Li Dongshan completed a thorough debridement, and the process was very smooth. During this process, Wang Linfeng watched with fascination and said with a smile: "Professor Li is indeed Professor Li. The secrets revealed in this debridement process are

The details are all things we have never thought of before.”

"And the team led by Professor Li is also extremely professional."

Although Lu Cheng was not as prominent in this process as blood collection, he was extremely familiar with anatomical structures. The visual exposure he personally performed during the operation and some of the little techniques were eye-opening to Wang Linfeng.

Even Wang Linfeng felt that if Lu Cheng could be assigned to him and be his assistant, he could at least challenge the kind of comminuted pelvic fracture that he had never dared to challenge, AO/TO C2 type.

However, he didn't even dare to think of poaching Lu Cheng. Firstly, he didn't dare, and secondly, he couldn't afford it.

If it is just a simple infection, complete surgical debridement is enough.

But this surgery is not just that, Lu Cheng can now also see the blood strips on the patient's wound.

After internal fixation of comminuted femoral fractures with plates and screws: infection, nonunion, chronic osteomyelitis, plate rupture! lv67! lv67! (Lord level monster, characteristics: scar hyperplasia, bone absorption, infection regeneration ability: +200%!

Infection mutation rate: 20%. Mixed infection mutation rate: 15%! Multi-resistant infection mutation rate: 10%.) 201562/612144!

Surgical incision injury: lv32!31351/31351!

This patient suffered a lot of trauma. Even the incision caused by the surgery reached Level 31, which is higher than Lu Cheng's current doctor level.

There are two reasons why thorough debridement is not enough to reduce the blood level of the disease to a relatively safe level. The fracture ends are not treated, and the second reason is that the wound surface is not extensively sterilized.

Moreover, it is necessary to consider whether this patient needs internal fixation or continues external fixation. It can be said that as long as there is a fracture, whether it is old or not.

Regardless of whether it is infected or not, you cannot just leave it alone. Otherwise, the fractured end will exist and the patient will not be able to move. In this way, after the operation, the swelling of the patient's affected limb will be slow, which will not be conducive to his subsequent functional recovery.

Li Dongshan said: "Come and rinse with sterile salt water!"

"Pulse, the pulse wash is fast and convenient." Wang Linfeng quickly turned on the prepared pulse and connected it to 3000ml of physiological saline used for arthroscopy, two bags, a total of 6L for flushing, which is better than opening the pulse.

The small bottles are much more comfortable to use.

After the pulse was connected, it started clicking immediately.

Immediately afterwards, Li Dongshan did not rush to rinse the hydrogen peroxide and soak the inside of the incision with dilute iodine complex, but began to deal with the broken end of the fracture.

The broken ends of the fracture are estimated to be easily broken due to stress shielding due to osteoporosis. However, the closed space between the broken ends must be opened at this time, otherwise there will be residual lesions in the closed parts.

.

Allow the infection to regenerate.

This process is not complicated or difficult. Li Dongshan quickly used a curette to scrape out all the cavities at the broken end, exposing the fresh bone cavity, but not too much bone marrow was exposed. This was also

Not surprising.

The patient must have had osteomyelitis before, and the bone marrow inside the cavity was almost eaten away by bacteria. Some of the reconstructed bone marrow relied on the airtight cavity to confine the bacteria.

"Dry eyes."

"pulse."

"Dilute the complexed iodine! Just make it about 50%. Don't be too thick, and don't be too dilute."

Complex iodine that is too concentrated will suck up the water in the cells and cause direct cell necrosis. However, if it is too dilute, the purpose of sterilization will not be achieved.

After soaking like this for five minutes, the dilute iodine complex was sucked out again, and then the entire surgical field was cleaned with normal saline. Li Dongshan said: "We'd better install an external fixator. Director Wang,

You come and put in the drainage tubes, one inside and one outside, and the top and bottom must be connected."

"Patients after this kind of infection must be rinsed thoroughly, and the rinse solution is prepared with sensitive antibiotics. Only in this way can most of the remaining bacteria be killed, and the remaining small part must be used in sufficient amount and for a sufficient duration.

of antibiotics.”

"The level of antibiotics cannot be lowered or discontinued until the bacteria in the flushing fluid are cultured to a sterile level at least three times," Li Dongshan said.

Wang Linfeng immediately said: "Oh, okay, thank you, Director Li."

"You still need an external fixator after this operation, right? I'll call someone to bring the equipment right away."

Li Dongshan said: "We don't want the ring-shaped ones, just ordinary connecting rods. This time it's just a temporary fixation. You can open the drainage tube first. Don't use negative pressure suction. Use a long and big tube."

Make openings around the pipe, and use the same inlet and outlet pipes.”

"This will produce a siphon effect, which will also completely extract the flushing fluid inside, and it will not easily block the tube." Li Dongshan threw out another personal item.

When Wang Linfeng heard this, he immediately said: "Professor Li, what exactly is going on with this suction tube? You have to demonstrate it yourself."

