top student at medical school

Chapter 432 A Leisurely Stroll Doesn't Hide His Powerful Aura (Please Subscribe)

"Properly managing the blood supply and morphology of soft tissue is only the first step in debridement of traumatic injuries. This does not violate the principles of trauma treatment. However, it requires us to reinterpret these principles."

"Remove all inevitably necrotic tissue and strive to preserve as much 'non-necrotic tissue' as possible!"

Fang Ziye turned to the next page, which stated the time window for lower limb necrosis: "Necrosis can occur after 4-6 hours of severe ischemia due to arterial embolism in the limbs."

"The above time statistics are time windows that our many predecessors in trauma surgery have compiled after experiencing hundreds of thousands or even millions of patients with limb necrosis."

"This timeframe is a very appropriate objective standard for judging whether limb necrosis has occurred."

"However, after understanding this absolute standard, we should delve deeper into whether the 'intermittent' time window of our body tissues can be extended if, after severe ischemia, blood supply is intermittently restored?"

"Could it even reset the 'time window' to give us more time for surgery?"

Fang Ziye's voice was neither impassioned nor did he deliberately create any suspense for the audience; he simply narrated in a straightforward manner.

But don't forget one thing: Fang Ziye has upgraded his basic theory skills to level 5.

Once a theory reaches a high level, it is difficult to discover directly and it is also difficult to play a reversible role in clinical practice. However, such a profound theory allows Fang Ziye to easily navigate the basic principles of various common diseases by explaining them in a simple and easy-to-understand way.

"During the debridement procedure, we should understand the following concepts. First, crush syndrome; second, whether the tissue is necrotic and whether it is in a state of impending necrosis; third, cell lysis caused by violent compression is immediate and irreversible, while local disorder caused by ischemia is adjustable."

"Therefore, during the debridement process, we need to analyze each of them one by one. First of all, crush syndrome is common in long-term pressure trauma, and its essence is rhabdomyolysis."

"Here is a key point: prolonged tissue pressure leads to cell damage mediated by intracellular calcium ion overload, resulting in cell membrane damage, leakage of cell contents, and reperfusion injury after they enter the bloodstream."

"Therefore, this part of the tissue absolutely cannot be preserved, but should be removed promptly..."

"Besides..."

Fang Ziye did not elaborate on the detailed operational methodologies, but only talked about some principles and concepts.

The speaker's presentation should also be prioritized. What you need to show others is not high-end technology or new operations, but rather to let others understand what you are doing, what you have done, and what the results are.

Only a very small number of the audience members knew that what you were doing was limb salvage surgery for severe injuries. This technique is theoretically feasible, and only a very small number of people have been able to deduce it.

If you don't explain to others that it's theoretically feasible, then it's not feasible to promote and it's difficult to attract other people's interest.

Of course, what these people want to see most is the result of your work.

Fang Ziye spent three minutes flipping through six pages of PPT, clearly describing some theoretical details that should be paid attention to in the debridement of necrotic injuries, and then began to explain the results.

"The second key step in trauma surgery is still to follow the principles of trauma management: restore blood circulation, using various methods to restore blood circulation."

"Unobstructed blood flow is the key to limb survival and a prerequisite. If blood flow to the affected area and the distal part of the affected limb cannot be restored, the consequences will be catastrophic, and in severe cases, it can lead to electrolyte imbalance or even death."

"Methods for restoring blood circulation are not the main focus of this section."

"Next, let's look at the final results of the three groups of cases we recently performed."

Fang Ziye flipped to page 15 of his PPT, where before-and-after photos of the little girl Yan Chu's first debridement surgery appeared before everyone.

The first picture shows fresh, mangled damage, with skin torn open and bloody flesh dripping from it, and it's placed on the left.

The second picture shows scarred skin. Although the scar tissue is torn apart, the foot that doesn't look good isn't gone; it's actually been reattached to the lower part of the fair calf.

Moreover, the image shows the lower limb dangling in the air, which means that after the surgery, the affected limb not only survived but also regained a certain degree of active movement.

