Chapter 158 Can you not speak if you can’t speak?! (Second update, please subscribe)
Unobstructed blood supply is the guarantee for successful replantation of severed fingers!
Blood is the source of life.
However, although Chen Tingye was extremely excited after seeing the blood, Zhou Cheng did not let the blood flow for too long. After seeing the blood stains, he immediately clamped the proximal artery with an artery clamp.
The remaining blood still flowed for a while, and the tiny pools of blood formed were sucked up one by one by Zhou Cheng with a suction device.
He turned around and took a look at the patient's blood pressure. It was quite stable, and then he slowly breathed out.
Only then did Chen Tingye and Zeng Yi realize their gaffe.
This is a replantation of an amputated limb. Although as a hand surgeon, the instinct is to be excited when seeing blood, but one should not look at it for so long. Let the blood flow and ignore it.
"Vascular sutures." Zhou Cheng directly asked the handwashing nurse to open the prepared sutures.
In fact, the best way to remove thrombus is to have a professional thrombectomy tool from vascular surgery. Even if it doesn't work, you can use a catheter at least, which will save more time.
Incisional thrombectomy, although cheap, does not require the expense of a catheter!
But in fact, the time wasted and the cost of anesthesia are no less than the cost of the catheter.
However, Huang Shinan from the Eighth Hospital did not bring the catheter into the operating room. This was something that was impossible to do and could not be dealt with in a short while.
Purchasing new instruments, even syringes, must go through the hospital's formal approval process, and the hospital will purchase them uniformly! The procedures are trivial, and although they are also to ensure quality and other corruption, there will also be certain restrictions.
The temporary purchase required the signature of Huang Shinan, who was in charge of the Department of Vascular Surgery. Zeng Yi, as the chief director of the Department of Orthopedics, might have been able to get Huang Shinan to sign, but Zhou Cheng would definitely not be able to do this.
Yang Yifeng frowned slightly when he saw that after Zhou Cheng made an incision to remove the thrombus, he still had to suture the blood vessel before he could continue to remove the distal thrombus.
He shook his head slightly.
Now we are racing against time, but because of the equipment, the operation time has to be extended.
Fortunately, Yang Yifeng saw that Zhou Cheng was suturing the blood vessels very quickly. In a short time, he had sutured the artery that had just been cut.
Because it is not completely cut off, only part of the tubular blood vessel wall is sutured.
After tying the knot, Zhou Cheng stuffed the blood vessel into the muscle tissue, ignored it, and then opened the proximal artery clamp again——
Run your fingers along the shape of the artery, and continue to touch the pulse of the artery with the fingertip of the index finger (the index finger is the index finger, index finger is the official term, because the index finger is mostly used to point to things).
The naked eye is neither CT nor X-ray, and has no penetrating ability.
Therefore, the specific location of the thrombus cannot be seen.
In fact, speaking of it, the reason why arteriotomy and thrombectomy is classified as a level II operation is not that thrombotomy and thrombectomy is difficult. On the contrary, it is very simple, as long as CTA shows intravascular thrombus.
Location.
It can be completed by senior residents who are very familiar with surgical anatomy.
However, the reason why limb salvage surgery is quite difficult is how to recanalize blood vessels without CTA. This is an issue that vascular surgery currently needs to solve urgently.
There are multiple arterial embolisms after trauma, and the location of the thrombus is not fixed. It is basically unrealistic to penetrate the artery to find the thrombus throughout the entire process.
At present, blind thrombus removal is limited to one or two locations, and a catheter is used to remove the thrombus from a distant place. Life is important if the thrombus can be removed. If it cannot be removed, the only option is amputation.
How much time it takes depends entirely on the skill of the surgeon and the patient's own luck!
In other words, positioning is difficult.
In modern medicine, the most difficult thing is not the operation, but the diagnosis, which includes positioning and characterization.
Sometimes it is difficult to locate, sometimes it is difficult to determine.
Therefore, when Chen Tingye saw Zhou Cheng pulling out the radial artery again like a loach, he and Yang Yifeng finally saw something was wrong with Zhou Cheng.
Chen Tingye himself is a giant in hand surgery and has a deep connection with vascular surgery, so he knows a little bit about it. Yang Yifeng is extremely talented in vascular surgery and has made the professor of vascular surgery at the Shonan University Affiliated Hospital sigh more than once.
