Start From Emergency Doctor

Chapter 198

“Be careful, here is the lateral cutaneous nerve of the forearm, it is very easy to damage.” The director of cardiac surgery reminded subconsciously.

The truth is that Zhou Yuan’s age is too young, he looks like an intern, and the director of cardiac surgery subconsciously thinks he is here to supervise him.

Zhou Yuan nodded and carefully incised the deep fascia, exposing the lateral cutaneous nerve of the forearm.

“Teacher, please help me expose the radial artery below.”

Both the radial artery and the radial vein are buried under the lateral cutaneous nerve of the forearm.

He Jian nodded and carefully pulled the lateral cutaneous nerve of the forearm along with the brachioradialis muscle to the outside. After pulling it apart, the radial artery and vein from the wrist to the fossa of the elbow were all exposed.

The anterior, middle, and posterior segments of the radial artery have different characteristics. Since the middle segment has fewer perforators and is easier to separate, this segment is often freed first in the operation of dissecting the radial artery.

“Scalpel.”

“Tissue shears.”

Zhou Yuan’s operation is very careful.

There are many accompanying blood vessels in the radial artery. If the knife is too heavy or slightly deviated, the accompanying blood vessels will rupture.

In order to ensure that Qian Wei’s blood circulation is not hindered as much as possible, Zhou Yuan only blocked the radial artery. Once other blood vessels rupture, it will cause bleeding.

This is also because of Zhou Yuan’s confident technology. Others can only block all blood vessels and speed up the operation to reduce the impact of lack of blood flow in the hands.

After freeing the middle section of the radial artery, Zhou Yuan swam out the accompanying veins and adipose tissue of the radial artery in both directions of the wrist and elbow.

“Gauze with papaverine solution.”

At the moment of freeing, He Jianyi wrapped this section of radial artery tissue with papaverine solution gauze.

Papaverine solution can prevent ischemia caused by spasm of brain, heart and peripheral blood vessels, spasm of internal organs such as kidney, bile or gastrointestinal tract.

And now Zhou Yuan is most worried about Qian Wei’s vasospasm. Using papaverine solution can reduce the chance of vasospasm.

The director of cardiac surgery, who understood what Zhou Yuan was going to do, was startled.

Everyone knows that papaverine solution can prevent vasospasm, but…very few people can flexibly apply it to every operation!

The gaze he looked at Zhou Yuan became even more surprised.

Zhou Yuan next to him continued to free the radial artery.

There are few perforator branches in the middle section, preferentially free, the upper section is thick, the lower end has many perforator branches, and the blood vessels are small, so it frees after proceeding.

“Vascular clamp.”

Just after receiving the vascular clamp, Zhou Yuan suddenly noticed that Qian Wei’s finger jumped.

Zhou Yuan was taken aback and looked at the anesthesiologist subconsciously.

The anesthesiologist panicked.

What good things can the surgeon see during the operation?(Read more @ wuxiax.com)

“The anesthesia is no problem, the patient has been fully anesthetized, and all physical indicators are very stable!” The anesthesiologist said quickly, frightened.

Zhou Yuan nodded, looked carefully, and found the problem.

“Teacher, you don’t need to pull too much.”

The superficial branch of the radial nerve is on the radial side of the radial artery. Once it is stretched too much, it will touch the superficial branch of the radial nerve, and in severe cases, it may even damage the nerve, resulting in complications such as numbness of the back of the hand and fingers after the operation.

He Jian was taken aback one by one, “I have reduced my strength, and have I stretched too much?”

He Jianyi relaxed again, the radial artery almost had to merge with the tissue below, and the excessive traction was relieved.

Zhou Yuan said: “Every patient’s situation is different, and Qian Wei’s traction must be very small.”

He Jian nodded a little.

After observing Qian Wei’s fingers for a while, after confirming that the problem was resolved, Zhou Yuan blocked the perforating branch of the radial artery with a vascular clamp.

“Begin to free the upper segment of the radial artery.”

Zhou Yuan once again picked up the scalpel, tissue forceps, etc., and cut the tissue and skin bit by bit, extending the length of the free radial artery bit by bit.

Soon, the first branch of the radial artery appeared in the upper part of the radial artery.

“Sure.”

Zhou Yuan stopped.

The first branch of the radial artery, the recurrent radial artery, is the end point of freeing the upper radial artery.

This artery is also connected to other blood vessels, and it also depends on it to maintain a good compensatory blood supply.

If the recurrent radial artery is gone, the blood circulation of the entire arm will be affected.

Zhou Yuan continued to separate the lower radial artery.

Zhou Yuan performed these operations on the radial side of the biceps aponeurosis. On the other side, there are important arteries such as the brachial artery and ulnar artery and the median nerve. Deviations of one millimeter may damage them.

In a short while, the radial artery was completely free, and only the last step was cut off.

“Perform an improved Allen experiment.” Zhou Yuan said.

This is a method to check the blood supply of the hand and the anastomosis between the radial artery and the ulnar artery.

Zhou Yuan must ensure that there are no signs of ischemia in the blood supply area and good collateral circulation in order to completely remove the radial artery.

Zhou Yuan simultaneously pressed the radial artery and ulnar artery with both hands, blocking the blood supply.

On the other side, He Jianyi assisted the patient who had entered general anesthesia to make a fist repeatedly until the palm began to turn white.

This is a manifestation of ischemia.

Zhou Yuan released the compression on the ulnar artery and continued to press on the radial artery to simulate the blood flow after the radial artery was removed.

Soon, the palm of the hand returned to its blood color, indicating that there is a good collateral circulation between the radial artery and the ulnar artery. Even if the radial artery is cut, blood can be supplied to the palm through the collateral circulation.

Zhou Yuan and He Jianyi repeated it twice.

After the same results appeared three times, Zhou Yuan breathed a sigh of relief and said: “Allen’s test is negative, the radial artery can be removed.”

“Double clamp at the distal end of the radial artery.”

He Jianyi did it.

Zhou Yuan cut the radial artery two centimeters away from the wrist joint.

At the moment of cutting, the radial artery suffered segmental spasm due to the influence of tension.

“Inject a heparin solution containing papaverine!” Zhou Yuan said categorically.

The Director of Cardiac Surgery came up and inserted the injection needle along the proximal end of the radial artery, delivering papaverine-heparin solution to fill the radial artery.

Soon, under the influence of the drug, the segmental spasm disappeared completely.

“Indigo.”

Indigo is an alkaloid isolated from the traditional Chinese medicine Indigo Naturalis. It has a strong effect on a variety of bacteria and can also resist viruses.

Of course, Zhou Yuan is mainly used here to mark the radial artery.

After marking the dry dorsal side of the radial artery with indigo, Zhou Yuan took the scalpel and cut off the radial artery vascular bridge and handed it to the director of cardiac surgery.

“Director, please measure and record the inner diameter and length of the vascular bridge.”

After speaking, Zhou Yuan glanced at the time and said, “The time of collection, 14:01.”

Zhou Yuan began to process the surgical incision. On the other hand, the director of cardiac surgery began to record various data of the vascular bridge, which is very important when the heart bypass is performed later.

Determines the size and location of the opening of the coronary artery. .