Alongside the visual impact of the images came Fang Ziye's voiceover, each word spoken slowly and deliberately through the microphone: "After nearly six hours of effort by our team, this case of 'standardized lower limb injury' has finally been successfully resolved with limb-sparing surgery."

"However, this is not the end. In the first picture, we can clearly see that the patient has a large section of anterior tibial nerve damage."

Fang Ziye used a laser pointer to indicate the distance of the anterior tibial nerve stump in the image: "There is a defect of at least eight centimeters, which obviously cannot be sutured in one stage."

"As you can see, after these soft tissues have undergone debridement, all the surface of the muscles has fresh cut surfaces. With nerve damage and loss of local motor function, muscle adhesions in the foot and ankle are inevitable."

"Next, we will watch two sets of functional physical examination videos."

Fang Ziye flipped to the next PPT, which had a simple title: "Stillness and Movement".

However, the first short video without sound was Yan Chu's physical examination of the active and passive functions of her foot and ankle.

"No feeling? No."

In the video, a doctor in a white coat pricks Yan Chu's sole with a needle: "Doesn't it hurt?"

"It doesn't hurt," came the little girl's voice.

"Passive movement is significantly restricted, and there is adhesion and stiffness in the muscles below the ankle."

Fang Ziye did not explain, but instead clicked on the second video. The video opened with the same foot, but the shape of the other side was slightly fuller and smoother.

The video opens with a white coat poking the soles of someone's feet: "Can you feel it?"

The little girl flinched: "It felt like a mosquito bite."

"Move a little. Plantar flexion."

The little girl's plantar flexed at 5 degrees.

"Dorsiflexion."

The little girl's dorsiflexion was about 8°, and although her ankle joints could not rotate inward or outward, and her feet could not rotate inward or outward, these functions had been restored, even though they were not as good as normal.

Furthermore, it is clearly visible that the muscles contracted during this procedure, creating an uneven surface under the scar tissue.

At this point, Fang Ziye said, "What we're going to share today only concerns limb-sparing surgery, so we'll refrain from discussing unrelated topics for now. If any teachers, seniors, or colleagues wish to participate..."

Fang Ziye had only spoken half of what he said when someone in the audience, unaware of their manners, suddenly uttered a high-pitched slur.

"Why didn't you say you were going to post a 'der' video? Are you trying to bait people?"

He is clearly a person with a fiery temper.

It seemed like no one knew who it was, but after the cursing started, the people sitting around him turned around and formed a circle, with this guy in the very center.

Fang Ziye and the conference host both saw him, but Fang Ziye ignored him and continued, "If you are interested, we can discuss it in detail after the meeting or have another opportunity to exchange ideas later. After all, this is a conference venue, and time is limited."

"Today our topic is limb-sparing treatment for 'standardized ablation' injuries. We won't waste your time on other irrelevant topics."

"Next, let's look at the second case our team handled. This case is much more difficult than the first one..."

Duan Hong had actually seen the person hitting the high notes, but at this moment he only thought that the person was handsome and pleasing to the eye.

To use a trendy phrase, "If you dig a hole and don't fill it, you'll lose ten years of your life." Fang Ziye's actions were simply asking for a beating.

Of course, Fang Ziye is a standard scholar. He knows that each lecture should focus on only one theme, and during the process of developing the theme, he subtly foreshadows the simple and exciting content of the next lecture without any trace of Photoshop manipulation.

In fact, getting published also depends on whether the editor is interested in your research direction and content. If you happen to cater to their interests and capture their curiosity, then your subsequent submissions will become much easier.

If the first case was just setting the stage, then the second case was purely a "show-off" phase.

Fang Ziye has already laid the groundwork for understanding what constitutes catastrophic injury and what 'standardized' catastrophic injury is. In the first case of catastrophic injury, not only was limb-sparing surgery successfully performed, but the saved limb was not merely 'decorative'!
It's truly astonishing that some of the functions can still be restored.

After having this idea, everyone in the room was looking forward to whether this second patient with severe thigh injury could also have his limb saved, and whether he could rebuild his function after saving his limb?
The former is certain, because this is my personal understanding of limb-sparing surgery for severe injuries, but the latter is not necessarily true.

