Chapter 134 You are not as important as you think! (Please subscribe!)

Is such that--

Li Changhong thought to himself that he had exposed the brachial artery much faster than Yan Haihan. Later, after Wang Yaoxiang had tied up the brachial artery, he still looked at Yan Haihan calmly.

As he continued to move faster, he thought, at your level, Yan Haihan, do you still have the heart to compete for the position of chief director? Even a simple amputation is so laborious.

What he did next was so quick!

Amputation is already in progress.

Li Changhong was faster before. After completing the bandage to stop the bleeding, he had already neatly disconnected the two muscles!

I even feel a little proud that even though I haven’t had an amputation for a long time, my current level has actually not dropped!

As I was explaining the live training I was leading, I thought I could teach partial anatomy along the way.

Amputation involves amputating limbs anyway, so it is best to use them as teaching tools.

It is also in line with the reputation of the teaching hospital that the Eighth Hospital is currently preparing to strive for.

But now that I was in trouble, I quickly covered the incision with a saline pad, then raised my head, looked around calmly, stood on tiptoes and looked in the direction of Zhou Cheng's leg...

As the name suggests, amputation aims to amputate a limb.

Its definition is a therapeutic measure to amputate limbs that are necrotic, damaged, severely diseased, painful and harmful to life, or limbs that are completely useless and impede their function.

It's intended to be therapeutic, though.

Amputation will inevitably cause disability, so it should not be used lightly.

When amputation is performed, consideration should be given to future prosthetic limb installation as much as possible.

The purpose of amputation is therapeutic, but it has strict indications:

① The main blood vessels of the limb are damaged and the opportunity for repair is missed. The limb has become ischemic and necrotic. If it is not amputated, the necrotic toxin will be absorbed, which will be life-threatening.

②Diseases of the main blood vessels of the limbs (such as thromboangiitis obliterans, diabetes, arterial thrombosis, etc.) cause limb necrosis and the blood supply of the limb cannot be restored or reconstructed by other methods.

Etc. (To save word count, the remaining indications will not be released.)

However, since amputation is a surgery, it also has its requirements.

When amputation, you should try to choose the appropriate length:

If the foot is amputated, it should be at the metatarsal and should not be shorter than the talonavicular joint. Otherwise, there will be insufficient dorsiflexor muscle attachment and it will be difficult to resist the contraction force of the plantarflexor muscles, resulting in foot drop and hindering weight-bearing.

The lower 1/3 of the calf has poor blood supply and the severed end cannot bear weight, so it is generally not selected as the amputation site.

The junction of the middle and upper 1/3 of the calf has good blood supply and rich soft tissue, so it was selected as the amputation site of the calf. However, the residual limb should not be shorter than 10cm below the tibial tuberosity. Because the calf is too short, it will be difficult to control the prosthesis.

In thigh amputation and upper limb amputation, the limb should be preserved as much as possible.

This patient was an indication for amputation and had a blood clot.

Thrombus is similar to a stone stuck in a water pipe, resulting in no blood supply to the far end of the stuck area.

This is equivalent to cutting off the blood source of remote cells and tissues.

We humans will die if the water source is cut off, but we can move freely and find ways to get water.

But the cells and tissues in our limbs are fixed and cannot move freely, so we can only wait to die.

Limb salvage surgery is an extremely complex surgery that involves many disciplines.

Strictly speaking, it is not a surgery similar to internal fixation of fractures.

There are also indications for limb salvage. Let’s not mention other things for now. The first thing to ensure is the blood supply.

It's like our plumbers checking the water pipes to find out where they are blocked and then take them out.

However, in the human body, because the patient does not have time for preoperative examination, you have no idea where the blockage is.

Therefore, even directors such as Huang Shinan cannot guarantee that they can perform limb salvage surgery and remove the blood clot...

Zhou Cheng also doesn’t know how to perform limb salvage surgery.

This is a fact. However, Zhou Cheng is capable of amputation and arteriotomy and thrombectomy, which are level II surgeries.

