Monday.
Ling Ran brought his research paper and went to Yun Hua Hospital in high spirits.
At five o 'clock in the morning, the hospital was slowly waking up. Dozens of breakfast carts occupied several pedestrian passageways in Yun Hua Hospital. On the way to the parking lot, the security guards also began to collect fees. The most active ones were the scalpers. They sold the numbers of famous specialists. Whether it was the number of chief physicians or associate chief physicians, it was based on their reputation. It was fair, so the doctors would occasionally tease them about the price.
There was also a long queue in front of the consultation counter. The 13 or 17 RMB specialist consultation was their first choice. Only when the specialist consultation was finished would people choose the 5 or 7 RMB general consultation.
The scalpers who mingled among them could raise the price of the 17 RMB specialist consultation to 60 RMB, 80 RMB, or even 180 RMB.
In the month when Pan Hua brought back the "Japanese specialist", the highest price for the specialist consultation was 500 RMB, which was rare in Yun Hua Hospital.
Compared with the scalper tickets for celebrity concerts, the scalper tickets for the hospital were even more profitable. The specialists would make house calls every week, so they did not have to worry about selling out. The supply was very stable, and the transactions were mainly done in cash …
The Emergency Medicine building was a little more peaceful.
The patients at night had been settled, but the patients during the day had not arrived yet. The nurses in the reception area were a little sleepy.
"I brought you some fruits." Ling Ran put a bag of fruits he brought from home on the waiting counter.
The two young nurses were surprised and said, "Doctor Ling, you're so polite."
"It's my duty." Ling Ran still had a deep understanding of reciprocity. Nowadays, he often received gifts from the nurses, doctors, patients, family members, big sisters, and others, so he had to repay them one or two times in the end. Fortunately, Ling Ran's mother, Tao Ping, had been preparing gifts for Ling Ran, so the supplies were sufficient.
"Wow, the grapes are so fresh …"
"And apples, I like apples the most …"
The two young nurses did not care whether it was true or not, but they still expressed their fondness for Ling Ran's gifts.
"The grapes and apples were planted by my relatives and friends in the neighborhood. My family orders some in advance every year, and they can be sent to my house at any time during the picking season." Ling Ran deliberately explained and said, "Although fertilizers and pesticides are used, they are all within the standard range, and it's very easy to clean."
The two young nurses nodded excitedly and said in unison, "Doctor Ling is the best."
Ling Ran entered with a smile and placed the research paper he had written on Huo Congjun's table. He then changed into a large white coat and headed to the Operating Area.
He changed into scrubs in the Operating Area and walked past the waiting room. As expected, he smelled braised meat.
Ling Ran entered with a smile and was surprised to find a flat plate with more than ten pig trotters piled up on it. There was a small sign at the bottom right of the plate with a QR code on it. There was also a description written on the side. [To balance our expenses, please pay for each pig trotter.]
When she looked up again, she saw Lu Wenbin standing beside the table with a smile on his face. The more she looked at him, the more he looked like a chef.
"Are you ready for the surgery?" Ling Ran's focus was still on the operating theater. Pork trotters … were delicious, and of course, very useful.
As Ling Ran spoke, he whipped out his phone and scanned the QR code to buy a pork trotter.
Lu Wenbin scooped up a big one from the bottom and passed it to Ling Ran with both hands. He then smiled and said, "The operating theater is ready. The anesthetist is still Su Jiafu, and the MRI scans are also inside. He's a thirty-eight-year-old air conditioner worker. His hand got stuck when he was installing the air conditioner. His index finger was amputated due to rotational avulsion. The skin defect was quite serious, and the tendons and blood vessels were also pulled out. "
Compared to a cut wound, a rotational avulsion amputation was much more serious.
For doctors, the survival rate of the replantation would also be reduced.
Ling Ran nodded slowly and asked, "What are the expectations of the patient and his family for the surgery? They know that the possibility of a full recovery is close to zero, right? "
"The family understands," Lu Wenbin said. "I told them that skin grafts and blood vessel grafts will be done, and that it is inevitable that the finger will become shorter. The family said that they can accept it. However, the patient hopes that he can recover the function of his hand as soon as possible. He also hopes that he can recover faster so that he can work again. "
Lu Wenbin paused for a moment and said, "The patient's family is not very well off, and they are quite concerned about medical expenses."
Ling Ran nodded slightly. For finger replantation surgeries, these were considered normal requirements.
