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Chapter 184 Amputation is Possible? (6k views, bonus chapter, 4 more chapters added)

Wu Guonan and Xue Tao had already disinfected both lower limbs, and Li Junfeng from the joint surgery department had arranged for Xu Yanlin to complete the preoperative disinfection procedures, while Wang Zhongxing held the patient's legs up with both hands.

The current proposed surgical plan for this patient is bilateral lower limb amputation and bilateral upper limb limb salvage with the option of amputation. However, the possibility of amputation has been discussed with Liu Chaodong outside the hospital.

However, Director Wu Guonan's team couldn't handle so many procedures, and given the patient's special circumstances, they sought help from a director of the joint surgery department. This director, Li Junfeng, was an orthopedic surgeon who was also skilled in hand surgery, but was currently working in the joint surgery department.

Because the patient was quite robust, his legs were not light.

Seeing this, Fang Ziye first put on a pair of sterile gloves, then asked Huang Yu for a leg so that Huang Yu could switch between his left and right hands as a buffer.

Xue Tao washed her hands with Li Junfeng, and the two even talked to each other in between.

Xue Tao then turned to Li Junfeng and asked, "Director Li, does this mean that this patient could actually avoid amputation, but no one dares to perform the procedure?"

Li Junfeng glanced at Xue Tao, his eyes and tone strange: "Xue Tao? Why are you asking this? Don't cause any trouble."

"This patient's situation is quite special, and his identity is also special."

Xue Tao is clearly an orthopedic surgeon. If he were to get involved in vascular surgery matters, especially with this patient, Li Junfeng would absolutely not allow it.

Wu Guonan also glanced at Xue Tao again.

Xue Tao quickly explained, "No, Director Li, I was just asking out of curiosity. Of course, I wouldn't rashly undergo limb-sparing surgery."

“I’m not a vascular surgeon myself. Since Director Peng said amputation is necessary, it must be very difficult to save the limb.”

Then Xue Tao said, "Director Li, Ziye is also a senior resident physician. Limb amputation is a genuine Level II surgery. It's okay if I let him perform the procedure and I'll be his assistant. It won't delay the patient's condition."

"What do you think?" Xue Tao wanted to do Fang Ziye a favor.

Amputation is a simple procedure, classified as a Level II surgery, which Fang Ziye is qualified to perform. Moreover, amputation is actually not a difficult procedure.

"It's alright, just tie the artery first. The most important thing now is to address the blood loss caused by the damaged blood vessel," Li Junfeng emphasized.

Li Junfeng wasn't entirely clear about Fang Ziye's background, but the amputation was a done deal regardless of who performed it. The only difference was that Li Junfeng held a higher rank than Wu Guonan; he was the administrative director of the joint surgery department, on par with Zhang Mingcan.

The current situation is.

Amputation is not difficult, but limb preservation is. Wu Guonan knew that even if Zhang Mingcan or Director Hongdu were called in, it might not be as reliable as Li Junfeng saving both upper limbs.

The critical issue for patients today is multiple injuries and severe blood loss. The key is to stop the bleeding, administer blood transfusions, and ensure that blood intake exceeds blood output.

However, if the bleeding is stopped for too long, the blood in the arteries and veins will coagulate. If amputation is not performed, the muscles in the limbs will gradually die, and the creatine produced by muscle breakdown will also be fatal.

Therefore, this amputation can actually be done in two steps.

Pinch the artery to stop the bleeding; an emergency measure to save your life.

Then amputation to save his life!
Amputation can be performed up to six hours later, it doesn't matter, it won't put any burden on the body.

"Okay!" Xue Tao nodded.

The disinfection and draping were completed quickly, and then Fang Ziye and Wang Zhongxing went to the handwashing and disinfection sink outside the operating room.

Wang Zhongxing said with a wry smile, "Ziye, you're really lucky to have encountered such an emergency."

"You might not encounter one even after a long time."

Fang Ziye just smiled and pondered whether it would be more appropriate to add a blood vessel incision, a blood vessel thrombectomy, or both if limb-sparing surgery were to be performed.