Once the femoral nerve and sciatic nerve are damaged, reconstruction is extremely difficult. There are far too many patients in the world with impaired sciatic nerve function who suffer from unbearable pain and even become paralyzed in bed.

Fang Ziye said, "The surgery for this patient took twice as long as the first destructive surgery."

"One of the key reasons is his hip joint injury, and the second is that he has bone defects, meaning that the primary insertion points of many muscles are not properly located..."

"Our team spent nearly seven hours cleaning this hip joint injury, and another two to three hours on the subsequent closure and reshaping."

"Of course, one of the easier aspects of treating an injury in this location is that the blood vessels are relatively simple, mainly the connection between the femoral artery and the popliteal artery. The difficulty in completing a primary limb-sparing surgery is not ensuring unobstructed blood flow, but rather properly managing the soft tissue..."

"This is a picture of him after his limb-sparing surgery. As you can see, the lower limb is intact. Although the damaged skin is still there, it can be effectively treated with flap transplantation and bone defect transplantation in the second stage."

"I imagine all of you seniors are very curious about his condition when he was finally discharged from the hospital."

Fang Ziye resorted to his old trick again, digging a hole but not burying it, and directly posted a picture of the patient walking out of the department on crutches.

There is no video, but in the pictures, the patient is using crutches, with both feet on the ground, the affected limb moving forward, and the unaffected side on the ground, which says it all.

"This is our team's second limb-sparing surgery for a severe injury, and the result is encouraging..."

As Fang Ziye was speaking, he noticed that several unfamiliar old men had squeezed in from behind the door. Among them were Xiong Zhizhang and Professor Wen Dongfang from Zhongnan Hospital. Fang Ziye couldn't recall the names of the others.

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

Flipping through the PowerPoint presentation, I began to share the third group's 'comeback story' after suffering damage.

After reaching page 29 of the PPT, we are about to come to an end.

Fang Ziye's PPT was not very long, only thirty-six pages in total, with the last page being a closing remark thanking the audience for listening, which meant that there were only seven pages of content left.

After Fang Ziye announced the discharge results of the third patient with severe injuries, the people in the audience began to grumble and sway...

Even from the podium, Fang Ziye could hear bursts of cursing.

Have some shame!

"Have some decency!"

"Do they have any manners? They dig holes and don't fill them, they don't mention a single important word, but they talk a lot about unimportant things."

"Let's get down to business..."

Fang Ziye pretended not to hear.

It wasn't that Fang Ziye lacked manners, but rather that time was limited.

At such academic exchange conferences, who would actually present purely technical content on stage? If they did, given the limited time, they'd barely get started before it was time for the next person to move on...

That was truly unbearable.

Those who understand can sympathize with Fang Ziye, but that doesn't stop them from cursing him from the audience...

Once Fang Ziye's next slide is released, it will inevitably mark the end of this lecture: "Take home the message (key points)."

"Based on our team's experience, we would like to make some careful summaries here. If limb-sparing surgery is required for severe injuries, we recommend confirming the diagnosis first."

"1. Start with limb salvage surgery for limb injuries, beginning with those involving the lower limbs."

"Based on our team's experience, the surgery time for the lower leg and below is generally between five and eight hours. If it is a serious injury to the thigh, it will take about twelve hours. If it is an injury across a joint, the surgery time will be extended to about sixteen hours."

"2. Currently, our team does not perform limb-sparing surgery for severe upper limb injuries."

"When the team privately planned the operation time and procedure, considering that the complexity of hand function is dozens of times that of foot, the operation time may be extended to more than 20 hours or even longer, which requires the cooperation of a super large team."

"3. The core focus of limb salvage surgery for severe injuries is debridement, while the theoretical focus of limb salvage surgery is blood supply."

"It's the same old story: the core of emergency trauma care is debridement to ensure the integrity and viability of local soft tissue embryos. Unobstructed blood supply is a prerequisite for tissue survival."

Three sentences, each accompanied by a picture, and we've reached page thirty-two.

The noise from the audience gradually subsided, and everyone focused intently on the stage.

