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Chapter 374 This Thunder Pool is a Must-Visit! (Please Subscribe)
Fang Ziye stared for a while, and finding no further bleeding from the branches of the left common iliac artery, he breathed a sigh of relief and looked up: "Proctor, has the syringe arrived?"

While it's good to feel relieved, one shouldn't get too excited, and certainly shouldn't act impulsively and disregard the surgical procedure.

Although the bleeding of the rupture has been stopped, and the common iliac artery has been clamped and reopened, it is essential to check whether a thrombus was formed during this process, and whether it caused ischemia in the distal arteries of the lower limb.

To save lives, many emergency evacuation procedures can be performed. However, the consequences of each procedure must be rehearsed.

Naturally, Fang Ziye was able to think of this because he had already reached a terrifying level 5 in vascular surgery theory. He naturally realized that most non-vascular surgeons wouldn't have this awareness.

Subconsciously, you might think, "Damn, the bleeding's stopped. At worst, it'll just be an amputation. Life is more important than the leg."
Patients may have differing opinions, but doctors prioritize life above all else.

Striving for life is the bottom line of a doctor's profession and also the ultimate goal for a lifetime!
Doctors will consider the nature of your profession, and they will consider your need to keep your leg so you can continue your studies, maintain your appearance, work, and earn a living. But in a doctor's eyes, your life is more important than your leg, because it is something a doctor dedicates their life to protecting.

Your feeling that your life is less important than your legs is just your own understanding of life.

Fang Ziye was in control of the surgery, and neither Deng Yong nor Professor Han Yuanxiao objected.

The patient's foot was not injured, so no sterile drape was used. After the scrub nurse said that the patient had been brought to the operating table, Fang Ziye asked the scrub nurse to ask the circulating nurse to puncture the patient's toes.

The circulating nurse understood the intention, and after giving the injection, she looked up and said, "There is bleeding in the lower limb!"

After saying that, he was about to leave.

Fang Ziye said, "Okay, don't rush to leave. Try inserting another needle into the lower front part of the tibia. This is the blood supply area of ​​the branches of the anterior and posterior tibial arteries. If there is bleeding here as well, it proves that the blood circulation in the lower limbs is excellent."

Fang Ziye explained that this requirement was unconventional.

The nurse did as instructed!

"She's bleeding too," the circulating nurse quickly reported.

"Thank you for your hard work. We're relieved."

Fang Ziye then looked at the two 'bosses': "Master, Professor Han, now I feel..."

Deng Yong began his instruction: "Don't feel awkward. You're the lead surgeon now, and we're your assistants. Just tell us what you want to do, and we'll tell you how we can help you!"

The chief surgeon is in charge of a surgery, but they don't necessarily have to operate the entire procedure. After the key procedures are completed, they can delegate some less important steps to their assistants.

For example, in trauma surgery, Deng Yong only performs the key procedures, while Yuan Weihong helps with most of the other operations.

Fang Ziye's progress has been too rapid, and he can't quickly transcend the perspective of a junior physician. Deng Yong doesn't blame Fang Ziye, because Fang Ziye is still a junior. However, as his teacher, he sees the limitations of Fang Ziye's current status and understanding but doesn't offer guidance.

The teacher is incompetent!
"Then Master, please suture up these ruptures in the arteries and veins for me," Fang Ziye said with a smile.

"Okay!" Deng Yong nodded, and just as he was about to say something to the circuit breaker, Yan Zhiming entered the operating room.

Deng Yong said, "Yan Zhiming, hurry up and wash your hands and come up on stage to help with the hook. I'm about to start suturing the vein."

"Okay, Master!" Yan Zhiming put down his phone and went out immediately, not wasting a single word.

Fang Ziye and Professor Han Yuanxiao worked together to move to the right side, where the bleeding was relatively less. There was less arterial damage on the right side than on the left, with the most ruptures only in the branches of the medial iliac artery!
After the clamping of Fang Ziye, the branches of the lateral iliac artery and venous return continued, but no obvious blood seepage was observed.

As a doctor, one should know that the lateral iliac artery and vein return form a closed loop. If there is no major rupture in this closed loop, it means that this closed loop hardly needs to be managed. Therefore, what Fang Ziye needs to do now is to check the rupture of the branch system of the medial iliac artery!
Fang Ziye, quick-witted, noticed the awkwardness between Deng Yong and Professor Han Yuanxiao earlier. He stopped trying to be clever, lowered his head to start operating, and skillfully gave instructions: "Professor Han, pull the hook a little lower and angled down. This position is blocking my view."

Han Yuanxiao did as instructed, then watched as Fang Ziye carefully examined the medial iliac artery and inserted two hemostatic forceps...

Then, after Fang Ziye opened the hemostat on the right internal iliac artery, he found that there was no active bleeding. This meant that there were only two bleeding sites on the right side, and the openings were not small!

In this way, Fang Ziye has finished treating the bleeding points of the arterial system on both sides. The bleeding points that needed to be clamped were clamped to stop the bleeding, and the blood supply to the unruptured blood vessels has been restored.

Blood circulation in the lower limbs was also relatively smooth, thus resolving half of the patient's crisis at the first step.

The next step is to suture the blood vessels.

Fang Ziye's operation was quite skilled. With a level 4 vascular suturing technique plus a level 5 suturing technique, and with all his strength in needle manipulation, Professor Han Yuanxiao and Fang Ziye began vascular suturing. Surprisingly, they sutured two more blood vessels than Yan Zhiming and Deng Yong combined.