I haven't encountered it, or I don't know about it, so who cares?

Since I've encountered this situation and have quite a few knowledge points remaining, I might as well use them temporarily.

Isn't that the point of having your own knowledge?
So, Fang Ziye simply found the corresponding basic skills in vascular surgery.

Hemangiotomy, thrombectomy, vascular suturing...

More than a thousand knowledge points just vanished like that.

This is Fang Ziye's largest expenditure to date.

Upon re-entering the room, Fang Ziye discovered that the patient's condition was extremely dire, yet simultaneously, it was also remarkably fortunate—

The incision was made in the upper right abdomen, presumably directly into the liver. The edges of the incision are clean, so it should be relatively easy to repair.

The edges of the incisions in the jejunum and ileum were neat, indicating that the assailant did not stab the victim cruelly before stirring the wound.

If that were actually done, then it would truly be beyond saving—

Even so, the abdominal cavity still emitted an extremely pungent smell.

The intestines ruptured, and the taste was both heavenly and hellish.

Even Fang Ziye couldn't help but frown...

When Fang Ziye and Wang Zhongxing washed their hands and walked in, they saw Li Junfeng, along with an unfamiliar colleague from the joint surgery department, dissecting the brachial artery on one side of the upper limb.

Wu Guonan and Xue Tao formed a temporary team to perform surgery on one side of the lower limb.

After Wang Zhongxing and Fang Ziye entered, Wang Zhongxing immediately took over Xue Tao's position. The four of them split into two teams and began to search for arteries and stop the bleeding.

Since amputation is necessary, the brachial and femoral arteries can be located and temporarily ligated.

Fang Ziye changed into a sterile surgical gown and circled around Xue Tao.

Wu Guonan then turned around and said, "Xue Tao, you take Ziye to do the other side first. Femoral artery exploration and ligation is just a simple Level II surgery, which is part of the amputation. It shouldn't be difficult for you to complete, right?"

This is actually an exposure technique, also called an incision technique.

However, vascular exposure and vascular wall incision are actually two different surgeries. Vascular exposure is a basic vascular skill under incision, while vascular incision is a specialized skill of vascular surgery.

One is the foundation, and the other is the content that truly requires operation of specialized diseases when you reach the specialist level.

Fang Ziye nodded, and Xue Tao smiled and stood in the assistant's seat.

Femoral artery exploration is only a Level II surgery and is also a component of amputation. It is not difficult. As long as Fang Ziye has some anatomical experience, he can just follow the anatomical structure.

Ligating an artery is even simpler; just tie it off with a silk thread.

Blood vessels are similar to water pipes, but not entirely the same; the similarity is that they can both carry liquids.

The difference is that water pipes can be on the surface of the body, while blood vessels are generally buried deep inside the body, especially large arteries, which rarely run superficially.

If a water pipe has a leak, you can stop the water flow first and then slowly search for the leak. But you can't do that with blood vessels. The heart is the main switch for blood in blood vessels; if it stops beating, the person is gone.

Therefore, it is necessary to quickly locate the proximal end of the blood vessel, then apply pressure to control the bleeding.

Xue Tao said, "Ziye, you help me apply pressure to stop the bleeding first. I'll expose the femoral sheath first, and then I'll hand it over to you."

Fang Ziye nodded.

Then, as Fang Ziye slowly tore open the gauze with his right hand, his left hand went to his abdomen, stroked it for a while, and then pressed down firmly!

This involves applying pressure to the skin surface, following the pathways of blood vessels, to stop bleeding!

It comes naturally from anatomical knowledge and is not a very advanced skill.

The application of manual pressure to stop bleeding during surgery is on a different level and is not the same.

However, by pressing down on the proximal end of the arterial rupture, the amount of bleeding can be greatly reduced.

Because the patient's blood pressure was not high, and with Fang Ziye's pressure, there was not much bleeding after Fang Ziye removed the gauze!

At the same time, Fang Ziye temporarily spent about 500 knowledge points to upgrade the downstream skill of Hemostasis, Press Hemostasis, to level 4.