Although the key information provided by Fang Ziye is purely theoretical, the core of each disease is still supported by theory as a framework, and the operation is just a repetition of the on-site performance supported by the theoretical framework.

If something is theoretically impossible, it's impossible to put it into practice.

For example, perpetual motion machines—there are always people who think they have invented perpetual motion machines.

Fang Ziye continued speaking at a steady pace as he turned to page thirty-three.

Page 33 offers a future outlook on the treatment of destructive injuries.

Page 34 contains recommendations on team staffing for standardized treatment of destructive injuries.

Page 35 provides feedback on the shortcomings of the team's current destructive techniques, pointing out areas for improvement in the surgical approach. Page 36: Thanks for your attention!

"Thank you for listening, teachers, seniors, and colleagues. That concludes my presentation on some recent case studies our team has been working on. I look forward to your feedback and suggestions. We have another twenty minutes!" Fang Ziye's words were interrupted before he could finish.

Duan Hong then picked up the microphone and interrupted, saying, "Which of the many speakers in the second half of the morning session are you most interested in? Next up is the Q&A session. Personally, I would like to ask Dr. Fang not to leave the stage yet, as I have a few questions to ask."

Fang Ziye turned his head to look in Duan Hong's direction. All three hosts were eager to try, clearly having a lot of questions to ask.

However, as Fang Ziye turned his head, a familiar voice from the surround speakers spread and invaded his ear canal: "Chairman of the conference, this is the Q&A session. Questions should be asked one by one according to the order of the speakers in the second half."

"According to the agenda of this conference, each speaker only needs to answer a maximum of five questions. This means that we, the audience, can ask each speaker five questions, right?"

"I am personally very interested in the topic that Director Han Xianlong shared in the first quarter of the second half. I wonder if I will have the opportunity to ask Director Han Xianlong for advice in person?"

Deng Yong stood up and very proactively and enthusiastically shared his ideas.

Meanwhile, next to Deng Yong were Han Yuanxiao, Yuan Weihong, Associate Professor Chen Fang, and Liu Huanglong, who had just arrived, all eager to try their luck.

Everyone had a notebook in their hand, obviously having recorded a lot of questions, and they asked all the previous speakers, thus delaying the Q&A session.

As soon as Deng Yong stuck out his butt, Duan Hong knew what kind of shit he was taking.

He raised an eyelid and frowned: "Professor Deng, this is an academic conference. Shouldn't we be listening to everyone's opinions and ideas?"

Deng Yong stated frankly, "Academic exchange should be based on fairness, impartiality, and freedom, not on the opinions of the majority."

"If scholarship follows the crowd, then scholarship is meaningless. If scholarship reveres the mainstream, there is no room for innovation and diversity."

"Furthermore, whether it's based on the order of speakers' appearance or seniority, there should be a proper order of arrival," Deng Yong said with a smile.

He pointed at Fang Ziye and said, "You young man, you don't know any better. When did you book this entire stage?"

After listening, Fang Ziye immediately walked to the center of the podium, bowed in front of everyone, and then, like a well-behaved student, carried his computer and walked off from the side.

Fang Ziye has run away again!
The crowd erupted in uproar.

Isn’t this too shameless?

Just as Duan Hong was about to say something, Deng Yong stood up straight and said, "Chairman of the conference, I'm about to start asking questions. I can't wait."

Duan Hong was helpless.

The only option is to let Deng Yong speak.

Then Director Han Xianlong had no choice but to stand up, accept the attention of everyone present, and be forced to start working.

Deng Yong asked a seemingly trivial but difficult question.

"Director Han, when you're doing micro-innovations on your research project, what's the clinical basis you're basing yourselves on?" Deng Yong asked, his face full of anticipation, as if he deserved an Oscar.

How can this be answered? Are the minor innovations in clinical research projects at prefecture-level city hospitals truly based on clinical benchmarks? For example, in areas like trauma, there are certain blind spots, clinical blind spots that almost no one in the world is currently working on, which Deng Yong and his team have squeezed into.

But when a problem arises, there must be an answer, regardless of whether the answer is good or bad.

Han Xianlong hesitated for more than ten seconds before cautiously replying, "Professor Deng, our team's innovation is mainly based on the hope of reducing the operation time and speeding up the patient's postoperative recovery."

