Since 1981 Health School

  Chapter 657 Free skin flap transplantation

  In the surgical conference room, Lao Guo, Zhu Huoyan, Chen Qi, director of burn surgery Luo Yuyang, deputy director Zhang Xing, and all doctors of burn surgery sat together.

  The burn pictures of Fu Zhenzhen were being shown on the slide, and they played round after round.

  Finally, Director Zhu paused the slideshow, leaving a frontal photo of Fu Zhenzhen's lower limbs.

   "Let's talk about it, how is this skin grafting done?"

  As the head of the burn department in name, Director Luo could only bite the bullet and be the first to speak:

"Now the tendons, large blood vessels, nerves, and even bones of the little patient are exposed. Such deep burns cannot be treated with ordinary skin grafting. Like the stinky tofu skin grafting invented by Dean Chen, I think, hehe, what, maybe ..."

  Stinky tofu skin grafting is the first of its kind in Vietnam. Everyone definitely wants to use their own hospital’s trump card patented skin grafting.

  Now he wants to deny the skin grafting technique invented by his boss in front of everyone. Director Luo feels the pressure is huge, and it is a big taboo in the workplace.

  Chen Qi was delighted to hear Director Luo’s speech:

"Lao Luo, it's okay. Now everyone is discussing the condition. You just need to be realistic according to the clinical needs. There is no need to look at my face. For example, if you say that stinky tofu skin grafting is not suitable for Fu Zhenzhen's burn, what is the reason? There are many little doctors, tell them about it.”

  Director Luo wiped his sweat, thinking that it would be good if the dean didn't blame him.

  Chen Qi was thinking in his heart, this Luo Yuyang is indeed an honest man, but lacks courage, he is suitable as a transition director, and he will definitely have to change in the future.

   "Since Dean Chen asked me to talk about it, then I will talk about it. Please forgive me for the bad explanation. The stinky tofu skin grafting only involves the surface, with a little dermis at most. It is suitable for skin grafting with relatively shallow burns.

  Look at Fu Zhenzhen’s burns in the picture. The tendons, large blood vessels, and bones are all exposed. It’s like planting turf in a park. If you plant turf directly on the concrete floor without soil, the turf will not survive.

  The best way now is to transplant the turf together with the soil, so I think Fu Zhenzhen's burn is suitable for transplantation with skin flaps. "

  The so-called skin flap transplantation is a special type of skin transplantation, which is to transplant a piece of living skin and subcutaneous tissue containing blood vessels and nerves to the parts that need skin or repair.

Viable skin refers to the red skin with blood circulation cut from the skin, but the skin cannot be a complete flap, and it is also rich in other tissues such as subcutaneous superficial fascia tissue, fat, and may also have deep deep fascia tissue, but must have blood circulation.

   To describe it more simply, skin grafting of stinky tofu requires a thin and light piece of skin.

  The skin flap transplant looks like a piece of meat has been cut, not only the epidermis, but also subcutaneous tissue such as fat, and part of the muscle layer.

  You can’t just “cut off a piece of meat”, you must ensure that the blood vessels of this piece of meat are connected with the mother’s body, that is, the blood vessels cannot be cut off, and the blood circulation must be preserved.

  So it is very different from skin grafting.

  After Director Luo finished speaking, everyone focused on the slides.

  Zhu Huoyan was a little thoughtful:

"There is no problem with the idea of ​​flap transplantation that director Luo said, but the problem is that the flap transplantation is pedunculated, so you can only choose the adjacent skin for excision and transplantation, but look at Fu Zhenzhen's lower limbs, where is there a piece of good meat? ?”

  Fu Zhenzhen's burns were mainly concentrated on the front part of her lower limbs.

  The right leg was concentrated on the calf, the dorsum of the foot to the toes, and the burn area was very large, at least 34 cm in length and 18 cm in width;

  The left leg was mainly from the ankle joint to the dorsum of the foot, and the burn area was relatively small, but it also reached about 15 centimeters.

  As mentioned earlier, the pedicled flap transplantation is to cut off a piece of meat, and the blood vessels are not cut, so it can only be transplanted adjacent to the skin, and it is impossible to do it any farther away.

  Obviously, Fu Zhenzhen did not have this condition. The main reason was that the burn area was too large, so big that there was no skin to transplant over.

  If the burned area is only as big as a palm, or as big as a mobile phone, then you can still discuss it, and the difficulty of transplantation will be much less.

  Everyone in the office was also talking about it, and there were many opinions about how to treat it later.

  Old Comrade Guo is a surgeon, but he was born in general surgery, the type of operation, and he is not so proficient in burn surgery, so he can only scratch his head and cannot express his opinion.

  The treatment plan of this burn surgery is finally decided by Director Chen Qi and Chen.

  Zhu Huoyan looked at Chen Qi with a relaxed face, eager to eat melon seeds:

   "Chen Qi, it seems that you have a plan in mind. Tell me how to deal with this wound?"