.
Yang Yifeng entered the wrong profession.
Seeing Zhou Cheng's technique, Yang Yifeng was very excited.
Zhou Cheng's arteriotomy and thrombectomy seems to be no longer just a skill, but can be called a skill.
Skills, skills are skills, ability is ability, and knowing this skill.
Skill is art.
Being able to feel the location of blood clots and the pulsation of arteries with his fingertips, he was the most aware of how difficult it was.
The reason why Yang Yifeng now dares not go to the operating table again is because he is nervous, and secondly because his hands are trembling due to the nervousness.
For a good surgeon, hands are extremely important!
To a certain extent, cognition determines the upper limit of surgery, and the amount of surgery, or the refined surgical skills, is another guarantee of the quality of surgery.
If I could have Zhou Cheng's hands, wouldn't it be possible that my parents wouldn't die?
…
Another blood clot was pulled out by Zhou Cheng. The long dark red blood clot had a stagnant feeling when it was pulled out of the blood vessel. It looked like quite a relief. It was a long strip and it was continuous and unbroken, which was pleasing to the eye.
.
Very suitable for relaxing.
Perhaps Li Changhong had seen Zhou Cheng take blood clots, so he was not surprised, but the expressions on the faces of several people were quite strange.
This almost shows Zhou Cheng's kung fu to the extreme.
Although they have never been exposed to too much thrombectomy in vascular surgery, they have all eaten hot pot, and duck blood in hot pot is a common order.
Dried duck blood is very hard and may rot if you pick it up, let alone coagulated wet duck blood?
PS: (If it’s hard to understand, use chopsticks to pick up duck or pig blood when eating hot pot!)
Zhou Cheng was busy and unhurried, concentrating completely. He didn't pay attention to other people's eyes and expressions.
Although arteriotomy and thrombectomy is only a simple level II skill, in order to perfect this skill, he spent his whole life immersed in simulated copies before reaching the perfect level. Naturally, there are reasons and methods.
Besides, this is not the time for teaching.
After sewing again.
Zhou Chengcheng also removed the thrombus in a communicating artery!
After releasing the proximal artery clamp, blood was seen.
After suturing, continue to test the blood supply to the distal end of the limb.
Simple.
Then a syringe was called over and the needle was inserted into the pulps of five fingers.
It was not torture, and the patient had been anesthetized. By the time he regained consciousness, the punctured needle hole had already healed.
I saw that the blood vessels in the thumb, middle finger, ring finger and little finger were all unobstructed, and little bits of blood slowly oozed out. However, the pulp of the index finger was still peaceful, and no blood was seen.
At this point, Zhou Cheng immediately said: "Professor Chen, the proper artery of the index finger is probably blocked. Let's ignore it for now. You deal with this hand first, and then I will remove the thrombus from the opposite side!"
"This patient's blood coagulation status is probably not very good. The incisions where I make the incision to remove the thrombectomy will not be closed for the time being, but can they be left alone?" This was the suggestion.
Chen Tingye nodded immediately, and then he had time to sigh and said, "Okay, thank you for your hard work, Dr. Zhou."
"I will start suturing part of the vascular bed immediately. If this patient is to be fixed, external fixation will be used at that time." Chen Tingye said quite excitedly.
After a severed limb is ischemic for a long time, the vascular bed is sutured. The vascular bed is another name for muscle. In fact, it can also be called nerve bed.
As a hand surgeon, Chen Tingye encountered a big problem when performing limb salvage surgery, which was that he did not have a top vascular surgeon to cooperate.
In fact, although the hand surgery department in Annex 1 is currently slightly more famous than the hand surgery department in Annex 2, its development is a bit slow because there is no good partner.
If Professor Shu from the Department of Vascular Surgery in Annex 2 was in Annex 1, Chen Tingye thought, how could Deng Lianggen, a newcomer like him, be able to catch up?
Chen Tingye felt that Deng Lianggen was a later scholar. This was not because he was a fan of Deng Lianggen, thinking that he was his junior, but because Deng Lianggen himself was not a person with a background in surgical surgery, that's all.
But attached 1, the subspecialty of hand surgery has been inherited for a long time.
If a good team can be built, that will be the most comfortable thing.
