Start From Emergency Doctor

Chapter 178

Relatively speaking, both the big toe and the second toe are more flexible, but the big toe has a greater effect on the sole of the foot. Moreover, the volume of this toe is too large. It is really unsightly to be used as a transplanted toe, so the second toe is chosen.

As for why the fourth toe was chosen, it is because the little toe is very inflexible, and it is useless even if it is transplanted, while keeping the middle toe is for aesthetics.

There are also many important blood vessels in the sole of the foot, such as the dorsal foot artery group and plantar artery group.

Both the second toe and the fourth toe have two arteries from the deep arch of the plantar, extending from the root to the toe, and they are the main blood supply. There is also the proper toe plantar artery, which also plays a role in supplying blood flow.

Zhou Yuan chose to use toes to recreate his fingers. In addition to the similar shape, another important reason is that the distribution of blood vessels and nerves is consistent.

For example, there are deep palmar arches and shallow palmar arches on the palm. The soles of the feet have deep arches and so on.

“Scalpel.”

Zhou Yuan took the scalpel and carefully disinfected the soles of the feet. Taking advantage of it not paying attention, he slashed it up.

On the side of the instep near the calf, Zhou Yuan sliced ​​open the superficial skin, and then clamped the posterior tibial artery with vascular clamps.

This is a major artery supplying 913 plantar blood. Between the toes, including the soles of the feet, blood flows through many arteries.

If you don’t clamp this place, you will cause heavy bleeding when you cut the toe.

After blocking the posterior tibial artery, Zhou Yuan carefully divided it along the joint between the toe and the sole.

When it was about to be severed, Zhou Yuan did not directly cut off the internal blood vessels, but marked the toe plantar arteries with ribbons. Different blood vessels used ribbons of different colors.

It can be matched with the marked blood vessels in the hand.

Zhou Yuan completed this step very quickly.

After removing the two toes, Zhou Yuan quickly filled the stream with the prepared heparin saline to shorten and fix the bones of the toes.

At this point, the patient’s vital signs, limb blood supply and various laboratory indicators are all normal.

Zhou Yuan heaved a sigh of relief, “Let’s start picking up fingers.”

When this sentence fell, the faces of Dean Fang, Wu Guohui and others became serious.

Here comes the most critical step in the operation…

Sweeping the stump of the finger, or cutting the toe, is a very common operation, and maybe it can be done by an attending physician.

Of course, they can’t distinguish each blood vessel and nerve with a microscope like Zhou Yuan. Even Dean Fang might have a headache.

The real difficulty is here, connecting toes with different blood vessels, nerves, and bone structures to the fingers…

“Prepare a temporary intraluminal shunt.” Zhou Yuan said.(Read more @ wuxiax.com)

This is to prevent blood from entering the cavity of the finger due to the rupture of the blood vessel during the finger connection.

“Intramuscular injection of atropine mg, phenobarbital sodium 0.1g.”

Atropine can relieve smooth muscle spasm, and injection of mg can relieve small blood vessel spasm, improve microcirculation, and inhibit glandular secretion at the same time.

In addition, the use of atropine can relieve the inhibition of the vagus nerve on the heart to a certain extent, accelerate the heartbeat, excite the respiratory center, and relieve respiratory depression.

The patient’s body functions are temporarily enhanced, which is helpful for receiving toe transplantation.

Phenobarbital sodium mainly acts as a sedative.

Zhou Yuan put his toe on the severed surface, trying to make the blood vessel anastomosis as much as possible, then put the toe down and temporarily fixed it with Kirschner wire.

The first step is to rebuild blood vessels.

The anastomosis ratio of blood vessels must reach one-third, otherwise, even if the transplanted toe survives, the functional recovery will be seriously affected.

Compared with arteries, veins need to be anastomosed more. Anastomosing as many veins as possible can promote the recovery of limbs after surgery.

“Rebuild the artery first.” Zhou Yuan said.

Taking the lead in rebuilding arteries can restore blood supply as soon as possible, which is helpful for postoperative recovery of limbs.

He could not complete this step alone.

Using a microscope, Zhou Yuan can find the blood vessel that needs to be anastomosed, but he needs other people to help fix the position of the blood vessel before he can perform the anastomosis.

Dean Fang also looked at the opposite microscope.

“Which one should fit first.”

Zhou Yuan said: “The second toe is transplanted on the thumb, and the fourth toe is transplanted on the index finger.”

“First, connect the proper volar artery and the proper plantar artery of the toe, and then try to connect the structure of the deep plantar arch with the deep palmar arch and the superficial palmar arch.”

This step is easy to describe, but it is as difficult to achieve it.

Under the microscope, the slightest tremor will make the blood vessel out of the field of view, and the position needs to be re-adjusted to continue the suture.

Dean Fang struggled to fix the blood vessels on both sides, and sweat slowly overflowed all over his body.

His expression became more and more frightened.

Under the microscope, Zhou Yuan’s sutures are still extremely smooth…

There is a superficial fascia on the palm side. The fatty tissue in the superficial fascia is elastic and difficult to suture, but Zhou Yuan just tapped it lightly and the thread passed through.

The subcutaneous fat pads divided by the fiber bundles are also extremely relaxed, being pulled together by the sutures.

The subcutaneous blood vessels, lymphatic vessels, etc., were anastomosed together under the drive of a needle holder. Zhou Yuan gently pressed the blood vessels at the moment of the anastomosis, and quickly passed the line with the other hand to connect the blood vessels. .

“Bleeding from the wound.” Dean Fang reminded.

Zhou Yuan nodded and completed the anastomosis of the last marked artery.

“Bleeding from the wound is a good thing, and then start anastomosing veins.”

Zhou Yuan asked the nurse to wipe his sweat, and closed his eyes.

The light of the shadowless lamp is very bright, and it is easy to fatigue the eyes for a long time to concentrate, but it must be so for the sake of a good surgical field.

After a while, Zhou Yuan resumed stitching.

The beginning of bleeding on the tip of the finger is a good sign, indicating that the anastomosed arteries can allow blood to pass, and then the veins are anastomosed so that these blood vessels return to the heart, and blood circulation at the finger is established.

The diameter of the vein is relatively thick, so it is less difficult to suture than the artery.

There are many ways of anastomosis, such as directly performing an end-to-end anastomosis, or inserting a relatively thin blood vessel into a large blood vessel, and performing an insufflation anastomosis and so on.

Ordinary blood vessels are easy to say. It is nothing more than connecting two blood vessels together. What is uncomfortable is the reticulated blood vessels.

This kind of blood vessel is difficult to judge which is an artery and which is a vein. The textbooks make it clear about the characteristics and differences between arteries and veins. It is really difficult to distinguish between arteries and veins.

Once the classification is wrong, the venous blood that originally flowed into the heart ran into the arteries, which would cause the blood circulation to collapse.

Under the microscope, Zhou Yuan carefully distinguished various blood vessels.

Vascular transplantation, coupled with the knowledge of so many major operations, made Zhou Yuan well aware of the characteristics of blood vessels. In Zhou Yuan’s eyes, some subtle differences are like “this is a vein” and “this is an artery”. .