  Everyone looked at this miraculous dean and believed in him completely.

  Chen Qi stood up, walked to the front of the slide, pointed to the wound and said, "Director Luo is right, this kind of wound can only be transplanted with skin flaps!"

   As a result, Luo Yuyang himself was the first to be unable to sit still:

   "But Dean Chen, this patient's condition does not support pedicled flap transplantation at all."

   "What if it is a non-pedicled free flap transplant?"

"this…"

  Director Luo hesitated a little, but didn't say anything, a little doctor next to him couldn't help it:

   "If the blood vessel is cut off without a pedicle, the cut off skin will have no blood circulation, which is equivalent to a piece of dead meat. I'm afraid it will be difficult to survive if it is directly transplanted to the wound?"

   "Yes, yes, the flap transplant must be pedunculated..."

   "Blood supply is the key..."

  Obviously everyone disagreed with Chen Qi's views on free flap transplantation. Only Lao Guo and Director Zhu remained silent. They knew that Chen Qi must have a plan.

  Chen Qi stood there listening to everyone's discussion, and sighed inwardly.

  Vietnam Hospital of Traditional Chinese Medicine has insufficient background, and this deficiency is mainly reflected in the personal quality of doctors.

  If it is a doctor in a top hospital, when someone proposes a new idea, the first thing everyone thinks of is whether it is possible to succeed, and in what way can it be successful?

  In this way, a good learning environment will be formed, everyone interacts and complements each other, and perfects a new idea and new technique.

  When the doctors of Yuezhong Hospital heard a new idea, their first reaction was to deny it.

How can this be? How can this be done? There is absolutely no way!

   I just don’t want to think about it. Think about why Dean Chen said that free flap transplantation is feasible? In what way is it possible to achieve success?

  One is positive and the other is negative. This is the difference in the background of the hospital.

  To be honest, if it wasn’t for Chen Qi’s ability to toss and mess things up, the Yuezhong Hospital would be too awesome, and it could only be regarded as an ordinary local hospital.

  But the joy of being a dean is not that you get a good deck of cards, but how you play a bad deck of cards well.

  Being able to turn an ordinary hospital into a first-class hospital in the country and a world-renowned hospital can only show the true qualities of a reborn person!

   "Everyone, do you remember the hand surgery I did in the Fourth Hospital?"

  Young doctors are all confused. What does this flap transplant have to do with hand surgery? Lao Guo and Zhu Huoyan's eyes lit up.

   "Think about it, the principle of hand surgery is actually very simple. If the hand is broken, we can put the hand back on. Bone to bone, blood vessel to blood vessel, nerve to nerve, right?"

  The little doctors continued to nod in confusion.

   "Then what is the key to replanting a severed limb or palm? Wu Guoliang, please answer."

  Suddenly his name was called, the little doctor Wu Guoliang hurriedly got up, thought for a while and replied:

   "I, I think it should be the recovery of the blood generation of the severed limb or palm? If the nerve is not connected, at worst some functions cannot be restored, but if the blood supply is not restored, the severed palm and severed limb will be necrotic immediately."

   Chen Qi thought to himself, it is not hopeless.

"Okay, Wu Guoliang answered very well, blood supply. Then everyone can completely regard the cut off flap as a severed palm. If you want to reattach it, you must restore the blood supply. What everyone was worried about just now is the sessile transplant blood. It cannot be restored.

  Then the question is, since the severed palm can be picked up after it is completely free, why can't the skin flap work? We can also carefully cut off the arteries and veins in the room when separating the skin flap, and then find similar arteriovenous connections at the place where skin grafting is needed, so the blood supply will not be restored? "

  Old Guo excitedly slapped the table, startling everyone:

   "Inference from one instance, well said, Chen Qi's method is totally feasible."

  The little doctors also looked at me and I looked at you, and both saw shame and remorse.

  Shame is such a simple reason, I didn't expect it, but I regret that you questioned the dean just now? My God, I'm going to die, but I dare to touch the tiger's butt.

  At this time, Director Luo Yuyang asked: "Dean, this blood vessel anastomosis is not easy, and special tools are needed."

  Chen Qi laughed:

   "Did you forget? After merging the four hospitals, we have a plastic surgery department. This is my old team. Anastomosis of blood vessels requires special tools, and a full set of electron microscopes is available."

   This electron microscope was dismantled by Chen Qi from the space operating room at the beginning. Although the surface is rather dilapidated, the core technology inside is actually far ahead of this era.

   Zhu Huoyan gave an order: "Then what are you waiting for, let the plastic surgery doctor come to participate in the consultation."

  Yan Shifan and Bian Meng had already received Chen Qi's instruction and waited early, and arrived at the Burn Surgery Office as quickly as possible.