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

"As I understand it, you only improved the quality, but you didn't specifically mention the operation time and postoperative hospitalization time. Is this because they weren't included in the statistics?" Deng Yong asked.

At this point, some people realized Deng Yong's purpose.

This is probably to shorten the time Fang Ziye will have to answer questions later.

The Q&A session only lasted twenty minutes in total. There were five speakers in the second half, and the first four had to answer five questions each, so Fang Ziye wouldn't need to go on stage.

……

At 11:547, Director Han Xianlong sat back down cautiously, a little sweat on his forehead.

When he handed over the microphone, he felt a sense of relief, as if he had survived a disaster.

Han Xianlong never imagined that his micro-innovations actually had so many unsettling details to scrutinize. If he were to be targeted by someone with ulterior motives, his research could very well backfire and trap him.

However, once the topic reached this point, Deng Yong and Han Yuanxiao sat down!
Yuan Weihong and others did not continue the Q&A session with the subsequent speakers, handing over the entire Q&A session to Duan Hong.

Deng Yong naturally wanted to pave the way for Fang Ziye, but the way he did it was not to prevent Fang Ziye from being questioned, but to show everyone that everyone should stop going too far and that every family has one or two elders.

Ask the questions you need to ask, don't deliberately make things difficult for people...

Upon hearing this, Fang Ziye, who was leaning against the wall, smiled slightly.

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

The benefits of joining a team go beyond just the assistance and resources they provide. There are many other things, such as giving you more confidence and ensuring you won't be bullied in crucial moments.

Duan Hong's voice rang out 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 if anyone else had any questions for the subsequent speakers. The entire room then fell silent.

After that, Duan Hongcai said, "Is everyone alright? Then I have a question that I'd like to ask Dr. Fang Ziye of Zhongnan Hospital."

When called out, Fang Ziye could only walk a few steps forward from the crowd, lean against the left side of the second row, and take the microphone handed to him by the staff.

He smiled obsequiously: "Teacher Duan, please ask, but please don't ask anything too difficult."

The differences in status, influence, connections, and resources between myself and Duan Hong are completely on different levels.

These things need to be accumulated gradually, not achieved overnight. If you have this ability, these things will immediately come to you.

Fang Ziye's initial show of weakness did not cause discomfort among the people. On the contrary, they felt that Fang Ziye, who had just been high and mighty, was now just an ordinary young man with all the joys and sorrows of life.

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

Duan Hong's first question was quite provocative: "Dr. Fang, what is your position in your team?"

"What was your position during the surgery?"

Duan Hong knew that Fang Ziye was the lead surgeon.

But the others didn't know that Fang Ziye was the surgeon, and it wasn't written in the surgical record either, so Fang Ziye replied very naturally, "Professor Duan, you're just asking a question you already know the answer to."

"I'm a recent PhD graduate, currently a resident physician, so naturally I'm an assistant."

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

"That's right, the first case your team handled. Who was the lead surgeon on your team? How did you come up with the idea of ​​focusing on traumatic injury?" Duan Hong directly brandished a massive sword over three thousand meters long.

Who performed the destructive surgery on Yan Chu?

Duan Hong, Deng Yong, Qi Qiaowen!

Without Fang Ziye, back then, debridement techniques were still a relatively new skill.

Fang Ziye was able to go on stage thanks to Duan Hong's support, who allowed Fang Ziye to perform a fracture repositioning surgery.

This is a difficult question to answer; Fang Ziye needs at least a few seconds to think about it.

As Fang Ziye's gaze met Duan Hong's, Deng Yong and Yuan Weihong's hushed whispers came from the speaker, as if they were about to stand up and put the blame on their own heads.

After hearing a few syllables, Fang Ziye quickly interrupted: "The first limb-sparing surgery for severe injuries was performed by Professor Deng, Professor Duan, and Professor Qi."

"The reason we considered moving towards the topic of limb-sparing surgery was that after the three professors discussed it together, they felt that there was a certain chance of limb preservation, so they tried to perform the first limb-sparing surgery in clinical practice."