Industrial workers were the most common patients in finger replantation surgeries. Industrial workers did not care much about their appearance. They were more concerned about their ability to survive and the burden of medical treatment.
"Let's go in." Ling Ran threw away the pork trotter bone, wiped his mouth, washed his hands, and entered the operating theater. With the help of a nurse, he put on a surgical gown that covered his entire body.
At this moment, the operating theater was almost in a sterile state.
However, the sterility standard of the operating theater in the Emergency Department had never been high, and it was the same for the Hand Surgery Department. After all, it was impossible to thoroughly clean the patient every time he entered the operating theater.
The Neurosurgery Department could operate in the craniocerebral operating theater, and the cardiothoracic operating theater could also prevent foreign pollutants from entering the operating theater. The Emergency Department did not have such conditions, and the Hand Surgery Department also did not have such conditions.
Similarly, the General Surgery Department also did not have a high-cleanliness operating theater. When a bag of feces sprayed on the roof, any high-cleanliness operating theater would be at a loss.
As usual, Ling Ran first read the MRI scan. Lu Wenbin and Ma Yanlin untied the towel wrapped around the patient's hand and tried to clean the oil stains on the patient's non-surgical position.
When Ling Ran came back after reading the scan, he carried out debridement.
His waist and neck were kept straight, his legs were spread apart, his elbows and wrists were firmly supported, and he was highly focused …
Lu Wenbin and Ma Yanlin watched as they learned.
Among surgeons, microsurgeons paid the most attention to surgical postures. This was because microsurgery was a typical surgery that required physical strength. Not only did it require a long period of concentration, but it also placed a heavy burden on the body.
Without a good surgical posture, microsurgeons would have to go to the operating table before they could become famous.
"Lower the light." Ling Ran ordered, and the circulating nurse immediately came over and lowered the searchlight on the first layer of the patient's hand.
The main function of a spotlight is to maintain temperature.
One of the key points in finger replantation was the temperature of the hand. Once the temperature of the blood dropped too much, it would be very difficult for the replanted finger to survive.
At the same time, the anesthetist, Su Jiafu, also braced himself. He paid attention to the monitor at all times and was ready to deal with the problems of vasospasm and blood clotting at any time.
In the operating theater, in addition to heparin, doctors could also use a few doses of papaverine. The latter's anticoagulant effect was even more prominent, and it belonged to the category of super effective drugs. It would probably not be eliminated for a long time.
"Today, I'll use the reverse method." Ling Ran made his decision after he finished debriding the wound.
Anterograde and retrograde were relative to the order of suturing.
The so-called anterograde was to first fix the bone and joint, then suture the extensor tendon, then the dorsal tendon of the finger, the skin of the dorsal finger, then the flexor tendon, arteries, and nerves, and finally, the skin of the palm of the finger. It could be said that it was easy at first, then difficult at the end.
Retrograde was basically the opposite. Once the most difficult arteries, nerves, and flexor tendons were sutured, then the joints and extensor tendons were sutured.
Newbies usually performed the surgery in an anterograde manner. They could complete more steps step by step and build up their confidence step by step. Retrograde was considered a rather high-end operation, and only a few doctors would use it.
If Ling Ran was only at Master Level in finger replantation, he might only master the anterograde method, which was why he could skillfully use the retrograde method now that he was at Perfect Level.
There was not much difference in the outcome between anterograde and retrograde. The main difference was the doctor's habits, the patient's condition, and the ability to control risks.
For an avulsion wound, it was relatively easier to fix the bone and joint, and the artery and tendon replantation was the most important.
Ling Ran and Ma Yanlin stood on one side of the two-person binocular microscope. Lu Wenbin used a high-powered microscope to cut off the patient's blood vessels from the upper part of the patient's right arm for transplantation.
The arteries and veins needed to be transplanted, and the skin flaps needed to be transplanted on a large area.
The three of them worked on this finger for two hours before they finished the most difficult part.
"Install another 10-0." Ling Ran was a little tired, but his eyes did not leave the microscope, afraid that he would lose his field of vision.
* Shick. *
The door of the operating theater opened, and Nurse Liu entered with a smile. "Remember to get your eggs when you come out. Each of you gets a box of free-range eggs and a box of salted duck eggs. Those who are associate chief physicians and above will get a box of four potatoes. "
Nurse Liu paused for a moment before she said, "Doctor Ling, Department Director Huo asked you to get his share."
"Oh." Ling Ran still did not raise his head.
Lu Wenbin and Ma Yanlin did the same.
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