Knowledge is meant to be used, and Fang Ziye can't worry about that now.

The result was that Fang Ziye managed to grab the proximal end of the femoral artery before Wang Zhongxing could.

"silk!"

His right hand moved as if catching a loach, and he cleanly and decisively pulled out a section of the femoral artery. He pinched it tightly between his thumb and forefinger.

Then switch to your left hand and use your thumb and forefinger to press firmly on the groin area!
With a slight pull outwards, quickly wrap the two prepared silk threads around the blood vessel, tie them tightly into a half-tight knot (similar to tying shoelaces, but tighter).

Only then did they release the femoral artery! They gently tapped the stump of the blood vessel, saw no bleeding, and breathed a sigh of relief.

Xue Tao's side hadn't even prepared surgical instruments like scalpels yet.

Looking back, he saw that Fang Ziye had already finished binding the thread and was just waiting for him to cut it.

Xue Tao then said, "Please release the pressure first, and I'll check if there's any other bleeding."

Wang Zhongxing, sitting opposite him, raised an eyebrow. When he realized that Fang Ziye was performing surgery in front of him, he couldn't help but quicken his movements slightly.

But in that moment of carelessness, Wu Guonan didn't have time to grasp the arterial stump!
Immediately, blood began to gush from the artery!
It flew incredibly high!

Then it sprayed down, some of which even hit the lenses of Li Junfeng's glasses, the director of joint surgery.

Of course, Li Junfeng didn't budge, but said sternly, "Wipe the blood off, and let me off the stage..."

Wang Zhongxing was not blamed.

Nobody wants anything to go wrong during surgery, but for some diseases, bleeding is necessary.

While Xue Tao, who was working with Fang Ziye, was still looking for other blood vessel openings, he saw this scene and immediately reached over the operating table, using his thumb, index finger, and middle finger to forcefully grasp the femoral artery stump on the opposite side.

It can be described as steady, accurate, and ruthless!

The bleeding stopped immediately.

The sprayed blood continued to fall, landing on the operating room floor and on everyone's heads and shoulders.

Even so, everyone only glanced in the direction of Wang Zhongxing, and after seeing that there was no more bleeding there, they left.

Instead of leaving, he ignored the scene and continued the surgery.

Their vision was not impaired by the bloodstains, and they did not have to step down like Li Junfeng.

What's the big deal about getting sprayed with blood during surgery? As long as the scalpel isn't held to the neck and the patient doesn't have any infectious diseases, the surgery will still have to be performed.

This is the composure a surgeon should routinely possess.

Wu Guonan immediately pressed down on the area, stopping the massive bleeding, and then had Wang Zhongxing take over pressing the area, gently reassuring him, "Don't panic, the surgery needs to be done slowly." In the tense moment of the surgery, Wu Guonan didn't even want to waste time cursing.

They just didn't quite coordinate their actions of pressing the button to continue the call.

……

After Xue Tao finished cutting the thread, she handed over the main scalpel position to Fang Ziye.

The tone was brief: "Ziye, a role reversal."

Intelligent swapping means that the main surgeon and the assistant switch roles, but do not swap positions.

Fang Ziye nodded and accepted the scalpel and toothed forceps handed to him by Xue Tao, and began the surgery.

Xue Tao took the opportunity to blink, then raised her neck to adjust her posture. When she looked back at the surgical field, she was in a bad mood.

In just a short while, Fang Ziye was seen opening the wound, exposing the injured femoral artery, and then 'playing' with the adjacent femoral nerve and vein...

Actually, they were checking whether these two things were injured.

However, this skillful technique left Xue Tao completely bewildered.

Damn it, you're having surgery right now, and you're just rolling around like that.

No, when did I grow taller but my arms aren't big enough?

Xue Tao was completely baffled and dared not touch it.

Just then, Xue Tao saw that Fang Ziye's hemostat seemed to have come to life, and with a quick pry from somewhere, it appeared to have pulled out the great saphenous vein from the wound. After the pressure on the wound was relieved, blood gushed out.

