Start as an Emergency Physician

Relatively speaking, the big toe and the second toe are more flexible, but the big toe has a greater role on the sole of the foot, and the volume of this toe is too large, and it is really unsightly to be used as a transplanted toe, so the second toe is chosen.

As for why the fourth toe was chosen, it is because the little toe is very inflexible and useless even if transplanted, while the middle toe is kept for aesthetic reasons.

There are also many important blood vessels in the soles of the feet, such as dorsalis pedis artery group and plantar artery group.

Both the second and fourth toes have two arteries from the deep arches of the plantar that extend from the root to the toes and play the main role of blood supply. There is also the intrinsic artery of the toe plantus, which also plays a role in supplying blood flow.

The reason why Zhou Yuan chose to use his toes to reconstruct his fingers is that in addition to the general similarity in shape, another important reason is that the distribution of blood vessels and nerves is consistent.

For example, the palm of the hand has a deep palm bow and a shallow palm bow. The soles of the feet have deep arches and so on.

"Scalpel. "

Zhou Yuan took the scalpel, carefully completed the disinfection of the soles of his feet, and took advantage of his inattention to cut it with a knife.

On the side of the dorsum of the foot near the calf, Zhou Yuan cut the superficial layer of skin, and then clamped the posterior tibial artery here with a vascular clamp.

This is the main artery that supplies blood to the soles of the feet, and between the various toes, including the soles of the feet, blood flows from many arteries.

If you don't cut it off, you can bleed profusely when you cut your toes.

After blocking the posterior tibial artery, Zhou Yuan carefully divided it along the joint where the toe and the ball of the foot joined.

When he was about to break off, Zhou Yuan did not directly cut off the internal blood vessels, but used ribbons to mark the plantar arteries of the toes and feet, and different blood vessels used ribbons of different colors.

It can be paired with the marker blood vessels on the hand.

This step was completed very quickly.

After removing the two toes, Zhou Yuan quickly poured the prepared heparin saline into the stream to shorten and immobilize the bones of the toes.

At this point, the patient's vital signs, limb blood vessels and various laboratory indicators are normal.

Zhou Yuan breathed a sigh of relief, "Let's start taking the fingers." "

When these words fell, the faces of Dean Fang, Wu Guohui and the others became serious.

The most critical step in the operation is coming...

Cleaning the stump of a finger or amputating a toe is a very common operation that may be done by a single attending physician.

Of course, they can't use a microscope to distinguish each blood vessel and nerve like Zhou Yuan did. Even Dean Fang might have a headache.

The really difficult thing is here, to connect the toes with different blood vessels, nerves, bone structures to the fingers...

"Prepare a temporary intraluminal shunt. Zhou Yuandao.

This is to prevent blood vessels from rupturing and causing blood to enter the cavity of the finger during finger grafting.

"Intramuscular atropine 0.3 mg, phenobarbital"

Atropine can relieve smooth muscle spasm, and injection of 0.3mg can cause spasm of small blood vessels, improve microcirculation, and inhibit the function of gland secretion.

In addition, atropine can relieve the inhibition of the vagus nerve on the heart to a certain extent, accelerate the heart beat, stimulate the respiratory center, and relieve respiratory depression.

The patient's physical function is temporarily enhanced, which is helpful for receiving the transplanted toe.

Phenobarbital sodium is mainly sedative.

Zhou Yuan placed the toe on the severed surface to make the blood vessels anastomosis as much as possible, and then put the toe down and temporarily fixed it with a K-wire.

The first step is to rebuild the blood vessels.

The proportion of blood vessels must be anastomosed at one-third, otherwise the recovery of the transplanted toe will be severely affected even if it survives.

It is the veins that need to be anastomosed more than the arteries, and anastomoses as many veins as possible can promote the recovery of the limb after surgery.

"Rebuild the arteries first. Zhou Yuan said.

Rebuilding the artery first can restore blood supply as soon as possible and is helpful for postoperative recovery of the limb.

This is a step he can't do alone.

Using a microscope, Zhou Yuan can find the blood vessels that need to be anastomized, but he needs someone else to help fix the position of the blood vessels before he can perform the anastomosis.

Dean Fang also looked at the microscope on the opposite side.

"Which one to match first. "

Zhou Yuandao: "The second toe is transplanted on the thumb, and the fourth toe is transplanted to the index finger. "

"First connect the volar propria artery to the toe plantar propria artery, and then try to connect the structure of the deep plantar arch with the deep palmar arch and the superficial palmar arch. "

It's easy to describe, but it's hard to do.

Under the microscope, the slightest tremor can cause the blood vessel to be removed from view and need to be repositioned to continue suturing.

Dean Fang struggled to fix the blood vessels on both sides, and sweat slowly overflowed all over his body.

His expression grew more and more frightened.

Under the microscope, Zhou Yuan's stitches are still extremely smooth...

There is a superficial fascia on the palm side, and the fatty tissue in the superficial fascia is elastic and not easy to suture, but Zhou Yuan just lightly touched it, and the thread passed through.

The subcutaneous fat pads, which are separated by the fiber bundles, are also extremely easy and are pulled together by the sutures.

The subcutaneous blood vessels, lymphatic vessels, etc., are anastomosed together under the drive of needle forceps, and Zhou Yuan gently presses the blood vessels at the moment of anastomosis, and the other hand quickly crosses the line to connect the blood vessels.

"Bleeding from the wound. Dean Fang reminded.

Zhou Yuan nodded, and finished anastomosing the last artery marked.

"Bleeding from the wound is a good thing, and then the anastomosis begins. "

Zhou Yuan asked the nurse to wipe her sweat and close her eyes.

The light of the shadowless lamp is very bright, and it is easy for the eyes to get tired when you concentrate for a long time, but you have to do it for the sake of a good technique.

After a few moments, Zhou Yuan started stitching again.

Bleeding at the tip of the finger is a good sign that the anastomosed artery has allowed blood to pass through, and then the veins are anastomosed so that the blood vessels are returned to the heart and the blood circulation at the finger is established.

Veins are thicker in diameter, so they are less difficult to suture than arteries.

There are many ways to anastomosis, such as directly performing end-to-end anastomosis, or inserting a certain section of a relatively thin blood vessel into a large blood vessel to carry out a sleeve anastomosis and so on.

Ordinary blood vessels are easy to say, but they are nothing more than connecting two blood vessels together, and the uncomfortable ones are reticular blood vessels.

It is difficult to determine which of these blood vessels is an artery and which is a vein, and the characteristics and differences between arteries and veins are clearly explained in the textbooks.

If the blood in the veins that originally flowed into the heart escapes into the arteries, the blood circulation will collapse.

Under the microscope, Zhou Yuan carefully distinguished the various blood vessels.

Vascular grafting, coupled with so much knowledge of major surgeries, made Zhou Yuan know the characteristics of blood vessels well, and some subtle differences in Zhou Yuan's eyes looked like writing "this is a vein" and "this is an artery". _

Feilu reminds you: there are three things to read - collection, recommendation, and points