Is there no limit to this doctor's skills?

Chapter 204: I can't teach this anymore!

"Trauma orthopedics mainly focuses on three core skills."

In the lounge, after Guo Ziyuan had sent Chi Huanlin, who was on a follow-up visit, away, and then sent Liu Lingli and Yao Tiao out, Ding Xianqi began to build a specialized technical framework for Guo Ziyuan.

Guo Ziyuan listened attentively.

Actually, Ding Xianqi had said these words in his previous life, but that was in his previous life.

In the current timeline, Ding Xianqi has not yet told Guo Ziyuan about this.

"It can be roughly divided into three lines, one of which is the path centered on debridement techniques."

"One approach is centered around hemostasis."

"Thirdly, there is the approach centered on manual reduction techniques."

After writing down the names of the three basic skills, Ding Xianqi began to walk through the tree diagram.

"Trauma orthopedics is called trauma orthopedics because, as the name suggests."

"We need to treat patients with trauma. Fractures are just one type of trauma. There are multiple forms of trauma, such as soft tissue injuries, lacerations, crush injuries, etc."

"If the wound cleaning isn't done properly, I can't treat these patients."

Ding Xianqi then pointed to hemostasis: "Hemostasis is a life-saving technique!"

"You mentioned before that this hemostasis technique is equally important in emergency surgery."

"If the hemostasis technique is inadequate..."

"We have difficulty even taking on the most basic emergency patients in trauma orthopedics, and we don't have the energy to consider high-difficulty elective surgeries."

"If you're going to be a doctor, you have to do your general social duties first before you can consider playing a higher social role."

Do you agree with this statement?

Guo Ziyuan readily agreed: "Bone fracture surgery is relatively simple, and it can be treated at the county hospital."

"Yes, fracture surgery is relatively simple, but it is also the foundation of everything."

"Our orthopedics department is called orthopedics because it is related to the long bones of the limbs."

"Bone is the foundation of one's character."

"Treating fractures is the foundation of our orthopedics department."

"Therefore, manual reduction technique is also one of the core keys."

"Actually, whether it's a fracture, bone defect, or an extreme and complicated fracture, manual reduction is indispensable in the surgical treatment process."

"It's just that the way it's expressed is different."

"For simple fractures, direct reduction is sufficient."

"Complex fracture, try to reduce it."

"For bone defects, it is necessary to not only reposition them, but also to find ways to allow the bone defects to heal."

"Resetting is still the most crucial step."

"These three basic skills are the foundation of our profession as trauma orthopedic surgeons. If you want to make a living in trauma orthopedics in the future, you can only rely on these three basic skills to establish yourself."

"The basic principles of debridement and suturing are too simple, and you've already encountered them a lot, so I won't go into detail."

"The remaining techniques for repositioning, what we really need to understand is repositioning, alignment, and the reshaping of the force lines!"

"What happens if the fracture cannot be properly reduced?" Ding Xianqi asked Guo Ziyuan a very simple question.

Guo Ziyuan blurted out: "Deformed healing, non-healing fracture, slow healing."

Ding Xianqi then asked, "What additional complications might occur during bone healing?"

These are all fairly basic issues: "bone resorption, osteoporosis, osteonecrosis, and bone defects."

Ding Xianqi: "These are often accompanied by, and inevitably accompany, complications called functional impairments."

"If the position is incorrect, the function will not be correct, especially if the bone position is incorrect, the patient will have difficulty standing up."

"Actually, wound cleaning is the same!"

"You can't let it become necrotic..."

"Why don't we let you get involved in fracture reduction as early as possible? It's because we want you to understand the nature of the body's healing process through debridement."

"In principle, there are only three aspects to the treatment of fractures: reduction, fixation, and rehabilitation."

"But have you ever disassembled it? Before reducing a fracture, the wound needs to be cleaned. Fracture fixation is actually analogous to suturing soft tissue, aligning the suture lines."

"If you break down the basic principle of plate screws in the most primitive way, it is actually just debridement and suturing."

"It's simply because bones are too hard, and after displacement, they are not as easy to reposition as soft tissues. That's why trauma orthopedics, and the unique repositioning techniques specific to orthopedics and the spine, have emerged."

"Reduction cannot help accelerate fracture healing, but it is a necessary condition for healing."

"By observing clinical cases closely, research opportunities will naturally follow."

What are the underlying causes of non-healing fractures, bone resorption, nonunion, and bone defects?

Why do some patients experience bone resorption?

"Why is it that even though the surgery went well, the fixation was good, and the repositioning was good, it still can't grow?"

Guo Ziyuan blurted out: "The excessive pressure on the fracture ends caused local blood circulation dysfunction."

"Secondly, local infection, where the infection site leads to local arterial embolism."

