"Li Huamin, is that right?"
"Yes. 31 years old, female, was pierced by a hard object after falling..."
Ling Ran entered the operating room, asked a question, then listened to Lu Wenbin's report, and watched various films by himself first.
He didn't have such a request before. Since he had it, the operating room of the emergency department has specially added a large mobile backlight panel.
A hospital is such an institution. If your technical level is high enough, you can get what you want. If you can’t, it means that your technical level is not high enough. In simple terms, how much money does it cost to buy your life? How much does it cost to buy one of your own
In the face of high-level doctors, hospitals have always invested at all costs, and they are qualified to be the leaders of hospital decision-makers, and they are clearly enough to know that high-level doctors cannot simply be calculated based on income from surgery and medical expenses.
Of course, the level of a high-level doctor must be very high, far exceeding the average level of doctors.
In this regard, doctors are a lot like athletes.
An ordinary doctor is like an ordinary athlete. In order to reach the second or first level, they feel that they are exhausted and miserable. However, who cares? who knows? who cares
They have trained for 5, 8, or even 10 years to reach the level that outsiders don't bother to take a look at, and insiders just regard them as the cornerstone. The value is also about the same as a small stone.
A high-level doctor is more like a high-level athlete, who is at least qualified to win a place in a provincial sports meeting.
In larger tertiary hospitals, this requirement has to be even higher. You have to be qualified to participate in the National Games. At the very least, you have potential. In the next few years, you have hope to grow to this level.
Ling Ran obviously has them.
More than 100 cases of Tang method are his confidence.
The leaders of the hospital don't need too much energy to compare, just use Director Pan as a benchmark, and they can draw a bottom line for Ling Ran's value.
Director Pan is already a well-known hand surgery expert in the province, not so famous, but famous, he must be invited in the province's hand surgery-related conferences, if there are national flexor tendon-related and tendon-related conferences, he must be the one I can get an invitation.
On the tang method of suture alone, Director Pan is one of the best specialists in Changxi Province, and is the first choice for referral in the industry.
Ling Ran has only been in Yunhua for a short time, and his status is a bit embarrassing, which makes the bureaucratic system of Yunhua Hospital not yet functioning and making the final decision.
But in the emergency department, Ling Ran's treatment is already quite high. The right to use the operating room full time, the full amount of the operation fee, the full amount of commission for medical consumables, semi-full-time assistants and regular trainees, etc.
Of course, the ability Ling Ran displayed was even more surprising.
Patients who are continuously discharged with "excellent" ratings are amazing achievements in any hospital in the country.
Lu Wenbin looked at Ling Ran now with a sense of fear.
"The ulnar nerve is damaged, isn't it?" Ling Ran had seen the film before, so now he will ask one more question to confirm.
Lu Wenbin was stunned for a moment, then hurriedly said: "There is nerve damage in the ulnar nerve groove."
Lu Wenbin was somewhat used to Ling Ran's style of doing things, but it was rare for him to pay attention to nerve damage.
Some small nerve injuries do not need to be sutured, and slightly larger ones can be sutured or not. No matter how serious it is, that is, the so-called combined nerve rupture, it will not be sent to the emergency department of Yunyi. Section is here.
The professional departments of modern hospitals will screen diseases, and the more complicated diseases will be sent to the better hospitals. Ordinary hospitals will only do the cases they are familiar with to improve the success rate.
If Ling Ran didn't do nerve sutures before, he would screen out cases with severe nerve damage, and those with severe fractures would also be screened out.
He can do it now, and if he encounters such a patient with indications for surgery, he can suture it.
"After the tendon is sutured, he will be sutured for the ulnar nerve." Ling Ran quickly made a decision.
The so-called surgical indications refer to the fact that the disease meets the standard of conventional surgery. The surgical indications for hand nerve injuries are actually very low, because primary suture (for early good wounds) has a good effect on nerve damage.
And it goes without saying that sutured nerves are better than unsutured nerves.
However, doctors rarely like to suture nerves, especially in departments other than neurosurgery, they often do not suture without suturing.
The primary reason is naturally the difficulty of suturing. To put it simply, very few hospitals outside the top three can do nerve sutures, and even fewer can do good sutures. And if the sewing is not good, it is better not to sew.
It was the same with Ling Ran before, if he didn't have diamonds, he wouldn't do porcelain work.
Now, he has got the diamond.