It is impossible for Chen Tingye to go beyond his own hospital and go to Annex 2 to ask for external help from the Vascular Surgery Department. The hospital will not allow it. The Vascular Surgery Department will not allow it, and Professor Shu will not come over.
However, this was the first time that Chen Tingye felt that with a good vascular surgery partner, limb replantation and limb salvage would actually become relatively simpler. He only needed to worry and consider how to perform the surgery well.
!
Zhou Cheng did not think about or give instructions on the steps to replant Chen Tingye's severed limb, but went straight to the opposite side.
Wang Yongjin and Zeng Yi immediately went to help Chen Tingye start the follow-up surgery, while Li Changhong brought two subordinates to continue to assist Zhou Cheng!
Li Changhong also said: "Xiao Zhou, I have to work hard for you again today."
Li Changhong knew very well that the patient himself had no identity, but his company came forward for some reason. Not only did it invite Chen Tingye for consultation surgery, but the hospital was probably also paying close attention to this surgery.
I just don’t understand why the company doesn’t just transfer the patient to Shonan University Affiliated Hospital directly, but insists on sending it to the Eighth Hospital.
Zhou Cheng smiled and said nothing.
It was his job, but it was indeed hard work. He was actually a little tired, but he still continued to persevere.
However, what makes Zhou Cheng quite happy is that the blood supply on the side he is currently dealing with seems to be better than the blood supply on the opposite side. So after Zhou Cheng found two arterial thrombosis, the blood supply immediately became better.
It became smoother.
In this way, Zhou Cheng completed the step of unblocking blood circulation in just forty-five minutes.
You're done.
After that is done, Zhou Cheng can actually step down.
Li Changhong also took a long breath and said, "Xiao Zhou, thank you for your hard work. Please step off the stage and rest for a while."
With unobstructed blood supply, at least the possibility of replantation of the amputated limb is preserved. As long as the blood supply continues to be slowly connected, the timeline of the operation can be slowly extended, and there is no need to worry too much about ischemia and necrosis of the distal limb.
.
It left them more time to finish, but while observing Chen Tingye's surgery, it was a bit tiring and had to stay up late.
But when it comes to studying, everyone does it this way.
At the very beginning, in order to learn debridement, Li Changhong stayed in the ward day and night, waiting for the emergency room to come to the hospital in the middle of the night, and learned surgical anatomy while doing debridement.
Zhou Cheng was about to nod slowly when he saw that Chen Tingye had temporarily fixed the ulnar and radius bones with Kirschner wires and then sutured the tendons. However.
The severed end of this limb is just near the joint. Near the joint, most of the muscles are the starting and ending points, and most of the muscles are damaged, so the starting and ending points must be reconstructed.
If the suturing is done casually, it can be done and the skin grafting can be done in the second stage.
But ah.
If the starting and ending points of the muscles in the first stage are not reconstructed well, recovery after surgery will be very troublesome.
Before coming down, although Zhang Zhengquan didn't confess anything, he told him personally that he was a friend of Zhang Zhengquan's brother.
Zhou Cheng was not familiar with Zhang Zhengquan's brother, but the word "quanzi" was enough for him to do his best.
So after frowning for a moment, he suggested: "Director Li, how about I go help Professor Chen and Director Zeng come here and start suturing?"
Chen Tingye's careful debridement in the early stage has been extremely perfect. Although there are still some modifications, there is no need to spend so much time.
Whether the flaws cover up the flaws or not, this flaw does not matter. The suturing and reconstruction of the muscles are obviously more important.
Zhou Cheng's suggestion was not greedy for merit, and the previous blood vessel incision and thrombectomy had been approved by everyone. Zeng Yi raised his head and glanced at Chen Tingye.
At this age, he already has a sufficient foundation. The main thing he learned from Chen Tingye was his ideas. Now he understands that it will be of great benefit if he can do it himself, so he is quite moved: "What do you think, Professor Chen?"
"Director Zeng, please come over. We will start the operation at the same time, so the operation can be finished early." Chen Tingye naturally knew something about Zeng Yi.
After all, as the chief director of one party, he still has the name of hand surgery. Although he also takes on messy tasks such as spinal fractures, if he can be the director, he will at least be able to perform surgeries.
The purpose of his coming here was to save his limbs. Zeng Yi could complete some finishing work and side work without any problem at all.
So Zhou Chengcheng and Zeng Yi changed places.