After mastering amputation, it is natural to understand the indications and precautions for amputation.

The original planned amputation range was to cross the middle of the thigh, but in order to preserve the patient's function as much as possible, Zhou Cheng extended the blood vessels as far down as possible. By retaining an extra section of the limb, the patient's function could be preserved.

Zhou Cheng did not know how to remove thrombus in the strict sense of vascular surgery, and he had no preoperative examination, so he could only use the touch of his hands and perfect anatomical knowledge.

After releasing the proximal banded femoral artery, feel where it is blocked.

This is a technical job that requires very solid knowledge of anatomy to enable you to find the shape of blood vessels on the body surface and feel the touch of blood vessels.

Zhou Cheng performed a total of two arteriotomy and thrombectomy operations. He first went to the middle and lower part of the thigh, and then he was a little greedy and removed the thrombus from the posterior tibial artery of the calf. He made an unexpected discovery!

The dorsalis pedis artery is open!

This left him not knowing what to do.

Because Zhou Cheng’s original purpose was to amputate his leg, he just wanted to keep it longer.

Men all like thick and long...

Luo Yun wanted to strangle Zhou Cheng to death at this moment.

He glanced sideways at Yan Haihan, whose expression was stiff at the moment, the corners of his eyes twitching, his eyelids twitching, his eyes glancing at the sharp knife at hand, as if he wanted to give Zhou Cheng a slap in the face, and after reading it, he immediately cursed Zhou Cheng: "Get out of here."

"I'll check the situation first and then talk."

Luo Yun used his hands to explore the dorsalis pedis artery.

The most direct and official way to check whether the blood vessels are open is CTA, which checks whether the blood vessels are open.

However, the patient could not undergo this operation before the operation, and now his life is still hanging by a thread. Naturally, it is impossible to use this most standard examination to review.

There are also simple checks.

Palpation, that is, feeling for the pulse of the distal artery.

The arterial pulsation of the human body strictly follows a rule, that is, feeling the arterial pulsation at the far end definitely proves that the blood vessel is smooth.

Otherwise, you can't go to the far end.

Luo Yun quickly touched the dorsalis pedis artery, and then felt the weak beating of the artery with his fingertips.

Not strong.

It can't be stronger. The patient is already in shock. How strong can you ask him to be?

However, in addition to simple palpation, Luo Yun also plans to use another more direct way to confirm the evidence!

"Circuit, please prescribe a five milliliter syringe." Luo Yun immediately asked the circulatory nurse for the instrument.

Whether the blood vessels are unobstructed is a key factor in whether the amputation should be stopped. Therefore, such a guess cannot be made by palpation alone.

When Luo Yun called out, Yan Haihan, Li Changhong, and Wang Yaoxiang all stopped moving their hands.

Then he looked towards Zhou Cheng, his expression uncertain for a while.

Luo Yun also looked at Li Changhong and Wang Yaoxiang, meeting their eyes and seeing their tangled expressions.

At this moment, Wang Yaoxiang felt that his gluteal muscles were numb.

He has also started preparing for the amputation without stopping. He has cut a brachialis muscle and is in the process of cutting the biceps.

I planned to complete the amputation of the upper limb, and left my director Li Changhong and Yan Haihan and others together. I left, and you just looked at your back casually.

Can?

This problem occurred now!

Isn't this like having diarrhea halfway and having to forcefully stuff it back in...

But it’s okay!

It's just that one and a half muscles were cut, and it can still be made up, otherwise.

This joke has become a big deal.

My face and ears were a little red, and I was so embarrassed.

Zhou Cheng, a subordinate, can operate faster than them?

This actually made him feel quite shameless.

But fortunately, Zhou Cheng is very fast.

The second one feels lucky.

If Zhou Cheng, a lower-level doctor, should have slower progress than their surgery!

In the end, the three of us performed the amputation, and Zhou Cheng's leg was still there!

Four guarantees and one!

Jue Juezi!

Didn’t you live in Bengbu?
To be continued...