Deng Yong's skill level in vascular suturing is at most level 3, with a proficiency score of 3-400.

Vascular suturing and hemostasis are not entirely equivalent...

"It's so good to be young," Deng Yong sighed, gradually understanding the complaints Yuan Weihong had once told him, as if a new cycle had been completed.

Yan Zhiming's gaze flickered uncertainly over Fang Ziye. He had many questions, but ultimately, these questions all turned into silence.

Now is not the time to ask questions.

After the suturing was finished, the vascular surgery team finally arrived. It wasn't Chief Resident Liu Faming, but Attending Physician Lu Chaoyang, who was accompanied by two master's students.

He stood by the platform, tiptoed, and saw that Fang Ziye and the others were putting the hemostats back in place and checking whether the sutured blood vessels were leaking.

The quality of Fang Ziye's sutured blood vessels is beyond question; he is more than qualified to work on the operating table of a hand surgery department. Professor Deng Yong's vascular suturing is also of high quality, and there were no basic errors such as leakage or bleeding.

"Hey, you've sutured all the blood vessels, so we don't need to go on stage." Lu Chaoyang was taken aback after looking at the four trauma surgeons, and then he spotted Fang Ziye.

Fang Ziye looked up at Lu Chaoyang: "No, you still have to go on stage. This patient also has a retroperitoneal hematoma!"

"What? You want to open the retroperitoneal hematoma?" Lu Chaoyang asked incredulously.

Pelvic hematomas are classified into active intrapelvic hematomas and active retroperitoneal hematomas.

Basically, during undergraduate medical orthopedics courses, many instructors will say the same thing: an active hematoma in the pelvis is a matter of life and death; the future is uncertain.

Active retroperitoneal hematoma behind the pelvis is one of the relative no-go zones for surgery. Opening such a localized hematoma must be done with extreme caution, because once the retroperitoneal hematoma is opened, the bleeding cannot be stopped, and the patient will eventually die from shock.

"The patient's retroperitoneal hematoma is also an active hematoma, which must be cut open to find the bleeding point, and may even require vascular grafting."

“The patient’s current vital signs do not allow for any active vascular damage!” Fang Ziye was well aware of the patient’s current situation.

If it is just a simple retroperitoneal hematoma, it should not be opened casually without knowing the situation, but the patient's condition cannot tolerate the presence of such a hematoma.

If not opening it means death, then let alone retroperitoneal hematoma being a no-go zone in surgery, even if it is a forbidden zone in surgery, we must still venture into it!
If you don't break in, you will die!
All the bleeding that Fang Ziye did in the emergency room, all the procedures he performed to stop the bleeding, were in vain.

The intestinal repair and renal artery repair surgeries that the two small teams in general surgery and urology are currently performing will ultimately be a waste of time!

"But? I dare not open this retroperitoneal hematoma?!" Lu Chaoyang's expression was one of surprise and uncertainty.

"Where is Professor Wu Yong from your department?" Deng Yong knew that Lu Chaoyang was telling the truth. If he knew he wasn't confident, it would be irresponsible of him to rashly agree to rush into a dangerous situation.

To remove the retroperitoneum and open an open retroperitoneal hematoma, a skilled team is essential.

Trauma surgery, spinal surgery, and vascular surgery are all indispensable in principle.

"In emergency surgery! On the operating table!" Lu Chaoyang replied.

After listening, Fang Ziye explained in a low voice what had happened in the emergency room that morning.

Mickey is a staff member of this hospital, but he is also qualified and absolutely entitled to be an emergency patient because he is a citizen of China and enjoys the same right to health.

"What about the others?" Fang Ziye's explanation still failed to convince Deng Yong.

“One professor is in the outpatient clinic, and the other professor is in the operating room performing elective surgery,” Lu Chaoyang replied honestly.

"Our chief resident is still in the operating room next door dealing with a vascular injury in the brachial plexus."

It's incredible that a department has three highly skilled senior professionals.

One patient was in an emergency surgery, another in an outpatient clinic, and the last in an operating room. What else could they do?
"Then please call an associate professor over. Can you find a way to spare some time? Vascular surgery shouldn't be that busy, right?" Deng Yong understood, but still insisted on his own approach.

For vascular surgery, you must have someone, and their level must be at least high enough. It's okay if you, as an attending physician, are afraid to participate.

Deng Yong had complete faith in Fang Ziye's judgment, because Fang Ziye's hands were definitely blessed; they were incredibly sensitive during physical examinations.

Previously, when performing thrombectomy and limb-sparing surgery, others relied on examinations, but Fang Ziye relied on physical examinations, which is extremely unscientific.

Therefore, Deng Yong trusted Fang Ziye's judgment.

This dangerous place is a must-visit!

“That’s fine!” Lu Chaoyang gritted his teeth.

“Then let’s call it. We can clean up the hematoma in the pelvic cavity first, to prepare for rupturing the peritoneum later.” Deng Yong made the decision directly and looked up to ask.

"Anesthesiologist, what's the patient's blood pressure now? When we open the retroperitoneal hematoma later... what are you going to do?" As Deng Yong spoke, the anesthesiologist ran out.

"I'll go out and call our director." The anesthesiologist wasn't a novice; upon hearing this, he immediately ran away, knowing the danger of an open retroperitoneal hematoma.

Everyone in the operating room: "..."

Although they remained silent, their expressions all became extremely serious.

(End of this chapter)