Moreover, Chen Tingye's surgical skills are already extremely advanced, and his speed is not slow. When Zhou Cheng was removing the thrombectomy on the opposite side, he was already suturing the muscles and tendons. Of course, during this period, he had already sutured the nerves.
The broken end was found and rested, just waiting to be sutured.
It is best to suture the nerves in one stage, but it can be delayed for two to three months at the latest, which is no problem. On the contrary, it can be done in a short time.
Zhou Chengxian just took over the position of Zeng Yi's assistant and worked with Wang Yongjin.
However, after Zhou Cheng stood still, he discovered that Wang Yongjin's hook-pulling hand was occasionally trembling slightly, and even the amplitude of the trembling affected Chen Tingye's operation to a certain extent.
Although Chen Tingye didn't say much, he just glanced at Wang Yongjin's hand occasionally and then continued the operation.
Zhou Cheng looked at the time and saw that it was already 1:15 in the morning.
Wang Yongjin was re-employed and admitted to the hospital after retirement. He is close to 70 years old, and naturally he is not as good as a young man who stays up late.
Then he lowered his voice and asked, "Teacher Wang, would you like to step down from the stage and take a rest?"
It was difficult for Chen Tingye to bring this up, but after Zhou Cheng said it, he immediately responded: "Yes, Director Wang, look at me, you haven't noticed at all. You are so old, you should take a rest."
Now, let’s bring in a young man instead?”
The operation started at around ten o'clock. Wang Yongjin was already very depressed when he was called over.
At this moment, he was relying on support. Hearing what Chen Tingye said, he blinked his eyes slightly, and his eyes were obviously a little complicated. He was actually very tired, but as a surgeon, he could be regarded as a lifelong orthopedic surgeon at the Eighth Hospital.
Now he can't even stand on the platform, and he feels quite uncomfortable in his heart. However, Wang Yongjin also knows that if he continues to stay on the platform, not only will he not be helpful to the operation, but it will affect the normal progress of the operation.
Zeng Yi immediately shouted: "Wang Yaoxiang, go over and replace Director Wang."
Then he said to Wang Yongjin: "Teacher Wang, please go back and rest first. You will continue to work tomorrow. There are several of us young people here, and you have really worked hard today."
The tone was sincere, and he really thought about Wang Yongjin's health.
Wang Yongjin just sighed and nodded: "Professor Yang, thank you for your hard work later on. People don't rely on their bones and muscles for strength. I really can't hold on a little bit."
Chen Tingye immediately said: "Director Wang's words are serious. You are still getting stronger with old age. With my body and bones, it is not certain whether I can go to the operating table at the age of sixty."
This is the truth, a surgeon is actually a job that sells one's body.
The golden age is between the ages of forty and sixty. After this age, one is probably physically exhausted. There are not many people like Wang Yongjin who are still active on the operating table at the age of 67 or 8.
At least the professors at the Shonan University Affiliated Hospital have only been working in outpatient clinics for a long time.
Wang Yongjin quietly got off the stage, twisted his waist, and left the operating room.
When he was at the door, he looked back at the incandescent lamp and shadowless lamp in the operating room with great reluctance. His eyes were complex, filled with reluctance and helplessness.
This was once his battlefield, but now he must hand over the battlefield to others.
This is for your own consideration and for the safety of your patients.
…
In the operating room, after Wang Yongjin left, Chen Tingye was still saying: "Director Zeng, Director Wang in your department is really in good health. Can he still be on stage at his age? Are you still leading the team?"
Zeng Yi said guiltily: "Yes, Professor Chen, I am not afraid of your jokes. Teacher Wang should have reached the age of old age long ago, but there are not enough manpower in the department. Now only Teacher Wang is left among the older generation.
Active in the department."
"We young people can't handle it, so we can only exhaust Director Wang and continue to hold on."
This is a joke, and of course it proves that the current operation process is relatively smooth. Otherwise, everyone would definitely be silent. Not to mention that Wang Yongjin has stepped down, and everyone speaks simply and coldly.
Li Changhong said: "Yes, we are too shameless to say the least. Director Wang is the senior brother of Professor Wu and Professor Li."
Chen Tingye immediately opened his mouth when he heard this, then Wang Yongjin is really awesome!
Such a figure from the older generation.