"Third, traumatic arterial embolism, rupture of the nourishing artery."

Fourth, the fixation is not secure.

"But because of the general improvement in doctors' skills, the fourth reason is rarely seen now."

Ding Xianqi stared wide-eyed: "Are all non-healing fractures related to blood vessels?"

Guo Ziyuan nodded: "That's essentially how it is."

"If you don't think so, it's possible that a problem with your blood vessels hasn't been detected."

"If a fracture doesn't heal or resolve even after proper reduction, fixation, and alignment, it's definitely due to a problem with local blood supply!"

Ding Xianqi frowned: "Haven't you read about Perren's theory yet?"

Guo Ziyuan: "Master, Perren's strain theory describes the degree of deformation that occurs in an organization under mechanical loading!"

The calculation formula is: ε = ΔL/L0

Perren believes that the magnitude of micromotion (i.e., strain) at the fracture ends directly determines the healing process.

"Low-stress environment (<2%): promotes direct healing (primary healing), no callus formation, requires absolute stable fixation."

"Moderate stress environment (2%~10%): stimulates indirect healing (secondary healing), achieving connection through callus formation."

"High-stress environments (>10%): lead to delayed healing or non-healing due to excessive tissue damage."

"But even in high-stress environments, Perren's theory suggests excessive tissue damage."

"The direct cause of excessive tissue damage is poor local blood circulation."

"Personally, I think the problem lies within the local microcirculation or in the blood vessels between the microcirculation and the body's circulatory system!"

"As long as blood circulation is good, there are no underlying diseases or blood disorders, fractures can heal as long as they are properly fixed and reduced!"

"Master, diabetic foot ulcers can heal, so why can't fractures heal?" For the first time, Guo Ziyuan debated with Ding Xianqi in a relatively positive way, using basic theory.

This is not arguing; it is Guo Ziyuan's unique interpretation based on his own understanding and basic comprehension of existing orthopedic theories.

Although it has not been proven yet, Guo Ziyuan can make such "hypotheses"!

Ding Xianqi suddenly realized that he had made a preconceived mistake.

He proposed the Perren theory because he believed that many fractures fail to heal due to a multitude of factors, not just local blood supply.

However, Guo Ziyuan pointed out the phenomenon of diabetic foot ulcer healing, which silenced Ding Xianqi.

This is no longer a simple discussion of orthopedic debridement and suturing, or a discussion of a specific case.

Ding Xianqi then asked, "What should we do if some patients have problems with their local microcirculation?"

"Reconstruction, replacement, transposition."

"Bring the techniques of hand surgery back to trauma orthopedics!" Guo Ziyuan replied.

Ding Xianqi's brows furrowed: "You want to start a comprehensive orthopedic department?"

Currently, the medical community is facing a problem.

As vocational colleges become increasingly specialized and specialized, the collaboration between different vocational colleges is also becoming more and more complicated.

When a trauma orthopedic surgeon encounters a hand surgery case, they still need to spend time and effort to request consultations, referrals, and collaboration between the two departments.

This will waste time and cause delays in treatment.

Therefore, some hospitals have begun to explore establishing a comprehensive orthopedic department to handle complex orthopedic cases.

In the comprehensive orthopedics department, there is a team with the best experts from various specialties, ready to start a session at any time!

Similar to MDT (Multi-Team Collaboration), but different from MDT!

If it were any other master's or doctoral student who said they wanted to study general orthopedics, Ding Xianqi would slap them across the face.

You haven't even mastered a single specialized subject, and you want to become a general orthopedic surgeon?

However, Guo Ziyuan has this potential!

"Master, I don't want to develop general orthopedics right now, but I feel that we need to integrate the techniques and concepts of other specialties into our trauma orthopedics."

"Actually, as you know, the reason I proposed the microcirculation theory is because I performed limb-sparing surgeries on several patients before, which was based on the concept of a whole-body circulation device."

"Moreover, it borrowed the survival concept of 'half-body amputation technique'."

"Life isn't that strong, but our bodies might not be that fragile either."

"We need to integrate the theory as a whole, and refine the specific operations and local theories."

"Find the root point."

At this point, Guo Ziyuan's voice became much softer: "The key is to find the root cause of the problem."

Ding Xianqi's face suddenly contorted!

He really wanted to say, "Guo Ziyuan, how dare you!"

How dare you be so disrespectful? You actually said that in current clinical practice, some patients' diagnoses are not even clear?

How brave are you?

In reality, Ding Xianqi also knew that no matter how great a clinical team was, it was really just a matter of size and organization.

Looking back decades later, we'll realize we were all just amateurs!

With advancements in theory and technology, what is the current level of diagnostic capabilities?

Yes, nowadays doctors immediately think of tuberculosis when they hear about low-grade fever and night sweats.