Lu Wenbin hesitated and began to prepare for the operation.
Ling Ran watched the film for a while.
A large number of MRI films and X-ray films were inserted on the backlight panel, which seemed a bit confusing to laymen, but Ling Ran watched them with great interest.
For clinicians, the ability and experience brought by the master-level magnetic resonance film is like opening the eyes of the sky. No need for dissection is better than the clarity of dissection. Once you use it, you can't do without it. This is much more useful than a few words from the radiology doctor. Even the radiologist himself, without his professional knowledge, couldn't get as much information as Ling Ran could.
In the future medical environment, the requirements for doctors' ability to read images will definitely be higher and higher, but at present, it is still very difficult to popularize it.
Medical students graduating from undergraduate courses do not do special training, so they must read MRI as if they are reading from heaven.
However, Ling Ran's master-level image reading ability is stronger than most radiologists.
In order to do his first perineurial anastomosis, Ling Ran watched it carefully for a long time.
The sequence of suturing the tendons and nerves, the direction of opening the incision, etc., were all in Ling Ran's mind, and he thought about it carefully.
In the past, when doing tang method, it was a fixed technique and a fixed order, which didn't involve anything else, just do it step by step.
It's different with the addition of nerve anastomoses.
It's like originally planning to build a bridge, but now we want to build an overpass, the bridge can be designed step by step, and the overpass must be considered according to local conditions.
Although Lu Wenbin and the others were a little strange, they were still as quiet as cats.
"Let's get started." Ling Ran returned to the operating table, and said with a blank expression: "Finger function reconstruction surgery, combined with ulnar perineurial anastomosis. Today's surgery is different from usual, so we must cheer up."
Ling Ran gave a special reminder, and started with the bow-holding posture, and gently cut a big slit twelve centimeters long.
Lu Wenbin stared intently.
I have been a resident doctor for a long time, and sometimes I can guess a lot by looking at the opening of the chief surgeon.
Regardless of personal habits, the larger the opening, the more difficult the operation will be for the same surgeon in the same operation.
Ling Ran is a doctor who pays attention to the beauty of his mouth. At this time, he drew a large mouth that exceeded the standard, which immediately woke up Lu Wenbin.
No need for Ling Ran to say much, Lu Wenbin quickly went into battle with the gauze sandwiched between his hands.
Ling Ran stably and slowly sliced through the patient's muscle layer, not seeking speed at all.
Lu Wenbin participated more competitively and actively.
The familiar suturing of the flexor tendon, even though Ling Ran deliberately stabilized it, was completed very quickly, followed by the perineurium anastomosis.
The nerves of the human body are structured like network cables.
The core is multiple bundle membranes, which are the functional parts, just like the twisted pair in the network cable, and the outer membrane is like the skin of the network cable.
The difference is that because of the biology of the nerve, it has the ability to heal itself.
On this basis, there are usually three types of nerve anastomosis, which are adventitia anastomosis, perineurium anastomosis, and adventitia and perineuria anastomosis at the same time. The most commonly used is adventitia anastomosis, that is, the skin is sewn together and the inside grows by itself.
Whether it is good or bad, doctors can control it to a certain extent, but they cannot completely control it.
The controllability of perineural anastomosis is stronger, but the difficulty is also much greater. Adventitial sutures are often still possible with the naked eye, but perineural sutures are completely impossible.
Lu Wenbin looked worriedly at Ling Ran who was wearing microscope glasses.
He didn't wear a microscope, so he couldn't see Ling Ran's operations clearly. He couldn't even see the thread, and the 10-0 seam moved, truly impenetrable.
"The perineum is really tough." Ling Ran said suddenly.
Lu Wenbin was stunned for a moment, and asked curiously, "Tougher than pigskin?"
Ling Ran thought about it, and said, "It's much tougher. It's like pig's foot skin."
Lu Wenbin understood.
"Okay." Ling Ran quickly tied the knot with the needle holder, announcing that the stitching was complete.
Lu Wenbin was surprised: "It's just sewn up? There are several perineum."
"It's all stitched up." Ling Ran let out a breath, and then began to close the wound.
Lu Wenbin, who had already prepared to sew the skin, was stunned for a moment, so he could only continue to do it obediently, comforting himself in his heart: Today's surgery is more important, and Dr. Ling pays more attention to it. Don't be afraid, it's a technical adjustment, don't be afraid.