He also knew that the Professor Li Li Changhong was talking about was probably Professor Li, the director of the Department of Orthopedics and the deputy dean of the Second Affiliated Hospital of Xiangnan University. As for Professor Wu, he must be the boss of his department.
The boss of the Department of Orthopedics has stopped performing surgeries for a long time. I heard he only performs one surgery every month or half a month. A group of people below are helping him perform surgeries and are now focusing on scientific research and teaching.
Chen Tingye sighed: "Director Wang is really worthy of being strong."
When she said this, Weiwei felt pity for Wang Yongjin. At such an old age, he still had to run around in the department. This might be a different choice.
If he had continued his postgraduate studies and stayed in Annex One and Two, he would have had disciples all over the place by now, instead of being just an old director of orthopedics at the Eighth Hospital like he is now.
Maybe even his teacher.
The platforms are different, then?
However, it seems wrong to think so. Isn't Zhou Cheng's thing just that he is better than his master?
Chen Tingye glanced at Zhou Cheng and felt that there was something wrong with this young man.
The surgery continues.
Chen Tingye suddenly discovered that since Wang Yaoxiang came to work as an assistant, his operation had progressed very smoothly. During the tendon suturing process, every time, every stitch could be delivered to the door at the right suture point.
Just like the girl who went to the ancient 'Jiyuan', she came to the door very proactively. (Typography deliberately made.)
The surgery went quite smoothly, and the suturing process was naturally very smooth.
But Chen Tingye is a man, and as a man, it is not good to be too passive and smooth sailing.
The ups and downs and folds can give people the motivation to continue sprinting.
Very similar to the reader’s mentality——
It won't work if it's too dry, and I'll feel uncomfortable if it's too dry. It won't work if it's too watery. It'll feel like water hyacinth and I won't feel it.
He frowned slightly and temporarily interrupted the operation, his eyes lingering on Zhou Cheng and Wang Yaoxiang.
Either Zhou Cheng or Wang Yaoxiang took away the pleasure that should have belonged to him.
He himself is like a tool machine.
The stick that stirs the water makes the sound of water moving unpleasant.
Finally, when only the last muscle that needed to be sutured was left, the focus was on Zhou Cheng.
He asked a little curiously: "Can Xiao Zhou know how to sew? Why don't you come and try?"
In fact, there is no need to guess. It is either Zhou Cheng or Wang Yaoxiang. You will know who is causing trouble by calling one person on stage to sew it up.
And because blood circulation is smooth now and time is not so tight, he is happy to investigate the final "culprit".
When Wang Yaoxiang heard this, his face suddenly tightened and he bit his mouth, feeling a little disappointed.
As a co-author and an attending physician, he was not as good as Zhou Cheng. Chen Tingye obviously wanted to teach and give guidance on the spot. But the opportunity was earned by Zhou Cheng himself, not by Chen Tingye.
Zhou Chengze was slightly surprised and nodded: "Okay, Professor Chen."
Zeng Yi and Li Changhong both heard Chen Tingye's arrangements, but they didn't even raise their heads. Whether it was Wang Yaoxiang or Zhou Cheng, they were all members of the department. They had no control over who Chen Tingye liked to teach.
I'm afraid Chen Tingye doesn't want to teach.
Then Zhou Chengcheng took the suture from Chen Tingye's hand, and after slowly breathing a sigh of relief, he once again turned into a machine-like dexterity and began to move.
During the period when he was just pulling the hook, he only had to be an assistant and took it easy for a while, so at this moment his physical strength was slightly restored.
Bah. The needle tip sinks into the surface of the muscle.
Poof. The needle tip penetrated the surface of the muscle.
By going back and forth like this, several stitches were quickly completed.
Wang Yaoxiang's face was expressionless, and he was still wondering why Chen Tingye didn't choose him to suture, but Chen Tingye's expression gradually became serious.
An expert can tell the truth at a glance.
The 'culprit' was found, and it was this little guy named Zhou Cheng. He pretended to be a pig and ate the tiger. He looked at me from the sidelines for a long time, not knowing whether he wanted to stab him in the back.
Because from the angle of Zhou Cheng's insertion and removal of the needle, Chen Tingye felt an extremely professional style.
And the movements are fast, without any pause, and the techniques are sophisticated!
What does it mean to be old and what does it mean to be spicy? In fact, it means being straightforward and decisive.