"Sure." Li Dongshan also didn't want this patient to get into any more trouble, so he threw out all his personal belongings and prepared to finish the details himself. Then he turned slightly and asked, "Xiao Lu, do you know how to perform external fixation?"

A bracket?”

Lu Cheng looked at his advanced fracture fixation technique and nodded.

"If you don't know how, don't be brave. The patient's operation time is almost four hours. Please do it as soon as possible."

Li Dongshan, then Wang Linfeng and Li Dongshan went to the instrument nurse station. Li Dongshan began to explain how to operate a pipe as both an inlet pipe and an outlet pipe at the same time, while She Min, Fang Nixin and Lu Cheng were doing external fixation.

.

The instrument box for the external fixator was delivered quickly.

External fixation is actually to use connecting rods outside the skin to fix the upper and lower ends of the fractured ends, and the connecting rods and fractured ends are fixed vertically to the long bones with half-threaded nails.

The semi-threaded nail and the connecting rod are fixed with a special fixator, so that the fracture can be stabilized.

However, there are still many details that need to be paid attention to when performing these operations on infected patients.

When Fang Nixin and She Min were just looking for equipment, Lu Cheng had already used a sharp knife to break open the skin, and then drove in the fixing screws with a clang.

The screws were inserted into the body, but they didn't even react.

Generally, two screws are enough.

Just when they were about to see what Lu Cheng was doing, Lu Cheng drove in the second half-threaded screw.

Then the skin incision under the fracture end is being made.

Looking at this posture, he is planning to hit the upper and lower ends at the same time. Don't you use the connecting rod to compare?

The external fixator is very simple to install, but the fixator must be aligned with the same longitudinal axis. Otherwise, it will be crooked and the fracture cannot be fixed, or the fixation effect cannot be achieved.

The general routine operation is to compare the upper and lower connecting rods, then fix the connecting rods with fixators on both sides of the same line, and then drive the semi-threaded screws into the long bones.

Only in this way can the broken ends of the fracture be matched. What on earth is this reverse operation?

When Li Dongshan and Wang Linfeng heard the clatter behind them, they were stunned for a moment. They were still thinking about how She Min could operate the external fixator so quickly. When they turned around, they both looked a little stunned at that time.

Dumbfounded.

They each swallowed two mouthfuls of saliva.

The gall water in Wang Linfeng's stomach was almost coming out, so he stared at Li Dongshan without daring to speak.

Li Dongshan didn't know what to say. He just asked Lu Cheng if he would do it in order to give him a chance. He originally thought that Lu Cheng would make a move, but this move?

Li Dongshan complained in his heart, my little brother Lu, do you want to kill me?

I'm just reminding you not to be brave, not to speed up. You think you are me, you want to use the external fixator in the reverse direction, and you have to rely on experience.

But he didn't know how to say it.

Lu Cheng had four nails in his hand, and Lu Cheng didn't want to hide his clumsiness. He had advanced fixing techniques. This reverse operation was the most time-saving.

It has been more than three hours since the patient started the operation. It can save some operation time and is also good for the patient's postoperative recovery.

Moreover, Lu Cheng does not necessarily need to explain everything clearly now. Li Dongshan also let him go a little bit. As the temporary chief surgeon, he certainly has autonomy.

Ta-ta-ta!

Under the watchful eyes of everyone, Lu Cheng looked like a stubborn donkey who didn't know how to die, so he also drove out the fixing screws below the fractured end.

The length of the screw outside the skin is almost the same, but at this angle,

No one can be sure that it is in line with the longitudinal axis of the femur, nor is the effect of the fixation.

"Connecting rod, connector!" Lu Cheng shouted to Fang Nixin, who was in a daze and holding the connector in both hands.

Fang Nixin was still cursing in her heart at this moment, "Xiao Lu, you have lost the master's face by messing around like this."

But Lu Cheng's voice made her unconsciously hand over the two connectors in her hands.

Lu Cheng put the movable end of the connector on, and then took the other two connectors from She Min's head with trembling hands, and put them on the buttocks of the screws to lock them.

After a slight change of direction, Lu Cheng lifted the connecting rod from She Min's hand, and fixed the connecting rod with two swipes.

Immediately afterwards, he used a hexagonal screwdriver that he had prepared before to tighten the screws of the connector.

Suddenly, a miraculous scene occurred. Lu Cheng first fixed one screw on the upper and lower connectors.

A miraculous scene occurred.

Suddenly, the broken ends of the femur actually connected.

Fracture external fixation technique is a relatively basic technique in trauma surgery. It is easy to learn, but difficult to master.

Lu Cheng took shortcuts, so he was able to grow to his current level of operation so quickly.

Lu Cheng was actually very confident, but to be on the safe side, he bluntly separated the quadriceps to expose the broken end of the fracture. The anastomosis of the joints had already reached an excellent position.

As a result, Li Dongshan's cheeks couldn't help but tremble, and he cursed three words silently in his heart.
To be continued...