Start as an Emergency Physician

Zhou Yuan was still engrossed in the stitching, not noticing Dean Fang's gaze.

"It's done. "

Finally, Zhou Yuan put down the needle holder pliers and let out a long sigh of relief.

The blood vessels and nerves are small, about the size of a human hair, or even smaller. This is the part where suturing is very difficult.

However, it is better than a capillary with only 0.0076 mm.

If the capillaries are sutured, Zhou Yuan can announce the time of death on the spot.

It was about the same diameter as a red blood cell, and it wasn't something that a human could stitch together. The thinnest sutures are thicker than the capillaries.

"Perfect-grade butt seams can't suture capillaries, right?" Zhou Yuan suddenly had this idea in his mind.

However, he quickly shook off the distractions and said, "Continue to perform cross-suturing of muscles and tendons." "

The blood vessels ensure blood circulation, providing nutrients and power to the entire palm. Nerves, on the other hand, ensure that sensations and reflexes can be transmitted everywhere.

To complete the exercise, what is needed is the stretching, flexion and extension of muscle tissue, and so on.

Without muscles, it's like a ghost pressing a bed, feeling and living, but unable to move.

Different muscles have different contact methods, for example, tendons with similar diameters at both ends are directly sutured. Tendons with high tension need to be inserted into the muscle tissue and sutured in the auxiliary connection of the wire.

The incision left by Zhou Yuan when he sutured the nerve before is still there, and it is also for this step.

In order to minimize the injury, Zhou Yuan's incision not only exposed the nerve, but also provided a good surgical field for the current muscle sutures.

Since muscles are subcutaneous tissues, absorbable risks are generally used.

"Dean Fang, help tighten the two proximal ends of the tendons. "

The first step is to suture the proximal end of the tendon.

Dean Fang had experience, took a hemostat, clamped the broken ends of the tendons on both sides, tightened them and anastomosed them together.

The suture of the tendon does not need to be guaranteed to be tension-free, this thing itself has a lot of tension, and any movement will cause muscle contraction, so the sutures used are relatively firm, as long as there is no strenuous exercise, it will generally not rupture.

As for the fingers, there is not much strenuous movement on their own, and the possibility of re-breaking is very small.

"30cm silk thread. Zhou Yuandao.

It's time to start challenging the difficult sutures again.

Muscle suturing is not the same as nerve suturing, if it is intermittently sutured, it is time-consuming and laborious, and there are too many sutures to suture, which will cause muscle activity

Therefore, continuous seam stitching is the best way. Of course, the technique is tested.

Because the muscles are changing at any time, the person has lost consciousness, and as long as the muscles are still alive, they will twitch twice from time to time, just like a dead fish that has been patted on the head.

Zhou Yuan inserted two slender pointers on the filament thread, and then, 1.5 cm away from the severed end of the tendon, penetrated the tendon horizontally, so that the silk thread was of equal length on both sides.

Then, Zhou Yuan was close to the place where the needle had just been inserted, and the needle was inserted again next to it, diagonally crossing the tendon diagonally towards the severed end of the tendon and symmetrically, repeatedly crossing the needle for a total of three times, and finally threading the needle 3 mm on the proximal side of the tendon tightened by the hemostat.

"Scalpel. "

Zhou Yuan held the two slender pointers in one hand, and with the other hand, the scalpel cut the tendon along the proximal part of the hemostat.

"Dean Fang, please flip the hemostat. "

Dean Fang held the hemostat in his right hand and twisted it to the side, and after flipping it, the section of the tendon was revealed.

Now that the upper tendon has been sutured, it's time to close the tendon below the proximal end.

This time the suture was the same as the previous operation, and finally, after Zhou Yuan had multiple cross-sutures, he threaded the needle again 3 mm proximal to the hemostat, which happened to be symmetrically distributed with the suture line above.

There is no way to avoid the fact that some of the tendons are redundant at the sutures, and in order to ensure the quality of the tendon sutures, the two parts of the tendon must be crossed a little.

After all, tendon coincidence can increase the strength of the tendon, but if the tendon is missing, the pressure on the entire tendon will become great, and it may collapse if it is under undue pressure.

After removing the excess tendon, Zhou Yuan tightened the sutures and completed the proximal tendon suture.

Next, the distal end of the tendon is sutured. "

The first steps were similar, Dean Fang clamped the broken end with a hemostat, tightened the tendons on both sides, and some of them overlapped.

Zhou Yuan did not suture directly, but picked up a scalpel, cut off a part of the tendon along the inner surface of the hemostat, and then flipped the hemostat to expose the section.

Zhou Yuan looked at the tendon that had been sutured proximal and adjusted the tendon axis. The purpose of removing the tendon is to ensure that the axis of the distal tendon is consistent with the proximal end, so that the tendon will be evenly stressed.

After adjusting the tendon axis, Zhou Yuan crossed the needle diagonally at the position corresponding to the suture point of the distal section and the proximal section, and led the suture at a distance of 3 mm from the distal surface.

In the same way, Zhou Yuan performed three consecutive oblique cross symmetrical sutures at the distal tendon, and finally penetrated the tendon, pulled out the sutures, and inserted the needle with the other hand again, along the needle entry of the previous needle.

After completing the distal suture, Zhou Yuan picked up the scalpel again and removed the excess tendon at the distal anastomosis.

In the suture of the proximal tendon and the suture of the distal tendon, Zhou Yuan did not knot the sutures, at this time, Zhou Yuan pulled up a suture, pressed the distal tendon with the other hand, and straightened the curled sutures with a little force to eliminate the relaxation of the sutures in the tendon and affect the movement of the muscles.

On the other side, the proximal segment of Zhou Yuan also tightened the sutures, so that the severed surface of the palm was tightly connected with the tendon of the toe.

After finishing the work, Zhou Yuan began to tie the sutures.

Zhou Yuan picked up the needle forceps, tied the two sutures coming out next to each other, and then flipped the knots so that they fell into the surface of the tendon.

Dean Fang was silent.

Even the details are handled so well...

Generally speaking, in such a high-intensity precision surgery, after completing an extremely difficult operation, the surgeon's mood will be relaxed, resulting in the omission of some inconspicuous details.

This is human nature, and even Dean Fang sometimes forgets it.

At this time, Dean Fang was just a fixer, so he was able to observe and think carefully, and Zhou Yuan's attention was all on the operation of his hands, how could he still think about other things...

In other words, Zhou Yuan pressed the knot into the surface of the tendon, which was a subconscious act!_

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