After a while, a muscle with a long axis of less than two centimeters was sutured tightly by Zhou Cheng. Moreover, Zhou Cheng also tested the tension of the suture. It was just right, even slightly better than Chen Tingye's suture.
Little Diudiu.
If the tension is wrong, it will be easy to cut.
It is easy to imagine why the sutures break when sewing tofu. It is actually cutting, but you can sew the tofu together through techniques and skills. This is kung fu. (As an analogy, I will not go into depth and popularize science. If you are interested,
, you can search for knife skills on a certain website, it will be even more incredible.)
Zhou Cheng put down the sutures and needle holder.
Then he looked at Chen Tingye and said, "Professor Chen, should we continue to suture the nerves and reconstruct the insertion points of the muscles? Or should we suture the opposite side first?"
After the surgery has reached a certain stage and all the difficulties have been overcome, you can actually perform as you wish to a certain extent!
They can all be very sour and refreshing.
It is difficult to open the narrow forbidden area for the first time!
Blood vessels are the source of life, and muscles are the source of movement and the vascular bed. They accommodate and protect blood vessels!
Chen Tingye raised his eyebrows slightly, and Zhou Cheng's answer was very intuitive, saying: "Let's suture the nerves together first."
Your director is sewing the muscles and tendons on the opposite side. Should I go over to drive them down now, or should you and Wang Yaoxiang go? It's not appropriate for me to go. You two are seeking death.
"Can you suture nerves?" Chen Tingye asked again.
I want to explore Zhou Cheng’s background.
But one thing Chen Tingye got wrong is that men are no better than women, and there is no way to find the bottom——
"A little bit." Zhou Cheng didn't refuse.
Because nerve anastomosis is a secondary surgery, he has secondary surgical authority.
Even if things go wrong, Chen Tingye has authorized the surgeon to be Chen Tingye. He performs the Level IV surgery, so he is not afraid that no one will take the blame.
"Then sew together to save time." Chen Tingye said.
"Those two nerve sutures. Wei Qiao 6-0!" Then he ordered the equipment nurse.
"Okay, start it right away, antibacterial Micro-Qiao 6-0!" the circulating nurse replied, and then hurriedly found sutures.
Chen Tingye didn't expect Zhou Cheng to really dare to answer, but it was just right.
Although nerve suturing and tendon suturing are both level II surgeries, the difference is actually quite big and it is not as simple as muscle and tendon suturing.
After looking at Zhou Cheng for a while, his eyes narrowed and the smile on his mouth was covered.
This Zhou Cheng doesn't look very old, but he seems to have very solid basic skills. If he can come to the Eighth Hospital, he will at least prove that he is not a doctor. Let's see if he can get it back.
And if it can get Yang Yifeng's attention and recommendation?
Huh? Is this guy being targeted by Lao Ding?
Ask later.
However, after getting the nerve sutures and the attached microsurgery needle holder, Zhou Cheng started to get started without asking the circulating nurse for glasses and instruments.
Well, there are only one set of microsurgery instruments and two glasses. One is at Chen Tingye's place, and the other is on Chen Tingye's head now.
Zhou Cheng used to sew up the muscles, which were quite big, so they were not needed, but now?
It was not easy for Zhou Cheng to ask these two for it, and the nerve branch he sutured was not small, so Zhou Cheng quickly moved on the nerve, raising and lowering the needle tip.
The suturing of the epineurium was completed quickly.
Of course, Zhou Cheng did not suture everything, because the suturing of nerves, unlike muscles, cannot be sutured all at once.
The anatomy of nerves can be divided into epineurium and nerve bundles.
Orthodox neural anastomosis can actually be divided into interfascicular anastomosis and epineurial anastomosis!
The suturing of the epineurium is to pull the symmetrical point of the epineurium with 5-0 silk thread, then gently turn it to both sides like a sleeve to expose the nerve bundles at both ends. After correctly identifying and fixing the nerve bundles at both ends, use 9
Use ~11-0 fine silk thread or nylon thread to suture the membrane with 2 to 3 needles.
The anastomosis between bundles should preferably not be on the same plane to prevent adjacent nerve bundles from adhering to each other.
Finally, use 5-0 silk thread to perform 6 to 8 interrupted epineurial sutures after aligning the axis, that is, the perineurium and epineurium are sutured at the same time. After the suturing is completed, wrap it with polyester or chitin membrane and place it in a normal position.