Fang Ziye then asked, "Do you have vascular sutures? How many?"

"Yes!" the two circulating nurses answered immediately. Although they didn't know which department or which surgeon wanted it, they just wanted to follow orders and didn't care.

In urgent situations, even if an intern is standing next to her asking her to prescribe something, she won't hesitate to ask more questions.

Why ask? Saving even a second is a matter of life and death; it's a quality required in rescue and first aid procedures.

Upon hearing this, Li Junfeng and the others immediately glanced at Fang Ziye.

This patient is scheduled for amputation, what are you doing with the vascular sutures?
This also includes Wu Guonan from the Department of Orthopedics.

Fang Ziye said to Wu Guonan, "Director Wu, I think we can lower the amputation plane a little further so that it will be easier to fit a prosthesis later. The arteriovenous rupture here is not large, so we can suture and repair it."

Although it's amputation, how much is left and how much is amputated are completely different.

Amputation at the groin is amputation, and amputation at the ankle is also amputation, but the degree of functional preservation is completely different.

Wu Guonan said, "You handle everything. Don't ask me or worry about whether I'll look at you or not."

Don't use the suspect, but don't use it.

It's just an amputation. No matter how much Fang Ziye tries, the result is still just an amputation.

Wu Guonan then said nothing more.

Xue Tao secretly gave Fang Ziye a thumbs up.

With this awareness, Fangzi's future growth potential will not be too low.

Amputation is cruel, but we try to save as many limbs as possible for the patient's own good. That's probably all we can do now.

Orthopedic surgeons are not very proficient in vascular surgery. Since vascular surgeons cannot solve vascular problems, orthopedic surgeons can only try to leave as much of the vascular stump as possible to compensate.

After obtaining the vascular sutures, Fang Ziye quickly sutured the great saphenous vein. Since the great saphenous vein only had a small opening, there was no need for the three-point vascular suture method used in limb replantation surgery, and he quickly repaired the great saphenous vein.

The same applies to the femoral artery...

Upon hearing Fang Ziye's words, Wu Guonan felt a pang of bitterness in his heart. If Fang Ziye hadn't said those words, he would have genuinely intended to have his limb amputated from the injured area—a simple and brutal solution. But Fang Ziye's words...

As the director, Wu Guonan was embarrassed to say that the amputation area here was even shorter than that of Fang Ziye's, so he also asked for vascular sutures and then began to suture.

It's not that I'm deliberately trying to compare myself to Fang Ziye; I'm just doing this to make the patients feel better.

However, just as Wu Guonan finished stitching up and was about to see what Fang Ziye was doing,

Suddenly I noticed something was off—

Because Fang Ziye is currently performing surgery on the back of the patient's calf!
Moreover, their movements are skillful—

What is he doing?
After Fang Ziye used a round knife to break the skin, he didn't use a sharp knife to penetrate further. Instead, he used hemostats, as if entering his own home, to bluntly sever the muscle layer and head straight for the posterior tibial artery...

A minute later, the sharp knife pierced the wall of the posterior tibial artery, pulling out a blood clot the size of a little finger from the lumen of the blood vessel like pulling out a radish, resembling a black loach...

It is clear that this is an arterial embolism that Fang Ziye found in a downstream branch of the femoral artery!
He is performing an arterial thrombectomy!
Upon seeing this, Wu Guonan, like Xue Tao who was Fang Ziye's assistant, immediately changed his expression!
Instead of just one.

Fang Ziye is performing an arterial thrombectomy. How does he know where the blood clot is?

This is the first point.

Secondly, if Fang Ziye extends limb salvage to below the knee, what are they supposed to do?

Is it possible to have an amputation above the knee or above the elbow?

Doesn't this mean that we are inferior to Fang Ziye?
But what else can we do if we don't have the amputation done here? Will they understand what Fang Ziye is doing now?

will not!

Fang Ziye was unaware that anyone was watching him; he was completely absorbed in the activity.

Possibly. Under normal circumstances, it's difficult to detect blood clots. However, once you reach level 4 in basic medical examination skills, it should be possible.

