Start From Emergency Doctor

Chapter 155

Zhou Yuan glanced at the marked place again, and said: “Using the great saphenous vein graft to bridge, secondly, reconstruct the arteriovenous fistula outflow tract, and finally take out the thrombus.”

The great saphenous vein is a superficial subcutaneous fascia, which is very long, starting from the front of the medial malleolus and extending to the thigh, and it is inherently suitable for transplantation. The lumen is of suitable thickness and the length can be controlled flexibly. It is long enough to be long. , Can be intercepted if it is short.

Moreover, the method of obtaining is very simple, cut through the skin, you can find it under the skin. In addition, there are few collaterals, so fewer blood vessels need to be treated during transplantation.

“Really okay…” Several vascular surgery doctors hesitated.

He Jianyi glanced at Zhou Yuan, and Zhou Yuan nodded.

“Yes, let him do it.” He Jianyi said.

Seeing He Jian nodded, the doctors of vascular surgery couldn’t say much.

“Although blood vessel transplantation is only a three-level operation, … considering the patient’s current physical condition, the operation risk is very high.”

Zhou Yuan stepped forward, looked at He Jianguo’s pupils, and said, “Surgery must be performed immediately. I will be responsible for any problems!”

He Jianyi: “I am in charge. What responsibility do you intern have!”

Speaking of this, He Jian was taken aback after another.

Dean Fang told him this morning that Zhou Yuan might have to be promoted exceptionally recently.

Originally, Dean Fang planned to give Zhou Yuan a promotion after completing the finger regeneration surgery.

However, if someone who writes the essay sees that Zhou Yuan is just an intern at that time, I am afraid that he will just hit the paper without reading the title.

What’s more, if you really boarded the “Lancet”, the doctor who can write the “Lancet” magazine is actually just a small intern at the Yanjing International Hospital… This will make the medical community think that the Yanjing International Hospital is not Pay attention to talents and so on.

Anyway, Zhou Yuan’s intern hat has to be pulled off, or at least some people have to be sealed off.

“Hurry up! The old man can’t hold on!” Zhang Ling was a little anxious.

The heart rate and blood pressure are already a little unstable. He Jianguo is very dangerous if he does not undergo blood vessel transplantation as soon as possible to clear the blood clots.

He Jianyi became serious: “Quickly push to the operating room!”

He Jianguo’s son and daughter hurriedly stepped away, while Zhou Yuan and others leaned on the handle and pushed the operating table into the operating room.

In the operating room.

Under the shadowless lamp, He Jianguo was already unconscious.

Zhou Yuan and others gave simple first aid, stabilized their heart rate and blood pressure, and then started anesthesia.

Epidural anesthesia used for surgery.

He Jianguo was lying on the bed in a supine position, and his right limb was stretched out on the operating table.

“The anesthesia is complete!” the anesthesiologist said quickly.

Zhou Yuan nodded, glanced at the time, and said, “The operation has begun.”

The personnel of the operation.

Chief Sword: Zhou Yuan

One help: He Jianyi(Read more @ wuxiax.com)

Second help: a vascular surgeon

Misuke: A vascular surgeon

Instrument nurses, anesthesiologists, etc.

“Scalpel.” Zhou Yuan said.

The first step is to isolate the expensive veins of the upper arm and the cephalic vein near the elbow, and estimate the length of the blood vessels that need to be transplanted.

Zhou Yuan skillfully cut open the skin, then separated the subcutaneous tissue, muscle tissue, etc., found the important vein, and measured the length of the blood vessel to be transplanted.

“49.01mm.” Zhou Yuan said.

In the second step, the great saphenous vein is separated, and then the blood vessels are cut from the great saphenous vein for vascular transplantation.

Zhou Yuan put down the scalpel.

He Jianyi and a certain vascular surgeon have already disinfected the lower abdomen, the speaking area, and the thighs of both lower limbs.

“Put the towel.”

He Jianyi revealed the femoral artery, while Zhou Yuan took the knife and dropped it. On the inside of the femoral artery, he sat down with a longitudinal incision, about six centimeters long.

“Isolate the saphenous vein.” Zhou Yuan said.

“Scalpel.”

After finishing the incision on the inner side of the femoral artery, Zhou Yuan also incised the skin and subcutaneous tissue here, and cut the superficial fascia at the femoral artery incision, exposing the fossa ovale.

Once the fossa ovale is found, there is no difficulty in finding the saphenous vein. The confluence of the saphenous vein and femoral vein is here, and the saphenous vein can be easily seen.

“Bent hemostatic forceps.”

Zhou Yuan used curved hemostatic forceps to isolate the main saphenous vein.

“Cut off the branches of the saphenous vein.”

This step is very important.

Once a mistake occurs, or a blood vessel ruptures, there will be fatal situations such as inability to suture and blood oozing during vascular transplantation.

“Vascular clamp.”

Blocking the blood vessels, Zhou Yuan began to separate along the venous trunk of the great saphenous vein.

The great saphenous vein has branches such as superficial iliac circumflexion, superficial abdominal wall, superficial outer sound, ventrolateral and medial femoral veins. After finding these branches, ligating and cutting them one by one, the branches of the great saphenous vein are cut… …..

“Begin to intercept the saphenous vein segment.”

Zhou Yuan picked up the scalpel and peeled off the great saphenous vein that had been severed.

“Wait… Why did you just peel it off?” He Jianyi and the vascular surgeon were both taken aback.

Generally speaking, all kinds of connective tissues on the outside of the blood vessel need to be cleared, and the blood vessel should be separated separately.

But Zhou Yuan got started right away. He wanted to cut off all the blood vessels and the tissues sticking to them…

“Wait, did you use No-touch technology?” The second vascular surgeon was a little surprised.

“No-touch technology?”

“Yes, it is a technique proposed by country M, but it is not applied much…Moreover, it is quite difficult because it requires precise cutting of tissues and blood vessels, which will damage others if you are not careful. The tissues and blood vessels… this is more difficult than simply stripping the blood vessels!”

He Jian was taken aback for a moment, he had a little impression.

“This…seems to reduce the incidence of vascular stenosis?” He Jianyi said uncertainly.

“51.40mm. It’s intercepted.” Zhou Yuan took off a section of blood vessel connecting connective tissue and said.

“It is indeed the No-touch technology, which is used to intercept the saphenous vein, which can greatly reduce the incidence of vascular stenosis and increase the success rate of blood vessel transplantation.” Zhou Yuan explained.

The blood vessels in Zhou Yuan’s hand are similar to mutton on skewers, but the color is more bright red, and it is striped.

“Wait, why did you cut 20mm more?” asked the young and naive vascular surgeon.

Zhou Yuan examined the separated saphenous vein and explained: “You have not been exposed to this technique, don’t understand. The saphenous vein will retract after being taken out of the body, so it’s better to be better than expected. The length is 2~4cm.”

“Heparin saline.” Zhou Yuan said.

The next step is to infuse the saphenous vein with heparin saline.

This is to check whether this segment of the saphenous vein has infiltrated.

After the heparin saline solution was injected into the blood vessel, Zhou Yuan carefully ligated the saphenous vein again and examined it carefully.

——

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