In the intermuscular space or within the fascia.
Chen Tingye chose to use 6-0 sutures, which actually made it more difficult for the orthodontic epineurium, but this did not stump Zhou Cheng.
Zhou Cheng doesn't have many fancy skills in nerve suturing, but he is just familiar with it and has perfected the current suturing method.
After Chen Tingye fixed the epineurium first, Zhou Cheng shouted to the roving nurse: "Teacher circling, take a 10-0 suture, it's also a micro Qiao."
First suture the neural membrane, then suture the nerve bundle, and finally pack it!
One step ahead of Chen Tingye, Chen Tingye glanced at Zhou Cheng's suture position.
Well, no problem occurred.
Is this young man single? His hand speed is very steady and fast.
As we all know, speed is for fun, stability is for strength -
After Zhou Cheng got the micro sutures, he quickly found the perineurium.
The epineurium is not difficult to find, but the epineurium is really hard to imagine. It is not too thin to be as thin as a cicada.
Even before Wang Yaoxiang could understand, Zhou Chenggong had already put the needle in his mouth!
The movement was a little slower than before, but Zhou Cheng's suturing process made Yang Yifeng frown. Is this okay?
Looking for the epineurium without microsurgical glasses is actually not much different from looking for the epineurium with eyes closed.
There are only three important nerves in the forearm.
Ulnar nerve, radial nerve, median nerve.
The location where Zhou Cheng sutured was the ulnar nerve, while the location where Chen Tingye sutured was the radial nerve.
The ulnar nerve is broken at the transition point between the elbow and forearm.
The suturing in this position is difficult, not the most difficult, but it is certainly not the easiest.
Our ordinary nerves are composed of epineurium and nerve bundles.
The ulnar nerve originates from the medial bundle of the brachial plexus, where the number of internal nerve bundles in the ulnar nerve is 11, mainly mixed nerve bundles.
The number of nerve bundles in the ulnar nerve in the upper arm has increased to 16! Among them, there are 13 mixed nerve bundles mainly composed of motor nerve fibers, and 3 mixed nerve bundles mainly composed of sensory nerve fibers.
At the elbow! The ulnar nerve then descends into the ulnar nerve groove between the medial epicondyle of the humerus and the olecranon of the ulna. There are 12 nerve bundles inside the ulnar nerve here, including 4 mixed nerve bundles mainly composed of motor nerve fibers.
In the forearm, there are 18 nerve bundles in the main trunk of the ulnar nerve, including 3 mixed nerve bundles mainly composed of motor nerve fibers, 5 mixed nerve bundles mainly composed of sensory nerve fibers, and 10 mixed nerve bundles!
The diameter of the ulnar nerve is just that small! A few millimeters!
Divided by eighteen, it is the diameter of the nerve bundle.
And the epineurium is a small part of it...
Does Zhou Cheng have any special persistence and skills in finding masks this time?
Then he quickly shook his head and carefully considered the gap between Zhou Cheng's kung fu level and his own. At the same time, he kept scanning the gap between Zhou Cheng's and Chen Tingye's neural sutures.
Nerves can be divided into epineurium and nerve bundles.
The nerve bundle is wrapped by the perineurium, so in fact, the suturing of the nerve is not the suturing of the nerve, but the suturing of the epineurium and perineurium. The nerve itself cannot be needle-dropped.
If the needle drops, the person will go numb.
And the knots also need special treatment——
Because only special treatment can provide better protection for the nerves, knots may cause compression symptoms on the nerves, and compression of different nerve bundles will cause different results.
The ulnar nerve is in the forearm. Although there are eighteen nerve bundles, their functions are different——
2 motor nerve bundles form muscle branches.
The ulnar nerve continues between the flexor carpi ulnaris and flexor digitorum profundus muscles, and the ulnar artery descends medially and gives off the dorsal branch of the hand above the radiocarpal joint.
The main trunk of the ulnar nerve here consists of 5 mixed nerve bundles and 1 mixed nerve bundle mainly composed of motor nerve fibers.
The dorsal branch nerves of the hand are four mixed nerve bundles mainly composed of sensory nerve fibers. They are distributed on the ulnar half of the dorsum of the hand and the skin on the back of the ulnar half of the little finger, ring finger and middle finger. Its trunk goes down along the radial side of the pisiform bone.
