Start as an Emergency Physician

Amputation ensures that the toe can be transplanted quickly after amputation, but there is a risk of infection of the stump in the palm. Cutting off the toe first, the stump of the palm can ensure the best condition, but the toe will face the risk of losing vitality and so on.

The choice depends on the patient's condition and the skill level of the surgeon.

Zhou Yuan looked at the patient's heart rate and blood pressure, and said, "Amputation first." "

Zhou Yuan learned a lesson from previous mouse experiments, that too low a temperature will lead to complications such as vasospasm, and once the toe is amputated and waiting for transplantation, the temperature of the toe will gradually become lower.

Even if the activity is well preserved, it will be troublesome to transplant it when the time comes.

"Good. Dean Fang stood next to him and said.

After speaking, Dean Fang suddenly remembered something, and looked at Zhou Yuan with some concern: "Didn't you work the night shift last night, you should only get off work now, can you hold on..."

Zhou Yuan nodded.

He has just finished the medicine, and his energy and physical strength have reached the peak, and it is not a problem to complete a limb replantation operation!

"General anesthesia. Zhou Yuandao.

The anesthesiologist nodded, looked at the heart rate and blood pressure, and after making sure that the patient was in good health, he began to administer anesthesia.

Speaking of which, this severed finger patient is relatively lucky.

In general, in this case, there will be coma and even hemorrhagic shock, but the factory may have had frequent accidents, so the emergency measures were done well, and the bleeding of the severed finger was well stopped, so he persevered in the hospital.

"The room temperature is controlled at about 25 degrees Celsius, and the relative humidity is about 50 percent. Zhou Yuan specially emphasized.

At the same time, he looked at the instruments of the operation.

Although this operation is still a severed limb replantation in the strict sense, there are still some differences because of the need to regenerate fingers, and the instruments are also configured according to Zhou Yuan's needs.

Two sets of surgical microscopic instruments, three conventional debridement kits, two tissue scissors and bends, two straight ones, toothless short forceps, ant-forceps...

While the anesthesiologist anesthetizes the patient, the instrument nurse has already set up the surgical microscope.

"The anesthesia worked. The anesthesiologist's voice rang out.

Zhou Yuan nodded.

"Open two intravenous channels immediately, rehydrate in time, and transfuse blood throughout the operation, which can be used as a substitute for plasma or whole blood!"

"Place the urinary catheter!"

The last step was not required for surgery, so everyone was a little puzzled when Zhou Yuan proposed it.

The urinary catheter is placed to observe the changes in the patient's body.

Finger regeneration is not a minor operation, it can take more than ten hours, during this period, the patient's absorption of drugs and physical function can be judged according to the patient's urine volume, urine color, urine specific gravity, etc.

When the urethral tube entered the bladder and was orange, Zhou Yuan announced the start of the operation.

"Start debridement, disinfection. "

If it is a simple amputation, it can be removed after simple poisoning.

However, this time it is necessary to transplant the toes to the index finger and thumb, so the section must be carefully treated to ensure that the main nerves are fully exposed.

Otherwise, even the nerves and blood vessels can't be found, so how can we talk about transplantation?

"Soapy water, hydrogen peroxide. "

This is the cleaning fluid used for cleaning

Zhou Yuan turned over the patient's palm so that the section was facing down, and carefully washed it with soapy water and hydrogen peroxide.

After the debridement and disinfection were completed, Zhou Yuan began to perform the debridement operation.

The main purpose of this step is to completely remove the damaged severed finger, including the decaying tissue around the severed finger, etc.

Of course, there may still be some blood vessels available in the severed finger, and at this time, the blood vessels need to be separated separately - long blood vessels are easy to expose, and sutures and anastomoses are relatively easy.

"Tissue scissors. "

Zhou Yuan's movements were very steady, he took over the tissue scissors, and cut the severed finger one by one.

There are many tiny blood vessels inside the severed finger, most of which have been broken.

A small number of blood vessels that were still intact and could be connected were carefully marked by Zhou Yuan.

In addition, the axillary and brachial arteries anastomoses at the palm, creating a double layer of superficial and deep palmar arches, which are also due to damage to the thumb and forefinger, requiring forceps to tie the main arteries there.

The superficial palmar arch and the deep palmar arch are two layers of arcuate vascular arches on the deep surface of the skin of the palm, both of which are convex to the distal end, that is, the fingertip.

Among them, the projection of the shallow palm arch is basically the same as the "career line" in the palm print, and the deep palm arch is closer to the wrist, and there are abundant arterial communication branches between them, mainly to ensure that the palm will not be ischemic during various movements of the hand.

Therefore, when removing the residual finger, it is necessary to pay attention not to damage the shallow and deep arch of the palm, otherwise the recovery of the movement ability of the palm will be greatly limited in the later stage.

Then, Zhou Yuan found out the main muscles such as the abductor pollicis brevis muscle, the flexor pollicis brevis muscle, the palmaris pollicis muscle, and the flexor pollicis longus tendon.

These are the muscles that move the thumb and index finger to bend, stretch, etc., and must be connected to the muscles on the toes to drive the toes to move.

Zhou Yuan looked at the microscope, carefully removed the embolized blood vessels and damaged nerves on it, and repaired some smaller arteries and veins as much as possible.

The more blood vessels that can function, the better the ability to recover the transplanted finger and of course, the more functions the transplanted finger can accomplish.

"Needle forceps. "

Zhou Yuan looked at the broken blood vessels in the microscope and sutured them with needles.

"It's done. "

After a long time, Zhou Yuan cut off the last piece of rotten flesh, exposing a major hallux artery, and marking it with silk threads.

At this point, the thumb and index finger on the patient's palm have been completely detached, and the hand bone has also been severed from the human body.

"Zhou Yuan, give me these two fingers, and you can cut off your toes next. Dean Fang happily ran up.

Zhou Yuan nodded.

As a master of hand surgery, it is no problem to take care of the cross-section of two severed fingers.

"Preparing for amputation of toes. "

Comparatively speaking, this step is a bit easier.

The blood vessels in the soles of the feet are tougher and more elastic than in the palms of the hands, and the nerves here are responsible for monitoring the muscles for excessive or inappropriate movements, in addition to communicating the movements of the muscles and transmitting reflexes.

Because the foot is located farthest from the heart and brain, it is one of the organs that is difficult for blood and nerve conduction to reach, so the blood vessels can contract according to the change in the shape of the foot during walking, thus promoting blood circulation, and the nerves here carry more functions.

Zhou Yuan chose to amputate the second and fourth toes of his right foot.

Zhou Yuan also had his own reasons for choosing these two toes. _

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