Start as an Emergency Physician

"Be careful, there's the lateral cutaneous nerve in the forearm, which can be easily damaged. The director of cardiac surgery subconsciously reminded.

It's really that Zhou Yuan's age is too young, and he looks like an intern, and the director of cardiac surgery subconsciously thinks that he is here to supervise.

Zhou Yuan nodded, and carefully cut the deep fascia, just exposing the outer cutaneous nerve of the forearm.

"Teacher, please help me reveal the radial artery underneath. "

Both the radial artery and the radial vein are buried beneath the lateral cutaneous nerve of the forearm.

He Jian nodded, carefully pulled the lateral cutaneous nerve of the forearm and the brachioradialis muscle to the outside, and after pulling it apart, the radial artery and radial vein from the wrist to the elbow fossa were all exposed.

The anterior, middle, and posterior segments of the radial artery have different characteristics, and because the middle segment has fewer perforators and is easier to separate, this segment is often free first in the operation to strip the radial artery.

"Scalpel. "

"Tissue scissors. "

Zhou Yuan's operation was very careful.

There are many companion vessels in the radial artery, and if the surgery is too heavy or slightly deviated, the accompanying vessel will rupture.

In order to ensure that Qian Wei's blood circulation was not hindered as much as possible, Zhou Yuan only blocked the radial artery blood vessels, and once other blood vessels ruptured, it would cause bleeding.

This is also the reason why Zhou Yuan is confident in his technique, others can only block all blood vessels, speeding up the operation to reduce the impact of loss of blood flow in the hand.

After freeing out of the middle of the radial artery, Zhou Yuan traveled the veins and fatty tissues of the radial artery together in the direction of the wrist and elbow.

"Gauze containing papaverine solution. "

At the moment of dissociation, He Jianyi wrapped this section of radial artery tissue with papaverine solution gauze.

Papaverine solution can prevent ischemia caused by vasospasm of the brain, heart and peripheral blood vessels, and spasm of internal organs such as kidney, gallbladder or gastrointestinal tract.

Now Zhou Yuan is most worried about Qian Wei's vasospasm, and the use of papaverine solution can reduce the probability of vasospasm.

The director of cardiac surgery who understood what Zhou Yuan was going to do was stunned.

Everyone knows that papaverine solution prevents vasospasm, but ... There are very few people who can flexibly apply it to each surgery!

His gaze at Zhou Yuan became even more surprised.

Zhou Yuan next to him continued to free the radial artery.

The middle segment has few perforations and preferentially free, while the upper segment is coarse, the lower end has many perforations, and the blood vessels are small, so posterior dissociation is performed.

"Vascular clamps. "

As soon as he took over the vascular clamp, Zhou Yuan suddenly noticed that Qian Wei's fingers jumped.

Zhou Yuan was stunned for a moment, and subconsciously looked at the anesthesiologist.

The anesthesiologist panicked.

What other good things can be seen by the surgeon during the operation?

"The anesthesia is no problem, the patient is completely complete, and all physical indicators are also stable!" the anesthesiologist was frightened and hurriedly said.

Zhou Yuan nodded and looked at it carefully.

"Teacher, you don't need to be too stretched. "

The superficial branch of the radial nerve is on the radial side of the radial artery, and once it is overstretched, it will touch the superficial branch of the radial nerve, and in severe cases, it will even damage the nerve, resulting in complications such as numbness of the back of the hand and fingers after surgery.

He Jianyi was stunned one by one: "I have reduced my strength, and I have overstretched?"

He Jianyi relaxed again, and the radial artery almost merged with the underlying tissue, and it was relieved by excessive stretching.

Zhou Yuandao: "Each patient's situation is different, and Qian Wei's pulling strength must be very small. "

He Jian nodded.

After observing Qian Wei's fingers for a while and confirming that the problem was solved, Zhou Yuan blocked the perforating branch of the radial artery with a vascular clamp.

"Begin to perform dissociation of the upper radial artery. "

Zhou Yuan picked up the scalpel, tissue forceps and so on again, and cut the tissue and skin little by little, expanding the length of the free radial artery little by little.

Soon, the first branch of the radial artery appeared in the upper part of the radial artery.

"That's it. "

Zhou Yuan stopped.

The first branch of the radial artery, the recurrent radial artery, is the terminus of the free upper radial artery.

This artery is also connected to other blood vessels, and it is also relied on to maintain a good compensatory blood supply.

If the recurrent radial artery is gone, blood circulation throughout the arm will be affected.

Zhou Yuan continued to separate the lower radial artery.

These operations are performed on the radial side of the biceps aponeurosis, and on the other side there are important arteries such as the brachial artery, ulnar artery, and median nerve, etc., and a deviation of one millimeter may cause damage to them.

After a while, the radial artery was completely free, and only the last step was left to cut it.

"Perform the improved Allen test. Zhou Yuandao.

It is a method of checking the blood supply to the hand and the anastomosis between the radial and ulnar arteries.

Zhou Yuan must ensure that there are no signs of ischemia in the blood supply area and good collateral circulation before the radial artery can be completely removed.

Zhou Yuan pressed the radial and ulnar arteries with both hands at the same time, blocking the blood supply.

On the other side, He Jianyi assisted the patient who had entered the state of general anesthesia to repeatedly clench his fists vigorously until the palms began to turn white.

This is a sign of ischemia.

Zhou Yuan released the pressure on the ulnar artery and continued to press the radial artery to simulate the blood flow after the radial artery was removed.

Soon, the palm of the hand regained its blood color, indicating that there was good collateral circulation between the radial and ulnar arteries, and even if the radial artery was severed, blood could still be supplied to the palms through collateral circulation.

Zhou Yuan and He Jianyi repeated it twice.

After the same result appeared three times, Zhou Yuan breathed a sigh of relief and said, "If the Allen test is negative, the radial artery can be removed." "

"Perform a double clamp distal to the radial artery. "

He Jianyi did so.

Zhou Yuan cut the radial artery two centimeters at the wrist joint.

At the moment of severance, the radial artery has a segmental spasm due to the effect of tension.

"Inject a heparin solution containing papaverine!" Zhou Yuan said categorically.

The chief of cardiac surgery came up and inserted the needle along the proximal end of the radial artery to deliver a papaverine heparin solution to fill the radial artery.

Soon, under the influence of the drug, the segmental spasms completely disappeared.

"Indigo. "

Indigo is an alkaloid isolated from the traditional Chinese medicine Indigo, which has a strong effect on a variety of bacteria and can also be antiviral.

Of course, Zhou Yuan used it here mainly to mark the radial artery.

After indigo marked the dorsal side of the radial artery that had been wiped dry, Zhou Yuan took the scalpel, cut the radial artery vascular bridge, and handed it to the director of cardiac surgery.

"Director, please measure and record the inner diameter and length of the vascular bridge. "

After speaking, Zhou Yuan glanced at the time, "Time, 14:01." "

Zhou Yuan began to process the surgical incision, and on the other side, the director of cardiac surgery began to record the data of the vascular bridge, which is very important when performing the heart bypass later.

It determines the size of the vascular opening of the coronary artery, the location of the opening, and so on. _

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