Surgery Godfather
Chapter 690 - 615: Mysteriously Necrotic

Chapter 690: Chapter 615: Mysteriously Necrotic

PS: Very busy tonight, so no time to edit. As per usual practice, first draft published, will edit tomorrow. Please excuse any oversights.

Yang Ping, Song Zimo, and Xu Zhiliang all rushed back to the Trauma Orthopedics department in the main surgical building.

Surgeons are accustomed to brisk and rapid actions. Upon their arrival at the office of the Trauma Orthopedics doctors, several directors were already seated by a computer, studying case notes and information.

A handful of younger doctors were assisting by serving the senior doctors who came for the consultation with tea and water.

Professor Zhang and Director Tan were already discussing the case privately. Seeing Yang Ping enter, they both immediately greeted him.

"Wait for another ten minutes, you go and see the patient first," Professor Zhang suggested, glancing at the time.

It is mandatory to review the case files before a consultation and to question the history and conduct a physical examination at the bedside. This is common practice.

The clinical means standing by the bedside, interacting with patients.

Before seeing the patient, Yang Ping also reviewed the case files and picked up on some keywords.

Unknown cause of limb necrosis and ulceration, most notable on the right hand and the right hip, accompanied by headaches and whole body pain, frequent cold sweat, no past illnesses or history of trauma, no recent infections, no obvious cause, the sudden appearance of symptoms, that’s pretty much it.

After reviewing the case, Yang Ping then proceed to see this twenty-something year old young man in the ward. Despite being behind a mask, the stench of tissue necrosis hit him.

The patient was housed in a single isolation negative-pressure room. Before an accurate diagnosis could be made, they had to consider some special bacterial infections. To prevent cross-infections, he could only be kept in an isolation ward.

The right lower limb was significantly swollen, almost triple the size of a normal limb. Most of the right hip was necrotic, the large rough bone was exposed. This was because the large rough bone was a protrusion, very superficial, so once the skin and fascia were necrotic, it was easy for bone exposure to occur.

The right upper limb was also swollen, albeit not to the drastic degree of the lower limb. Except for a small part that still had its normal color, most of the right hand was a dark color, the color of necrotic flesh.

The limbs on the left side were somewhat better than those on the right. The left lower limb was also almost twice the size of a normal limb. Dead grey areas were evident necrotic areas. Scattered necrotic areas were also noticeable in the left upper limb.

In order to allow the consulting doctors to see what the condition of the necrotic parts was like, all the necrotic areas of the four limbs were exposed. Two standardized training students were on standby by the bedside, ready to assist the consulting doctors with the wound examination at any time.

When Yang Ping was inquiring about the medical history, he learned that this patient was transferred from Shipo People’s Hospital. Seven days ago, the patient felt pain all over his body for no clear reason and broke out in a cold sweat, to a degree where he could hardly bear it, so he went to Shipo People’s Hospital for treatment. The emergency department had been unable to pinpoint the cause and could only administer pain relief and rehydration therapies, meanwhile bullying him to the General Surgery.

The next day, the patient’s limbs began to swell to varying extents. Some places had blisters and then limbs started broad ulceration and necrosis, beginning from the right hip and right hand.

The General Surgery was as if engulfed in fog, unable to get a clear picture of the situation. Since the necrotic areas were on the limbs, they transferred him to the Orthopedics.

Director Miao of Orthopedics felt that something was off, but he was also unable to clarify the situation. Hence, he sought help from Director Han who also couldn’t determine what was going on based on the medical records but knew that the case was complicated. Out of caution, Director Han asked Miao to swiftly send the patient to Sanbo Hospital via ambulance. The patient was admitted to the Trauma Orthopedics and under the care of Director Tan.

The patient was kept at the Trauma Orthopedics for three days, but the cause of illness wasn’t identified. The necrosis continued, to prevent necrotic tissue toxins from entering the bloodstream and leading to toxic shock, Director Tan, determinedly proposed timely surgical debridement. The right hand and right lower limb were to receive a partial amputation, with life preservation as the utmost priority.

On the cause of illness, Director Tan considered necrotizing fasciitis or something caused by some special type of insect bite. In any case, the immediate priority is to remove these necrotic tissues.

After Yang Ping finished examining the patient and washing his hands, he went to the doctors’ office. Most of the directors had arrived, and those who couldn’t attend had sent stand-ins for the meeting.

Everyone settled down in the doctors’ office, and Director Zhao from the Medical Affairs Office also rushed over.

Director Zhao hosted the case discussion. He opened with a few official lines and then the supervising doctor reported the case.

After the case report, all the experts present had furrowed brows. The case appeared to be without head or tail, no clues, a young man without a history of trauma or signs of infection suddenly had necrotic, ulcerating limbs.

"Everyone can express their thoughts freely. Initially, I considered the possibility of necrotizing fasciitis for this case, but bacterial culture of the necrotic tissues did not support this idea. The initial bacterial cultures from Shipo People’s Hospital were all normal skin parasites. Our samples yielded few deep cultures that could cultivate bacteria. We found that the necrosis was not limited to the skin and fascia, but had spread to the bone. The patient’s blood level of lactic acid was not high, nor was there increased red blood cell distribution width. The necrosis of the right hip had reached the bone, the large rough bone is exposed. The MRI also showed some cases where the necrotic tissue has invaded the bone." Director Tan supplemented some information and presented his view.

"Have there been any recent contacts with drugs or chemical substances, is there any consideration given to severe exfoliative dermatitis, is there a history of gout, and has the patient taken allopurinol," The director of endocrinology thought of exfoliative dermatitis first.

However, this patient’s necrosis is spreading towards deeper tissues, not confined to the skin.

Trauma? Infection? Allergic reaction? Blood clot? Insect or mosquito bite?

Trauma can be excluded. If there had been crush injuries, the patient certainly would have known.

A widespread blood clot, color doppler and blood D-dimer tests don’t support such a diagnosis.

Allergic reaction, it was hard to determine. The patient himself could hardly recall what he ate or came into contact with. The exact allergen is unknown to him.

For example, there have been cases where online bought face masks have caused severe exfoliative dermatitis.

Infection, Director Tan just mentioned that many examinations do not support it.

Insect or mosquito bites, this is possible, but causing such severe necrosis in the limbs is very rare, especially since the most severe necrosis occurred on the right hip. The necrosis has rapidly deepened to the bone, affecting the entire layer, making it seem possible that the right hip and right hand were bitten.

Due to the necrosis and ulceration, finding the wounds left by insect bites has become very difficult.

For symptomatic treatment, he can presently only receive amputation. Necrotic tissues must be completely cleaned up in order to prevent toxins in the tissue from entering school and causing toxic shock.

Exactly what caused the limb necrosis, with the necrosis of the right hand and right hip most severe and continuing to develop?

This is surely a tricky medical conundrum that leaves everyone at a loss for any concrete answers. There was silence, with no one breaking it initially.

Professor Zhang was the oldest, most experienced expert among those present. She has seen and experienced more than anyone else there.

"Limb necrosis is often caused by internal or external factors. Internal ones like blood clot have already been ruled out. External ones can be anything from physical, chemical, to biological factors, etc. When diagnosing illnesses, encountering a challenging and complicated case is exactly when this kind of investigative thinking is needed."

Seeing that no one else was voicing their thoughts, Professor Zhang started with her opinion, aiming to stimulate divergent thinking among the group.