Start From Emergency Doctor

Chapter 177

First amputation, although it can ensure that the toe can be quickly transplanted after the toe is amputated, but there is a risk of infection in the stump of the palm. Cut the toe first, the palm stump can ensure the best condition, but the toe will face the risk of losing vitality and so on.

The choice depends on the patient’s condition and the skill level of the surgeon.

Zhou Yuan glanced at the patient’s heart rate and blood pressure, and said, “Amputation first.”

Zhou Yuan learned a lesson from the previous experiment on mice. Too low temperature can cause complications such as vasospasm. Once the toe is cut off for transplantation, the temperature of the toe will gradually decrease.

Even if good activity is preserved, transplantation will be troublesome at that time.

“Okay.” Dean Fang said while standing by the side.

After speaking, Dean Fang suddenly remembered something, and looked at Zhou Yuan with some worry: “Did you not work the night shift last night? You should be off work now. Can you hold on…”

Zhou Yuan nodded.

He has just finished the medicine and has reached the peak in both energy and physical strength, and it is not a problem to complete a severed limb replantation operation!

“General anesthesia.” Zhou Yuan said.

The anesthesiologist nodded, looked at the heart rate and blood pressure, and after confirming that the patient was in good health, began anesthesia.

Speaking of which, the patient with severed fingers is relatively lucky.

Normally, coma or even hemorrhagic shock may occur in this situation, but because of frequent accidents at the factory, emergency measures were done very well. He stopped the bleeding of the severed finger and allowed him to go to the hospital.

“The room temperature is controlled at about 25 degrees, and the relative humidity is about 50%.” Zhou Yuan emphasized.

At the same time, he looked at the surgical instruments.

Although this operation is still a severed limb replantation in the strict sense, there are still some differences because of the need to regenerate the fingers. The equipment is also configured according to Zhou Yuan’s needs.

Two sets of surgical microscopy instruments, three conventional debridement kits, two tissue scissors and two straight, toothless short forceps, Ant’s forceps…

When the anesthesiologist is anesthetizing the patient, the instrument nurse has already placed the operating microscope.

“The anesthesia has taken effect~ˇ.” The anesthetist’s voice rang.

Zhou Yuan nodded.

“Immediately open two venous channels, timely rehydration, blood transfusion during the entire operation, plasma or whole blood can be used!”

“Place the urinary tube!”

The last step is not required for surgery, so when Zhou Yuan proposed it, everyone was a little puzzled.

The reason why the urinary tube is installed is to observe the patient’s physical changes.(Read more @ wuxiax.com)

Finger regeneration is not a minor operation. It takes more than ten hours at any time. During this period, the patient’s absorption of drugs and physical function can be judged according to the patient’s urine volume, urine color, urine specific gravity, etc.

When the urinary tube entered the bladder and the orange urine was discharged, Zhou Yuan announced the start of the operation.

“Start debridement and disinfection.”

If it is just a simple amputation, it can be removed after a simple disinfection.

However, this time the finger is regenerated, and the toe needs to be transplanted to the index finger and thumb. Therefore, the section must be carefully processed to ensure that the main nerves and blood vessels are fully exposed.

Otherwise, even the nerves and blood vessels will not be found, so what about transplantation?

“Soap water, hydrogen peroxide.”

This is the cleaning fluid used for cleaning

Zhou Yuan turned over the patient’s palm, turned the section face down, and washed it carefully with soapy water and hydrogen peroxide.

After debridement and disinfection were completed, Zhou Yuan began to perform debridement.

This step is mainly to completely remove the injured severed finger, including the decaying tissue around the severed finger.

Of course, there may still be some blood vessels in the severed finger. At this time, the blood vessels need to be peeled off separately-long blood vessels are easy to expose, and it is easier to suture and anastomose.

“Tissue shears.”

Zhou Yuan moved very steadily, took the tissue scissors, and cut off his severed finger with one cut.

There are many small blood vessels in the severed finger, most of which are broken.

Zhou Yuan carefully marked the few blood vessels that were still intact and connectable.

Moreover, the axillary artery and the brachial artery are anastomosed at the palm of the hand, forming a double-layer superficial palmar arch and deep palmar arch. These also require blood flow clamps due to damage to the thumb and index finger, and ligation of the main arteries here.

The superficial palmar arch and the deep palmar arch are two arc-shaped vascular arches on the deep surface of the palm skin, both of which are convex toward the distal end, that is, in the direction of the fingertips.

Among them, the projection of the shallow palm arch is basically the same as the career line in the palm prints, and the deep palm arch is closer to the wrist. There are abundant arterial communication branches between them, mainly to ensure that the palm will not be able to perform various hand movements. Ischemia.

Therefore, when removing the remaining fingers, care must be taken not to damage the shallow palm arch and deep palm arch, otherwise the recovery of the palm’s motor ability will be greatly restricted in the later period.

Then, Zhou Yuan found out the major muscles such as the abductor pollicis brevis, flexor pollicis brevis, opposing pollicis muscle, and flexor pollicis longus tendon.

These are the muscles that urge the thumb and index finger to complete bending, stretching, etc., and must be connected with the muscles on the toes to drive the toes.

Zhou Yuan looked at the microscope, carefully removed the embolized blood vessels and damaged nerves, and repaired some smaller damaged arteries and veins as much as possible.

The more blood vessels that can work, the better the recovery of the transplanted finger. Of course, it also means that the transplanted finger can perform more functions.

“¨ˇ Needle-holding pliers.”

Zhou Yuan looked at the broken blood vessel in the microscope, threaded a needle and sutured it.

“finished.”

After a long time, Zhou Yuan snipped the last piece of rotten meat, exposing a main hallux artery and marking it with silk thread.

At this time, the thumb and index finger on the patient’s palm have been completely peeled off, and the hand bone has also been severed from the human body.

“Zhou Yuan, leave these two fingers to me, and you will intercept the toes.” Director Fang ran up happily.

Zhou Yuan nodded.

As a hand surgeon, it’s okay to take care of two severed finger sections.

“Prepare to intercept the toe.”

Relatively speaking, this step is easier.

The blood vessels in the soles of the feet are tougher and more elastic than the palms of the hands. In addition to conveying the movement of muscles and reflexes, the nerves here are also responsible for monitoring whether the muscles are excessive or improper.

Because the feet are located farthest from the heart and brain, they are one of the organs that are difficult for blood and nerve conduction to reach. Therefore, the blood vessels can contract according to the changes in the foot shape during walking, thereby promoting blood circulation. The nerves here are also Carrying more functions.

Zhou Yuan chose to intercept the second and fourth toes of his right foot.

Zhou Yuan also had his own reasons for choosing these two toes. .