  Since his second marriage with Bai Xue, Yan Shifan has lived a happy life, enjoying himself every day, and his whole state has recovered.

  Moreover, Chen Qi learned his lesson and repeatedly asked him not to work overtime, and to go home from get off work on time every day to accompany his wife, so the whole person was completely alive.

  As for Bianmeng, he has always been a heartless young master with a simple mind. Anyway, Chen Qi does whatever he says and is very obedient.

  After the two arrived at the burn surgery office, they turned their heads and bowed to the big bosses in the room, then sat to the side and began to look through the medical records.

  Zhu Huoyan waited until they put down the medical records and asked:

   "Well, I called you here just to ask if you have confidence in the vascular anastomosis of this operation?"

  Yan Shifan nodded heavily:

   "Don't worry, Director Zhu, we can suture even small blood vessels like fingers, and the arteries and veins on the thigh and calf side are thicker, so the difficulty is even smaller. Besides..."

  Bianmeng laughed beside him:

   "Besides, we still have a great master in charge. Our microsurgery techniques are all taught by Dean Chen, and the teachers are all there. How can we disciples get their turn?"

  Hehehe~~~ There was a chuckle in the office.

  Old Guo also patted his forehead: "Yes, yes, I forgot about Chen Qi. With him here, this is a freak with a 100% success rate of the operation."

   After laughing, everyone knew who was the core of this treatment. Director Zhu asked again:

   "Chen Qi, since we have decided to transplant the skin flap, which part should we choose?"

"We have to consider the safety and aesthetics of the skin harvesting site. Look at the patient's left lower limb, which is such a large piece. If the skin harvesting site is the part that the patient will expose in the future, it will be quite scary, so it must be covered by clothes and pants. The place.

There is another one, as I said just now, skin flap transplantation requires a relatively high blood supply, so it is necessary to choose a place with rich blood vessels. In this way, there are three main places for large-area skin flaps, one is the back, the other is the abdomen, Another is the outer thigh.

   Another point to note is that young women who are unmarried and childless should not choose abdominal skin, which will affect their future fertility, so we can choose either the back or the outer thigh. If the inner side is not selected, it will affect the function. "

   "Where should we choose Fu Zhenzhen's skin flap?"

  Chen Qi walked to the slide and clicked two places:

"The left leg needs a large flap area, and the patient's right thigh skin is intact, so we chose the outer flap of her right leg. In addition, the area of ​​the right **** and right sole is small, so we chose the flap above the deep circumflex iliac artery. The flap, which is the flap on the right side of the groin."

  Zhu Huoyan suddenly asked:

   "If this operation is successful, it should be the first time that microsurgical technology has been applied to skin flap transplantation in China, right?"

  Yan Shifan laughed and said:

"Director Zhu, I dare not say anything else. There are not many electronic microscopes in China. They use relatively primitive microscopes in hand surgery. Our Yuezhong Hospital is definitely leading in this area, so I dare not say what is going on in the world. Said, but I am sure of the first one in the country.”

  The first domestic society of microsurgery was established in 1986. At that time, there were only a dozen people participating in the meeting, and there were not many doctors who could practice this technology in the country.

  Because of the preciousness of foreign exchange, everyone has no money to buy foreign electron microscopes. They still use traditional optical microscopes. The equipment is not good, and the clinical practice is definitely limited. High-tech operations cannot be performed at all.

   Lao Guo was also happy to hear it:

   "Okay, okay, our burn surgery has not been open for a long time, and we can create some of the best in the country, and even the best in the world. It will be hard for us to think about it."

   After the meeting, Chen Qi came to Fu Zhenzhen's ward.

  In order to relieve her loneliness, Chen Qi arranged for a little nurse to accompany her to talk and take care of her every day. With the addition of a nurse, the ward was quite lively.

  Chen Qi put a tape recorder by the bedside:

"Zhenzhen, come here, here is Zhang Qiang's tape you want to listen to. There are 19 tapes in total here. I have not lost all the albums. But when you play it softly, I am afraid that the burn patients next door will jump." When it comes to disco, the newly healed wound will burst open."

  Fu Zhenzhen rarely showed a smiling face: "Thank you, Brother Chen."

  After Chen Qi put a tape in, the voice of Zhang Qiang, the hottest singer of this era, came out from the recorder:

   "Dear little sister, please don't cry. Where is your home, I will take you and take you back.

  Dear little sister, please don't cry, I will warm your heart with my love

   oh don't don't be sad

   oh don't don't cry

   Oh in this night..."

  As soon as it was placed here, Chen Qi quickly pressed the stop button, and then patted his chest with lingering fear.

   Fortunately, I was clever enough not to let Fu Zhenzhen listen to it, because the next line of the song is: "Oh, my mother is still waiting for you this night"

  Mom, perhaps for Fu Zhenzhen, it is a forbidden area that cannot be touched in this life...

  (end of this chapter)