Is there no limit to this doctor's skills?

Chapter 36 'Bullshit'!

The operating room was quiet, with only the piercing beeping of the anesthesia machine.

The circulating nurse and the anesthesiologist wearing a cap with silk flowers were talking in hushed tones about the new lipstick designs.

The scrub nurse sat bored at the instrument table, arranging the instruments according to their spacing; this was her favorite way to pass the time during "surgical boredom."

There weren't many people in the operating room. Huang Yantong, a second-year doctoral student, was called away by the chief resident, Liu Chuntao.

Zhu Xiande, a first-year doctoral student, also left the operating room to go to the laboratory to collect cells.

Only three master's students, Wang Hai, Gu Yuanqiao, and Qin Liangjue, replaced the previous doctoral students who stood on the foot pedals and stood on their tiptoes to observe the details of the surgery.

Under the operating light, there were no shadows in the surgical field.

Ma Chuanfeng clasped his hands together, focusing solely on the presentation, while Ding Xianqi and Zheng Jicong performed the surgical steps, with him responsible for ensuring the quality of the core procedures.

After explaining the essentials and key points, Ma Chuanfeng fixed his gaze on Guo Ziyuan: "Do you know what this is about?"

Guo Ziyuan looked up, his tone slightly hesitant: "Ilizarov system, ring-shaped external fixator, um..."

Seeing Guo Ziyuan's reaction, Ma Chuanfeng coldly remarked, "Farting is allowed in a laminar flow operating room; it won't contaminate the surgical incision!"

Ding Xianqi raised his head slightly at the opportune moment: "Professor Ma is right here. If you have any questions, why don't you ask them now? When are you going to?"

Guo Ziyuan glanced at the teacher and thought to himself,

Teacher, look at my expression, am I about to ask a question?

But this is not the Ding Xianqi of later generations; he doesn't understand himself that well now either.

After tidying up briefly, Guo Ziyuan chose to speak plainly: "Tibial bone transport is mainly used for acute segmental bone defects after trauma."

"The six-legged frame is preferred in established medical centers because it offers more precise transport control and provides better therapeutic effects than the traditional Ilizarov system."

"Stacked six-legged transport can correct deformities while repairing defects, reducing the need for major adjustments to the external frame and additional surgeries."

Ma Chuanfeng nodded and chuckled: "You really just farted when I told you to? Anyone could recite these books you've memorized."

"Right, Lily?"

Lily, an instrument nurse, was already bored, so she quickly turned her attention to the task at hand and replied promptly, "Professor Ma, you overestimate me."

Lily wasn't cooperating, so Ma Chuanfeng decided to find another one: "Wang Hai?"

Wang Hai, with his hands behind his back, solemn and calm, said, "Master, Guo Ziyuan doesn't just recite; he interprets and extracts the content from the teaching materials."

Guo Ziyuan thought to himself that Wang Hai was indeed a good brother, even after two lifetimes.

Since Ma Chuanfeng assumed he already understood the basics and didn't need to build up his language skills, Guo Ziyuan immediately started jumping around:

"If the affected limb has both shortening and segmental bone defects, the proximal extension must be greater than the distal shortening."

"In this case, fibular osteotomy is also recommended. During subsequent adjustments, the lengthening rate of the tibia should be faster than the shortening rate."

"This can reduce the risk of fibular healing during transportation."

Ma Chuanfeng finally nodded slowly; this was the kind of professional stuff he felt wasn't so superficial: "What are the specific parameters?"

"During antegrade transport, the shortening rate of segmental defects can be set at 0.5 mm per day, and the elongation rate of limbs and fibulas at 0.25 mm per day."

"But I recommend... this patient be transported retrograde."

After Guo Ziyuan finished speaking, he shut his mouth.

Then he saw that Ma Chuanfeng, Ding Xianqi, Zheng Jicong and the others were all looking at him.

Because they heard something they couldn't understand—

Reverse transport.

According to Guo Ziyuan, both external fixation rings and hexapods are theories that emerged in the 1990s.

However, retrograde transport is more suitable for bone defects or nonunion in the proximal third of the tibia, a consensus reached by experts only about 18 years ago.

Currently, when treating proximal tibial bone defects, people only use the antegrade transport method.

Ma Chuanfeng's eyes widened: "What are you talking about? What do you mean by 'going against traffic'?"

Guo Ziyuan was definitely not qualified to participate in the consensus of the experts in his previous life; he was only qualified to understand them.

Ding Xianqi, who was 18 years old, was still a "younger brother" and he helped him get to know him.

But none of this prevented Ding Xianqi from suddenly having an epiphany in 22, after which his strength soared, and he began to teach Guo Ziyuan the surgery for special bone defects.

The simple bone defect surgery that Guo Ziyuan knows came from Ding Xianqi's teaching.

The theory of retrograde transport for treating proximal tibial bone defects, which is applicable to extremely narrow areas, is also something that Guo Ziyuan has in mind.

But that was 23 or 24 years ago; it's only been 15 years now.

Expert consensus has not yet been reached, and most teams are still working on route-following transportation.

"The quality of regenerated bone formed by distal-to-proximal transport is not as good as that formed by antegrade transport," Ma Chuanfeng explained to Guo Ziyuan based on his own understanding.

Ma Chuanfeng certainly didn't refute Guo Ziyuan's "outlandish ideas." It's a good thing for a master's student to keep thinking; it's the right way to learn.

The expert consensus in 18 does not mean that this idea only came about in 16 or 17; it means that people had tried it before.

It was only because this operation was found to be inadequate that it was not taken seriously.

Guo Ziyuan blinked and pointed to the patient's knee joint: "What about the joint function?"

"If there is a bone defect in the proximal tibia, and the knee joint is continuously stretched during antegrade transfer?"

"Will this lead to damage to joint function?"

1991: Ilizarov was invited to give a lecture at the 301 Hospital in Kyoto. Ilizarov's technique was officially introduced to China, only 25 years ago.

At the beginning of the 20th century, this technology was still being continuously updated.

The application of retrograde tracing in proximal tibial bone defects is still in the exploratory stage and no consensus has been reached.

This knowledge point has extremely narrow applications, and the reasons are also quite simple.

The goal is not to improve the quality of new bone formation, but simply to preserve knee joint function.

Ma Chuanfeng has a wealth of knowledge and is no fool. His reply jumped to a question: "Is knee joint function limited after proximal tibial bone defect surgery due to antegrade transport?"

Currently, no one has personally stepped forward to speak out on behalf of the industry, so Guo Ziyuan, a mere master's degree holder, certainly cannot be certain.

Moreover, in his previous life, Guo Ziyuan only grasped the specific theories and did not know the detailed data supporting these theories.

In other words, Guo Ziyuan only knows how to use mathematical formulas; he doesn't bother to understand the fundamental principles behind their derivation.

"Teacher Ma, I just don't know, so after thinking about it, I've decided not to ask."

"However, I still think that if the reference ring and the fixation ring of the transport ring are too close to the knee joint, it will restrict the joint function."

(P.S.: Reference ring: the topmost, fixed ring, the one in the middle. Just get a general idea.)

"Compared to the possibility of affecting joint function, I personally think that delaying the healing time of the patient's bone defect is worthwhile."

"Even if the bone quality is sacrificed in the early stages, the bone will be remodeled under stress after the patient starts bearing weight, and it will not have too much impact on life."

Guo Ziyuan is a student, so he can freely make casual remarks and guesses.

"Teacher Ma, what do you think?" Guo Ziyuan threw the question back, but did not use a definitive tone.