Start as an Emergency Physician

One of the characteristics of academic speeches is that they are extremely simple, but the summary is very concise, and the whole topic of the speech can be seen from the title.

And this title, "Toe Transplantation and Reconstruction of Fingers and the Basic Perfection of Reconstructed Fingers and the Concept of Finger Modification Reconstruction", anyone with a discerning eye can see that it includes three things.

Everyone knows that toe transplantation recreates fingers, after all, everyone is here for this technology, but... What the hell is the foundation perfection of reconstructed fingers?

We haven't figured out your reinvention finger yet, you've already started perfecting it!

This feels like the experts are just preparing to learn the unary equation, and before they have figured out the concept and solution method, Zhou Yuan directly proposed the second and third solutions to the unary equation!

And the last "finger modification reinvention concept", just by the word concept, experts can see that this is a new field, and it is still in the theoretical stage... It feels like you've got a binary equation when you were on a one-dimensional equation...

"He's... Think we've mastered reinventing fingers?"

"Could it be that he alone has pushed the finger of reinvention to a new stage of development?!"

Some people with a keen sense of smell can't sit still, and their eyes seem to glow.

"Everyone here is here to listen to the reconstructive finger surgery, and there must be a lot of questions about this surgery, so I'll skip the others and talk about the process directly..."

Zhou Yuan pressed the laser pointer, and the ppt turned to the next side.

"First of all, the choice of sufficiency that everyone cares about the most. According to the principle of selection of dominant blood vessels, the second toe of the foot must be selected for the reconstruction of the index finger, the second toe of the foot can be selected for the reconstruction of the middle finger, and the second toe on the same side can be selected for the reconstruction of the ring finger..."

"Debridement of the hand is an ordinary debridement procedure to remove foreign bodies, remove inactive and contaminated tissues, and remove skin tissues that cannot be judged to be alive. In addition, it is necessary to bite the fracture section and clean up the bone fragments of the wound so that it can be transplanted to reconstruct the thumb in the later stage. "

"The flexor and extensor tendons are identified during the cleanup process and marked. Again, the wound was cleaned with dilute iodophor and saline, and this time it had to be done under a microscope!"

The experts were stunned.

Why do I need to do two debridements? And do I need a microscope?

The longer the delay, the lower the success rate of amputated limb replantation, the worse the postoperative healing, and whether the waste of time on debridement will cause inactivation...

Zhou Yuan obviously saw the experts' worries, and said: "Note, pay attention, this is a toe transplant and reconstruct the thumb surgery! That is to say, there is no broken finger waiting for implantation, we will perform the finger first At this time, the toe is still on the patient's body, so there is no need to worry about the broken finger and inactivating the question."

"The surgery of toe graft reconstruction thumb is more demanding than amputated limb replantation, and the use of microscope to remove foreign bodies and contaminated tissues that are invisible to the naked eye, and at the same time can separate and mark the need for tubes and nerves, which is helpful to improve the success rate of surgery. "

John Joe was stunned: "That's the case..."

Kamihara Jing glanced at the gate next to him, and found that his disciple was pondering, and seemed to have his own thoughts, but he didn't stand up and ask questions after all.

Zhou Yuan turned to the next page and said, "After that, it is the preparation for transplantation in the palm." Cut 0.5 to 1 centimeter of skin between the first and second metacarpal bones on the back of the hand - of course, this requires adjusting the incision according to the finger you need to recreate, such as reconstructing the middle finger and ring finger, and choosing to make an incision between the third and fourth metacarpal bones. "

"After cutting the skin on the back of the hand, one or two dorsal palmar veins were freed, marked, and set aside. After that, about one centimeter is incised between the webs of the fingers, and the common artery of the first finger is freed for use, and the propria nerves on both sides of the index finger are freed for marking, and for backup. "

At this moment, the gate unknown stood up, his eyes fiery, "I just want to know how your toes were cut!"

Another difficulty in finger reconstruction surgery is to amputate the toes and expose the blood vessels and nerves.

Normal limbs are protected by various tissues, how did Zhou Yuan remove them, and select blood vessels and nerves for anastomosis?

Dean Fang, Shenyuan Jing, Richard and the others all stared at Zhou Yuan, expecting him to give an answer.

Zhou Yuan smiled and glanced at the unknown son of the gate.

Sure enough, it's a person who doesn't care about anything but healing... It is very rude to stand up and question suddenly on the occasion of a speech.

However, not many people present were disgusted, and they also wanted to know the answer to this question.

"Okay, sit down, and I'm going to talk about the toe cutting. "

Zhou Yuan turned the page, and the dissecting picture of Wang Dong's operation appeared on the screen.

On the bloody toe, a V incision had been encircled, and a scalpel fell on it, carefully cutting.

Zhou Yuan: "Design a small V small S line on the dorsal side of the second toe, which will be conducive to subsequent excision surgery. According to the two design lines, the dorsal foot skin is incised, and an incision of about two centimeters is made from the dorsal side of the metatarsophalangeal joint to the proximal end, and a small V-shaped incision is made at the bottom of the toe. "

"Next, the dorsal tibial digital artery of the second toe is located in the incision between the webs of the first and second toes—this is an important vessel for connection and must be dissociated. Then it is determined that it has entered the body of the toe and the diameter of the tube is greater than 0.5 mm. "

"At the same time, the previous incision is continued, within which the artery propria plantar of the second toe, the artery propria of the plantar of the second toe, the artery of the plantar propria of the second toe, and the branch of communication between the plantar artery propria of the second toe and the common plantar artery of the first toe. These are the main blood vessels we need, and the absence of one will lead to blood supply disorders, affecting the effectiveness of the operation, and even causing the operation to fail. "

"Also, when the dorsal first metatarsal artery or the dorsal tibial digital artery mutates, the arteries I mentioned above can be used as alternative arteries. Sharply separate and cut the propria nerves of both digites, cut the flexor and extensor tendons of the toes according to the tendon defect, and finally cut the toes from the metatarsophalangeal joint capsule. "

Zhou Yuan combined pictures and texts, and explained while pressing the laser pointer.

At this point, the toes except the arteries and veins are completely free. _

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