locker room and changed the subject.

The discussion mainly revolved around Wu Guonan and Shen Tao, who were exploring advanced issues such as how to improve surgical quality and design surgical plans should they encounter similar pelvic fractures in the future.

This is feedback and reflection on the surgery.

Fang Ziye, on the other hand, was taking stock of the gains he had made from this surgery, which were not insignificant.

"Knowledge Points +29!~"

The improvement was very rapid; a single surgery resulted in an increase of nearly thirty points.

This has already exceeded the damage that Fang Ziye had previously removed under Yuan Weihong's care.

In other words, bone harvesting, a basic skill in the specialty, although only a basic skill, has been deeply integrated into the specialty and makes a significant contribution to the surgery.

This is much better than simply using an internal fixation device and performing manual reduction during the operation!

Of course, manual reduction surgery that is contraindicated for conventional surgery is not within the scope of comparison, as the nature of the two procedures is different.

Fang Ziye knew that the focus of future improvement should shift more towards specialized skills, since the charm of clinical practice lies in specialized skills, rather than simply basic skills.

Of course, a high level of basic operational skills is also very important.

If one's debridement skill level is not high enough, even if one's bone retrieval skill level reaches level 3 with 200/500 proficiency, one may not be able to design bone retrieval shapes with the same ease as one does now.

During meals, the surgical procedure is not discussed; instead, feedback is provided on the details.

But we won't go too deep, since it's in the cafeteria.

After finishing their meal, when they went back into the locker room, Shen Tao still asked, very resentfully, "Ziye, why don't you give me a heads-up? How many bones did you break?"

Unfortunately, among the skills Fang Ziye had previously demonstrated, apart from the manual repositioning technique, which was somewhat close to a professional level, the others were, in Shen Tao's view, just average.

Fang Ziye's manual reduction and suturing techniques are slightly better than his, but trauma surgery doesn't emphasize suturing, and manual reduction techniques have a very limited scope of understanding.

Shen Tao was confident he could completely outmaneuver Fang Ziye with his debridement and hemostasis skills, but he would never dare to show off in front of Fang Ziye.

How can a 35-year-old superior, the same age as Teacher Fang Ziye, compare basic skills with Fang Ziye? Does he have any shame?

The problem is that instead of bullying Fang Ziye, Fang Ziye actually chipped a piece out of his bone in his most important task of improvement.

Fang Ziye's access to bone harvesting was already remarkable, thanks to Professor Deng Yong's favoritism.

But Fang Ziye's bone-removing technique is even better than mine. Is there no logic to this?

Although it involves only some minor details, bone harvesting, a fundamental specialty procedure, is an important skill component of many major surgeries in the future, and it is used in a wide variety of procedures.

Of course, the reason why bone harvesting is a basic professional skill is because it is also very versatile. It can be developed and derived not only in the direction of bone defect treatment, but also in the direction of bone flap treatment.

These are basic procedures similar to incision and debridement.

"Teacher Shen, there really wasn't much. I can't remember either," Fang Ziye replied with a grin.

"Sigh, never mind." Shen Tao immediately covered his face.

So, as the old saying goes, comparing people will only lead to misery, and comparing goods will only lead to discarding them. Just stop comparing.

Although Shen Tao said it was fine, his expression became somewhat serious. He turned to Fang Ziye and asked with a mischievous grin, "Want to beat some of the big shots in the youth skills competition?"

"Hmm?" Fang Ziye tilted his head slightly, looking puzzled.

Shen Tao immediately puffed out his chest, looking slightly arrogant: "In last year's competition, I was only two places lower than your master, with a difference of only about 3 points."

Fang Ziye immediately became interested after hearing this: "Teacher Shen, how about we split the prize money? Could you give me some pointers?"

Fang Ziye was really looking forward to Shen Tao giving him some pointers, preferably on new directions, something new that would break through the existing barriers of understanding.

"Get lost, you think you're so great?" Shen Tao rubbed Fang Ziye's hat again and cursed him rather rudely, just like a real teacher.

"Then thank you, Uncle-Master." Fang Ziye also flattered him.

……

Upon hearing Shen Tao and Fang Ziye's conversation, Wang Zhongxing, who was going to participate in the skills competition, immediately looked worried and his expression became serious.

If Shen Tao were to interfere with Fang Ziye's participation, Fang Ziye would very likely overtake him. With one more person ahead of him, the chances of getting a result would decrease even further.

This is so much pressure.

But Wang Zhongxing didn't dare to mention asking Shen Tao not to give Fang Ziye any pointers.

Wu Guonan, however, didn't care about these trivial matters at all. Instead, he suggested, "Ziye, why don't you demonstrate your manual repositioning technique today? Let's do it quickly, get off the stage early, and then go out for a drink?"

Fang Ziye looked at Shen Tao.

Shen Tao squinted and nodded in agreement: "A little bit is good for your health."

For minor fractures, Fang Ziye's involvement can save at least twenty minutes, or even half an hour, of surgical time. However, Xue Tao, Wang Zhongxing, and others usually need opportunities for minor surgeries, so they don't let Fang Ziye perform aggressive manual reductions, thus denying them any chance.

(End of this chapter)