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As for why the fourth toe is chosen, it is because the little toe is very inflexible, and it is useless even if it is transplanted, and the middle toe is retained for aesthetics.

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

The second and fourth toes each have two arteries from the deep plantar arch, which extend from the root to the toes and play a major role in blood supply. There is also the plantar artery, which also plays a role in blood supply. The reason why Zhou Yuan chose to use toes to reconstruct fingers, in addition to the roughly similar shapes, is that the distribution of blood vessels and nerves is consistent.

For example, there are deep palmar arches and superficial palmar arches in the palm of the hand. There is a deep plantar arch in the sole of the foot, etc.

""Scalpel."

Zhou Yuan took the scalpel, carefully disinfected the sole of the foot, and cut it while it was not paying attention.

On the side of the dorsum of the foot close to the calf, Zhou Yuan cut open the surface skin, and then clamped the posterior tibial artery here with a vascular clamp.

This is a major artery that supplies blood to the sole of the foot. Blood from many arteries flows between the toes, including the sole of the foot.

If it is not clamped off here, it will cause heavy bleeding when the toe is cut.

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

When it was about to be severed, Zhou Yuan did not directly cut off the internal blood vessels, but marked the plantar artery of the toe with a ribbon. Different blood vessels were marked with ribbons of different colors.

It can be matched with the marked blood vessels on the hand.

Zhou Yuan completed this step very quickly.

After removing the two toes, Zhou Yuan quickly filled the creek with the prepared heparin saline to shorten and fix the bones of the toes.

At this point, the patient's vital signs, limb blood circulation and various test indicators were all normal.

Zhou Yuan breathed a sigh of relief,"Start the finger connection."

After this sentence, Dean Fang, Wu Guohui and others looked serious.

The most critical step in the operation has come...

Cleaning the finger stumps or amputating toes are very common operations, and perhaps an attending physician can do it.

Of course, they can't use a microscope like Zhou Yuan to distinguish each blood vessel and nerve. Even Dean Fang might have a headache. The real difficulty is here, connecting toes with different blood vessels, nerves, and bone structures to fingers.……

"Prepare a temporary intracavitary shunt tube.

This is to prevent blood vessels from rupturing and entering the cavity of the finger during the finger connection process.

"Intramuscular injection of atropine 0.3mg, phenobarbital"

Atropine can relieve smooth muscle spasms, and injection of 0.3mg can cause small blood vessel spasms, improve microcirculation, and inhibit glandular secretion.

In addition, atropine can relieve the inhibition of the vagus nerve on the heart to a certain extent, speed up the heartbeat, excite the respiratory center, and relieve respiratory inhibition.

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

Sodium phenobarbital mainly plays a sedative role.

Zhou Yuan placed the toe on the severed surface, tried to anastomose the blood vessels as much as possible, then put the toe down and temporarily fixed it with a Kirschner wire.

The first step is to reconstruct the blood vessels.

The anastomosis ratio of the blood vessels must reach one-third, otherwise even if the transplanted toe can survive, the recovery of its function will be seriously affected.

Compared with arteries, veins need to be anastomosed more. Anastomosing as many veins as possible can promote the recovery of the limb after surgery.

"Reconstruct the artery first." Zhou Yuan said.

Reconstructing the artery first can restore blood supply as soon as possible, which is helpful for the postoperative recovery of the limb.

He cannot complete this step alone.

Using a microscope, Zhou Yuan can find the blood vessels that need to be anastomosed, but he needs other people 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 should be matched first?"

Zhou Yuan said:"The second toe will be transplanted to the thumb, and the fourth toe will be transplanted to the index finger."

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

This step is easy to describe, but it is difficult to actually do it.

Under the microscope, the slightest tremor will cause the blood vessels to be out of sight, and the position needs to be readjusted before suturing can continue.

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

His expression became more and more terrified.

Under the microscope, Zhou Yuan's sutures were still extremely smooth...

There is superficial fascia on the palm side, and the fat tissue in the superficial fascia is elastic and not easy to suture, but Zhou Yuan just tapped it lightly, and the thread passed through. The subcutaneous fat pad separated by the fiber bundles was also extremely relaxed and was pulled together by the sutures.

The subcutaneous blood vessels, lymphatic vessels, etc., driven by the needle holder, were anastomosed together. Zhou Yuan gently pressed the blood vessels at the moment of anastomosis, and his other hand quickly passed the thread to connect the blood vessels.

"The wound is bleeding." Dean Fang reminded him.

Zhou Yuan nodded and anastomosed the last marked artery.

"Bleeding from the wound is a good thing. Next, we will start to anastomose the veins."

Zhou Yuan asked the nurse to wipe the sweat off his face and closed his eyes.

The light from the shadowless lamp is very bright, and it is easy to fatigue the eyes if you concentrate for a long time, but this is necessary for a good surgical field.

After a while, Zhou Yuan started to sew again.

Bleeding from the fingertips is a good sign, indicating that the anastomosed artery can allow blood to flow through. Next, the veins will be anastomosed so that these blood vessels return to the heart, and blood circulation in the fingers will be established.

The diameter of the veins is larger, so the difficulty of suturing is less than that of the arteries.

There are many ways to anastomose, such as directly performing end-to-end anastomosis, or inserting a thinner section of blood vessels into a large blood vessel for anastomosis, etc.

Ordinary blood vessels are easy to say, it is nothing more than putting Two blood vessels are connected together, and the uncomfortable ones are the reticular blood vessels.

It is difficult to determine which one is the artery and which one is the vein. The characteristics and differences between arteries and veins are clearly explained in the textbooks, but it is very difficult to distinguish them on the human body.

Once the wrong one is made, the venous blood that originally flowed into the heart will run into the artery, which will cause the blood circulation to collapse.

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

Vascular transplantation, plus the knowledge of so many major surgeries, made Zhou Yuan familiar with the characteristics of blood vessels. Some subtle differences were as if they were written"this is a vein" and"this is an artery" in Zhou Yuan's eyes.

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