Then, Yang Yifeng seemed to notice that Zhou Cheng's knots seemed to be heading in the direction of certain nerve bundles.
A rather absurd idea unfolded in his mind.
Does Zhou Cheng know which nerve bundles are pure motor branches, which nerve bundles are pure sensory branches, and which nerve bundles are mixed nerve bundles?
Yang Yifeng's evaluation was very professional because he is a professional himself.
Maybe Wang Yaoxiang doesn't even understand it or understands it.
That's because he didn't read the book thoroughly, didn't read it carefully, and didn't study it in more detail.
Clinical medicine is not traditional Western medicine, it is modern medicine, which can explain the truth thoroughly and clearly.
Yang Yifeng knew that there are some top limb preservation masters who can discard part of the sensory nerve bundles and then make room for the motor branches! This trick is called throwing away the car to save the handsome, and it can still be used in medicine.
It seems that Zhou Cheng's current direction of tying the threads is also the same. What's more, Zhou Cheng's direction is different from the kind of cutting.
Micro-neural sutures are absorbable. After a few months, when the nerve bundle grows, the sutures will naturally fall off and the knots will disappear. Once the outer membrane has healed, the compression will naturally be relieved.
However, a very professional question popped up in Yang Yifeng's mind.
"Brother Zhou Cheng, if you suture all the perineurium alone, how can you avoid the occurrence of neuroma and epineurial adhesion?" Yang Yifeng asked the most critical question.
Neuromas are not malignant tumors, but they grow between the epineurium and nerve bundles and become compressed, causing various symptoms.
The more knots in the suture, the higher the pressure within the nerve bundle, and the easier it is to cause entrapment!
Under stimulation, neuromas will appear.
A question actually involves many aspects of knowledge. This is Yang Yifeng's knowledge base.
Zhou Cheng frowned slightly. It's not that Yang Yifeng's question is difficult to answer, but that the possibility of neuroma caused by suturing the epineurium is not very high. Compared with long-term chronic irritation, the probability is much lower.
Much smaller.
Therefore, Zhou Cheng had not considered this problem even in the simulation copy before, but he had already thought about the adhesion problem: "The firm suture of the perineurium is conducive to early recovery, because the sutures are not in the same plane.
, so the chance of adhesion is not high.”
"You can even start slight passive movements as early as five days later."
Movement is divided into active and passive. Active means moving by oneself, and passive means moving by others.
"As for the issue of neuromas, we can discuss this."
"We can't control so much now. The most we can do is cut it after it has grown." This question is beyond Zhou Cheng's knowledge blind spot. This may be an issue that should be considered when redefining perfection in neurosuture, which is above the level of perfection.
Within the level of perfection, there is no need to do this.
But Zhou Cheng's words of weakness immediately caused Chen Tingye, who was standing opposite, to raise his eyebrows fiercely. He frowned and said, "Can I start passive activities five days after the operation?"
"When we encounter patients, we usually wait for ten to twelve days if we are brave enough."
"Director Zeng, do you have five days regularly or five days occasionally?"
The speaker was unintentional, but the listener was intentional. Chen Tingye looked at Zeng Yi!
That look seemed to say, Director Zeng, your amputated limb replantation surgery turns out to be more courageous than the rest of us. Can you move around in five days?
Hearing this, Zeng Yi immediately rolled his eyes, was startled, and hurriedly apologized and said with a smile: "Professor Chen, Xiao Zhou may have said something wrong. Our routine here is to start activities after three to five weeks. It's safer. After surgery,
It’s available for a month.”
At the same time, he glanced at Zhou Cheng, but did not dare to glare at him, because Zhou Cheng's operation of suturing the epineurium with his naked eye just now was too embarrassing, so he noticed that Chen Tingye had interrupted the operation and kept looking at Zhou Cheng.
So I asked the circulating nurse to hand the microsurgery glasses to Zhou Chengyong first. He was still suturing the muscles anyway, and he was not so dizzy yet.
When Yang Yifeng heard Zhou Cheng's words, he suddenly realized in his heart. Then when he heard Zeng Yi's words, he gave Zeng Yi a complicated look at the same time——
Actually, Director Zeng, we know that you can speak, but if you don’t understand, can you stop speaking?
We are seriously discussing academic issues, not playing around with you in the system of giving favors, steps, etc...