"In May, after nearly two months of exploration and discussion, Professor Deng, Professor Liu and Dr. Yuan finally performed functional reconstruction surgery to treat the traumatic injury."

"Throughout the entire process, I was just an assistant," Fang Ziye emphasized again at the end.

He openly and frankly explained the whole story.

Upon hearing this, everyone present fell into complete silence.

So that's how the topic of damage and destruction came about.

However, it seems that more and more strange problems have arisen.

Why did Zhongnan Hospital list it separately? Why didn't Tongji Hospital and Union Hospital highlight it as a clinical research topic?

After Fang Ziye finished speaking, he felt the scene become quiet for a moment, thought carefully for a moment, and did not say anything more!

If you're so capable, why don't you do it yourself? Hasn't Tongji Hospital secretly performed any destructive surgeries?
Didn't Peking Union Medical College Hospital secretly do this? What's the point of asking these questions? Deng Yong was also involved in the first case of destructive injury you performed.

The topics you discussed together, you can't each take back and do them individually?
If a serious injury occurs in the hospital, it will either require amputation, or we'll call Duan Hong and Qi Qiaowen and ask them to come to Zhongnan Hospital for surgery. Will you be available at any time?

Of course, there's no need to say these things aloud.

The continued silence around him did not make Fang Ziye panic. At this moment, Fang Ziye was grateful that he was the one who had come to speak.

Fang Ziye is young enough to be shameless enough to curry favor with many teachers. I'm just a doer; I can learn anything anyone teaches me.

After Fang Ziye finished speaking, Duan Hong's expression gradually softened from shock, then turned awkward: "I've finished asking my questions, Director Fu, Professor Qin. Do you have any more questions?"

Director Fu is the director of Yishi People's Hospital, holds a doctoral degree, and currently holds the title of associate professor. He is also one of the conference's chairpersons.

Professor Qin is the director of the orthopedics department at the provincial central hospital.

Duan Hong quickly handed over the question.

Don't be fooled by the current silence; once they recover from Fang Ziye's honest reply, they'll shift their focus to other targets.

You, Duan Hong, can't bully people just because you're old and senior. The research topic is public.

As long as others don't steal your data, misappropriate your core technology, or kick you out, then the project doesn't belong to Duan. Why are you asking these questions here?

Is the implication that you, Duan Hong, also bear some responsibility for this damage?
Do you want Zhongnan Hospital to put your name on the list?
As the chairman of the Trauma Surgery Branch, how can you be so sore loser?
Duan Hong had never expected Fang Ziye to admit it so openly.

Upon hearing that Duan Hong had relinquished the right to ask questions, Professor Qin Yu asked directly, "Dr. Fang, I only have two questions to ask. You can just give simple answers."

"Exactly, for a disease like destructive injury, is it difficult to build a team?"

"Approximately how many amputations did you undergo before you successfully performed your first limb-sparing surgery for a devastating injury?"

Qin Yu's question was more down-to-earth and closely related to what Fang Ziye shared.

"It's a bit difficult right now. Our team had a lot of people on hand for our first surgery. The lead surgeons were Professor Duan Hong, Professor Qi Qiaowen, and teachers Deng Yong and Yuan Weihong, among others."

"In my experience, the first surgery we performed was a limb-sparing success, but the number of failures before that is beyond my personal knowledge."

"Following that, our team treated eight or nine more cases of traumatic injuries, and their postoperative recovery is currently under control!"

“I believe that it would be much easier to build a limb-sparing surgery team for severe injuries than when our team was first established.”

"The current data is limited and lacks statistical significance, so we have not shared detailed technical information or objective data to avoid misleading everyone!"

"If our team finally arrives at a relatively clear result and explores a feasible treatment plan and procedure for destructive injuries, we will definitely release it to the public as soon as possible," Fang Ziye said, standing at attention.

After speaking, he put down the microphone, politely, without being nervous or raising his voice.

"Splash splash splash splash!"

"Clap clap clap clap!"

The crowd erupted in thunderous applause once again.

His leisurely strolls do not conceal his commanding presence.

Even Duan Hong once again offered his praise and explanation...

(End of this chapter)