At this point, Fang Ziye had cleared all his knowledge points to below 200.

After taking a deep breath, Xue Tao asked, "Do you know arterial thrombectomy?"

This isn't a question; it's an affirmation.

Fang Ziye was suturing the incision site in the posterior tibial artery where the blood clot had been removed. He nodded and replied naturally, "Yes, Professor Xue, I've encountered something similar before. I found it useful, so I learned a little bit about it."

Fang Ziye's words were very straightforward and direct, and even reasonable and well-founded.

While Fang Ziye was speaking, several ear-piercing sounds of rubber slippers rubbing against the ground could be clearly heard!
The voices were spoken by Peng Yuanming from the Department of Hepatobiliary and Pancreatic Surgery and Li Junfeng, the director of the Department of Joint Surgery.

They couldn't help but turn their heads.

After all, Peng Yuanming had a huge argument with his family outside, because they couldn't perform the thrombus removal procedure.

Currently, the only people he knows who can perform such a sophisticated and extensive thrombus removal procedure are Wu Xuanqi and Nie Mingxian. Wu Xuanqi has his own tasks, and Nie Mingxian is currently under anesthesia.

I can't believe Fang Ziye can do it. Isn't this utterly ridiculous?
Of course, this is the operating room, on the operating table, and the surgery is in progress.

All questions unrelated to the surgery are asked from the audience; this is a fundamental principle and basic quality of surgery.

……

The muscles at the corners of Li Junfeng's and Wu Guonan's mouths, like heart muscle, began to twitch simultaneously.

They either twitch or they don't; it's very synchronized.

Xue Tao took a small step back, but lost her balance and twisted her outer ankle. She felt pain, but it wasn't obvious.

He also noticed that Li Junfeng and Wu Guonan were glancing at Peng Yuanming, their eyes filled with a strange and complex expression...

Brother, why don't you come over and take a look and see if this is a surgery performed in your department?

Peng Yuanming felt that today was definitely his last day, as a whole host of bad luck came crashing down on him like it was free.

Peng Yuanming had to find some time to come and take a look.

……

Fang Ziye then proceeded to the next step: he first sutured the opening of the artery shut!

Then he loosened the ligature, and sure enough, he saw the posterior tibial artery begin to fill out, and there was no more blood seeping out.

Immediately use both hands to feel the pulse of the posterior tibial artery from top to bottom!

The femoral artery runs from the upper outer side to the lower inner side, while the posterior tibial artery pulsates from the posterior side towards the outer ankle.

Therefore, when Fang Ziye's hand reached down to the dorsalis pedis artery, he was immediately slightly startled.

Then, in disbelief, she withdrew her hand and tried again with her left hand.

I could also feel the pulse of the dorsalis pedis artery!

Fang Ziye then began to struggle with his decision, whispering to Xue Tao, "Um, Brother Tao, it seems, if I'm not mistaken, we might not need to amputate here. I actually just want to keep it longer."

"But now the dorsalis pedis artery is already pulsating."

"Can this still be amputated?" Fang Ziye was genuinely asking Xue Tao.

Upon hearing this, Xue Tao nearly rolled her eyes to the top of her head, her vital signs practically gone...

Damn it!

Fang Ziye's voice was soft, but the operating room was quiet enough at that moment.

It was almost so quiet you could hear a pin drop, because you could hear everyone else's breathing very clearly.

However, even under these circumstances, Fang Ziye said that he might not need to have an amputation.

But in fact, Wu Guonan next door was already undergoing an amputation. Even Li Junfeng, a joint surgeon, originally planned to perform a limb-sparing surgery. However, after seeing the poor condition of the upper limb arteries, Li Junfeng thought that since the patient had signed an amputation agreement, he decided to postpone the procedure.

It has already shifted from limb-sparing surgery to amputation.

But just then, Fang Ziye told them that he was no longer performing amputations and would instead perform limb-sparing surgeries.

Xue Tao remained silent, while Wu Guonan, as the director, muttered a low curse: "Damn it..."

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(End of this chapter)