Start From Emergency Doctor

Chapter 268

“Baga…” The door unknown son exclaimed incomparably.

People from other countries also expressed their shock with the beautiful vocabulary of their motherland.

“I messed with Fak.”

“Sheet.”

“What a dick!”

“Fuck people.”

Zhou Yuan smiled faintly, raised his hand and pressed it down, and the venue became quiet again.

“After completing the placement of the mini-drainage strip, then loosen the tourniquet and observe the excised toe. If the toe body is full, ruddy in color, and good blood supply, the pedicle of the foot can be cut off at this time to prepare for the final treatment before transplantation.

“What if the toes are not full and the blood supply is poor?” Richard asked.

Zhou Yuan glanced at Richard, who had a big beard, and he looked at Richard, and said silently, “Then cut another one.”

Can this be saved?

Besides, all of you present here are experts in hand surgery. They have their own achievements in the field of replantation of severed limbs. They don’t have thousands of operations experience, at least they have performed hundreds of operations…

Even a toe resection can’t be done well, and there is no need to come here to learn toe transplantation to reconstruct a thumb.

“Next is the most important thing-transplantation and reconstruction.”

Zhou Yuan pondered for two seconds before raising his head again, and said: “According to the reconstruction of the finger defect and the difference between the fingers, make appropriate trimmings to the phalanges, use Kirschner wires to fix the phalanges, or use The thin steel wires are fixed in a crisscross pattern.”

“At the same time, directly adjust the tension of the flexor and extensor tendons at this stage to facilitate the direct suture between the tendons in the later stage. Use the 3/0 tendon thread to suture the flexor and extensor tendons.”

“Next is the anastomosis of the blood vessels. The arteriovenous arteries and veins of the toes or the subcutaneous tunnel are respectively sent to the web between the first fingers of the palm and between the first and second metacarpal bones of the back of the hand. Under the microscope, each blood vessel is anastomosed with a 10/0 non-damage suture.”

The experts can’t sit still.

What they are looking forward to is nothing more than this-which blood vessels do the anastomosis in the end!

The elasticity, thickness, and size of the lumen are different among blood vessels, making it difficult to choose anastomoses.(Read more @ wuxiax.com)

Zhou Yuan paused for a while, deliberately suspending everyone’s appetite.

Looking at the door, the unknown child couldn’t help but started to shoot, and then smiled, and said: “The first dorsal metatarsal artery and the first common palmar artery are anastomosed together. The dorsal metatarsal vein and the dorsal palm vein are connected.”

The anastomosis of the first finger of the common palmar artery and the first dorsal metatarsal artery is actually a major difficulty, and normal people would not think of it.

The arteries of the hand have been studied in depth at home and abroad, but most of them only study the blood supply source, type and degree of variation and branches of the superficial palmar arch and deep palmar arch, as well as the length of the first common palmar artery and its relationship with the thumb. There is no detailed report.

Therefore, the first finger of the common palmar artery is an artery that is easily overlooked, but it does not mean that it is not important.

On the contrary, this place is not only very important, but also very complicated…

Near the common arteries are the common palmar arteries and nerves. There are 189 branches of the first finger common palmar arteries, of which 145 are anterograde. Forty-four retrograde blood vessels. The number of accompanying nerves has reached one hundred and seventy-six…

Therefore, the anastomosis mentioned by the mouth is very simple, it seems to be taken in one stroke, but only the surgeon knows the cumbersomeness and difficulty.

Another reason is that after the first finger’s common palmar artery is stripped, the common palmar nerve and the common palmar artery are distributed regularly in a certain area of ​​the palm, which is helpful for the repair process of palm injury. The finding and anastomosis of the common palmar nerve of the middle finger and the common palmar artery of the finger can reduce the difficulty of the operation.

Of course, the most important thing is that it is suitable for connecting with the first dorsal metatarsal artery regardless of its diameter or function.

It is not difficult to find the common palmar artery of the first finger, along the direction of the first metacarpal bone, deep under the skin and palmar aponeurosis, and the superficial layer of the intermetaphalangeal muscle can be observed. This is not necessary for Zhou. Yuan specifically stated that everyone knows.

“Next, the 9/0 line joins the proper finger nerve and the proper toe nerve. The wound is sutured, and the volar and dorsal incisions are placed with mini-drainage strips. Loosen the tourniquet, and observe the good blood supply of the reconstructed finger. After bandaging, the wrist rests in plaster fixed.”

Zhou Yuan finished speaking, and finally made a summary, “When recreating different fingers or recreating two fingers at the same time, the vascular anastomosis part is between the finger webs and metacarpal bones of the corresponding palm.”

When this sentence fell, it was poured into the hot oil with cold water, and the venue boiled all at once.

“The vascular anastomosis site is between the webs of the corresponding palm and the metacarpal bones?!”

“Just sum up the final law?!”

“The anterograde branches from the first finger’s common palmar artery and the common palmar nerves span fifty-seven, all of which are anastomosed between the webs of the corresponding palm and the head of the metacarpal bone?”

Zhou Yuan didn’t speak any more, but stood quietly on the stage, waiting for the experts below to figure it out.

Shenyuanjing, John Joe and others have quickly calculated in their minds, as if countless blood vessels appeared in front of them, they were slowly anastomosed under their control…Then the blood circulation was turned on and flowed along these anastomosed blood vessels. .

Dean Fang hugged Chuchu and sat aside.

He had already remembered the connections of these blood vessels when he was involved in the operation, and he had witnessed the blood flow through and finally completed the blood circulation.

Perhaps Dean Fang is inferior to Shen Yuanjing and others in simply replanting severed limbs, but at this moment… he is already the first person to recreate fingers other than Zhou Yuan!

Of course, it does not mean that Dean Fang can succeed. The first common palmar artery that was anastomosed had nearly 200 small blood vessels. The difficulty of anastomosis is beyond normal people’s imagination.

After a long time, John Joe was the first to recover, his expression extremely excited.

“It’s really okay! How did you come up with it! So many branches, you just match up like this?!”

Shenyuanjing also trembling hands.

He now wants to have an operation and complete the finger reconstruction with his own hands, but he has long been deprived of the qualification to perform the operation. Now he can only be behind the scenes, not to mention the operation of the scalpel, just to help count the gauze is a violation of the medical discipline of.

“It’s amazing… it’s amazing!”

Many old people with white beards at the venue patted the table with excitement, and looked at Zhou Yuan on the stage with an incredulous expression.

When Zhou Yuan uncovered the connections between blood vessels and nerves, everything seemed to be clear and simple.

Surgery is like this. No one understands until the answer is announced. After the answer is announced, everyone can instantly understand-of course, if you really want to perform this operation, many technical problems still require their own strength. Customer service.

“Wait…I still have some technical problems!” The door unknown son thought for a long time, and finally raised his hand and stood up. .