But decades ago, when the technology and theory were not yet complete, who would dare to make such a connection so easily?

That's the maturity of the theory, which has led to the current routines and fixed mindsets!

You need to be a professional when it comes to technology.

But professional skills need to be developed step by step...

A hundred years ago, modern medicine took pride in who had the most bloodstains on their white coat.

Decades ago, this kind of "honor" became synonymous with idiot.

"You can't just say things like that." Ding Xianqi pursed his lips.

"Some things are determined by the average level; just because you can do them doesn't mean everyone can."

If you can do it, then everyone can do it.

"This is the diagnosis, this is the treatment..."

Standards and guidelines in any technology industry serve as a protective layer.

It serves as a protective layer for both patients and doctors; otherwise, every death case could be analyzed in a nitpicking manner.

The medical practice could no longer continue.

"Master, I'm only saying this to you privately."

"Furthermore, just because I said it doesn't mean I have to do it. In fact, I can't make all the diagnoses accurately right now, and even if I could make the diagnoses accurately, I wouldn't be able to complete all the treatments."

"But we need to think about it this way!"

"Thinking about it and then putting in the effort gives you direction!"

"Technological progress lies in being demanding of oneself and tolerant of others!" Guo Ziyuan has his own understanding of technology.

He is not a saint, and likewise, Guo Ziyuan is not a saint.

Learning advanced technologies requires not only hard work but also talent.

As for the theory of talent, Guo Ziyuan was once a victim as well!

Ding Xianqi then steered the conversation back to Chi Huanlin: "So, the reason Chi Huanlin's previous surgery was ineffective was due to an unclear diagnosis?"

Guo Ziyuan glanced at the door and confirmed that the door to the lounge was closed.

"The direction is definitely right; there must be infections."

"However, we didn't find the right location."

"Of course...it's no one's fault."

Ding Xianqi started smacking his lips rapidly: "If the film viewing technique is well-developed, can it be this useful?"

"Master, in truth, there is no such thing as a useless skill."

Even something as simple as chopping vegetables well can eventually become a skill.

"Any technology, if perfected to its fullest potential, can create miracles, even something as simple as auscultation or physical examination..."

Guo Ziyuan then brought the topic to a close again: "In the end, all competition among doctors boils down to differences in their basic skills!"

"Talented people can learn some techniques, or they can create their own."

"But even with the modified Tang suture technique used in hand surgery, is it suitable for all tendon ruptures?"

"uncertain."

"Finally, we may develop a new suturing technique based on the application of basic principles and techniques of suturing, thus eliminating the improved Tang method."

"Just like limb replantation surgery, this technique is considered mature now, but that's because its theory is mature. It doesn't mean that all the procedures will always be mature."

……

An hour later, Ding Xianqi left the lounge looking dejected.

This time, Ding Xianqi was not as "angry" as he was when he left Guo Ziyuan's dormitory last time!

The reason Ding Xianqi was angry last time was because he felt that Guo Ziyuan was being ridiculous, and that Guo Ziyuan had no confidence to say such extreme things.

However, Ding Xianqi no longer dares to think that way.

Guo Ziyuan didn't do much, but he improved the basic medical skills he knew and had come into contact with to an incredible level.

This level of skill, combined with the basic surgical techniques of a specialist, is what creates miracles!

And it's not just Chi Huanlin.

There is also the treatment of diabetic foot ulcers.

Furthermore, Guo Ziyuan has even concluded through his own experience that a small number of diabetic foot ulcer patients can heal on their own without the use of blood growth factors.

This was something Guo Ziyuan actually did, through his own hands-on experience.

This is the basic skill!

It's basic, but once you become a supermodel!

That would drive others to despair!

Medical technology is both fundamental and advanced, like a pyramid with different levels, making it difficult for people to reach or imagine the horrors of the next level.

Of course, Guo Ziyuan's words still barely echoed in Ding Xianqi's ears.

"Master... we say this because we want to do it, not because we want others to do it."

"Being a doctor means being your own doctor and fulfilling your own duty."

"It's not about setting a benchmark for myself, but simply about doing more good for patients from my own perspective."

"It's not about becoming an 'expert team' to find mistakes in other teams, but about honing our skills to treat and save patients' lives."

Ding Xianqi stood at the door, holding the door open with one hand.

He closed his eyes:

This student is impossible to teach.

Guo Ziyuan is not wrong; the only one who is wrong is Ding Xianqi, who is not capable enough.

Ding Xianqi is now very envious and curious.

I admire Guo Ziyuan and am curious about him.

How will he be a doctor?

Therefore, Ding Xianqi doesn't plan to go to the lab today. He wants to see how Guo Ziyuan actually works as a doctor.