Start as an Emergency Physician

"Yaga...", the unknown son of the gate was amazed.

People from other countries are also expressing their shock with the beautiful words of their respective countries.

"I mess with Fack. "

"Shet. "

"What a dick!"

"Dick man. "

Zhou Yuan smiled faintly, raised his hand and pressed down, and the venue was quiet again.

"Once the micro-drain has been placed, the tourniquet is released and the removed toe is observed. If the toe body is full, ruddy in color, and the blood circulation is good, the pedicle can be cut off at this time to prepare for the final treatment before transplantation. "

"What if the toes aren't full and the blood supply is poor?" asked Richard.

Zhou Yuan glanced at Richard, who had a big beard and looked like a big man, and said silently: "Then cut another one." "

Can this still be saved?

Moreover, all of you here are experts in hand surgery, and they all have their own achievements in the field of amputated limb replantation, and they don't have thousands of surgeries, at least they have done hundreds of surgeries...

You can't even do a toe removal, and there's no need to come here to learn how to reconstruct a thumb with a toe transplant.

"The next thing is the most important thing – transplantation and reconstruction. "

Zhou Yuan pondered for two seconds before raising his head again and said, "According to the degree of reconstructed finger defects and the difference between fingers, make appropriate trimming of the phalanges. "

At the same time, the flexor and extensor tendon tension is directly adjusted at this stage, so that the suture between the tendons can be directly carried out in the later stage. Use 3/0 tendon sutures to close the flexor and extensor tendons. "

"Next is the anastomosis of the blood vessels. The open digital arteriovenous tract or subcutaneous tunnel was sent to the first finger webbed of the palm and between the first and second metacarpal bones of the dorsum of the hand, respectively, and each blood vessel was anastomosed with 10/0 non-invasive sutures under the microscope. "

The experts were a little overwhelmed.

That's all they were looking forward to – which blood vessels were anastomosed!

The elasticity, thickness, and lumen size vary between blood vessels, making it difficult to select anastomotic vessels.

Zhou Yuan paused for a while, deliberately hanging everyone's appetite.

Seeing the gate, the unknown man couldn't help but get up, so he smiled and said, "The dorsal artery of the first metatarsal bone and the common artery of the first metatarsal side are anastomosed together. The dorsal-metatarsal and dorsal-palmar veins are connected. "

The anastomosis between the common volar artery and the first dorsal artery of the first finger is actually a big difficulty, and normal people will not think of it.

The arterial studies of the hand have been carried out in depth at home and abroad, and most of them have studied the blood supply sources, types, variation and branches of the superficial and deep palmar arches, and there are no detailed reports on the length and relationship of the first common volar artery.

Thus, the common volar artery of the first digitis is easy to omit, but that does not mean that it is not important.

On the contrary, this place is not only very, but also very complicated...

There are 189 branches of the common artery and nerves on the volar side of the first finger near the common artery, of which there are 145 anterograde blood vessels and 44 retrograde blood vessels. The accompanying nerves also reached one hundred and seventy-six...

Therefore, the anastomosis is very simple and seems to be brushed aside, but the cumbersomeness and difficulty are only clear to the surgeon.

Another reason is that after the first common volar artery is dissected, because the common volar nerve and the common volar artery are regularly distributed in a certain area of the palm, it is helpful to find and anastomosis the common volar nerve and the common metacarpal artery during the repair of palm injury dissection, which can reduce the difficulty of surgery.

Of course, the most important thing is that it is suitable for connecting with the dorsal artery of the first metatarsal, both in terms of diameter and function.

It is not difficult to find the common artery on the volar side of the first phalangeal side, along the direction of the first metacarpal bone, deep under the skin and palmoaponeurosis, this blood vessel can be observed in the superficial layer of the metacarpophalangeal muscles, which does not need to be specially explained by Zhou Yuan, everyone will.

Next, the 9/0 wire junction refers to the propria nerve, the propria of the toe. The suture wound is made with a miniature drainage strip on the volar and dorsal incisions. Loosen the tourniquet and observe that reconstitution refers to good blood circulation. After bandaging, the plaster rest of the wrist is fixed. "

After Zhou Yuan finished speaking, he finally made a summary, "When reconstructing different fingers or reconstructing two fingers at the same time, the vascular anastomosis is between the webbing and metacarpal heads of the corresponding palms. "

When this sentence fell, it was like cold water poured into hot oil, and the venue suddenly boiled.

"The vascular anastomosis is between the webbing and metacarpal bones of the corresponding palm?!"

"That's how you summed up the final rule?!"

"The anterograde branch of the common cadar artery of the first digithale and the common volar nerve ride fifty-seven, all anastomosed between the webbing and metacarpal bones of the corresponding palm?"

Zhou Yuan didn't speak again, but stood quietly on the stage, waiting for the experts in the audience to figure it out for themselves.

Kamihara Jing, John Joe and the others had already quickly calculated in their minds, and countless blood vessels seemed to emerge in front of them, slowly fitting together under their control... The circulation of blood then opens up and flows along these anastomosed vessels.

Dean Fang hugged Chu Chu and sat aside.

He had memorized the connections of these blood vessels when he was involved in the operation, and he had witnessed the blood flow through and finally complete the blood circulation.

Maybe Dean Fang is not as good as Shenyuan Jing and the others in terms of simple amputated limb replantation, but at this moment... He is already the first person to recreate his fingers other than Zhou Yuan!

Of course, it does not mean that Dean Fang can succeed, just the first anastomosis of the first metacarpal common artery has nearly 200 small blood vessels, and the difficulty of anastomosis is beyond the imagination of normal people.

After a long time, John Joe was the first to come back to his senses, his face extremely excited.

"How the hell did you come up with it! With so many branches, you're so fit?!"

Kamihara Jing also trembled his hands.

He really wants to have an operation now, to complete the reconstructive finger surgery by himself, but he has long been deprived of the qualification to do surgery, and now he can only be behind the scenes, let alone use a scalpel, it is a violation of the medical profession to help count gauze.

"It's amazing... It's amazing!"

Many white-bearded old men in the venue slapped the table excitedly and looked at Zhou Yuan on the stage in disbelief.

When Zhou Yuan unveiled the way blood vessels and nerves were connected, everything seemed to be clear and simple.

The operation is like this, no one understands until the answer is announced, and after the answer is announced, everyone can instantly understand - of course, if you really want to do this surgery, many technical problems still need their own strength to help.

"Wait... I still have some technical problems!" The gate didn't know how to think for a long time, and finally raised his hand and stood up. _

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