Rogelini's situation is indeed a blessing in misfortune, and the odds are very low.
His luck in being able to make it to the operating table alive was better than that of most people with cardiac firearm injuries. While the bullet grazed the heart and entered the back, it only caused tangential injuries to the heart and did not cause damage to other important anatomical structures behind the heart. This made him one of the truly lucky ones.
The anatomical structure behind the heart has no fuel-efficient lamp other than the lungs when facing firearm injuries. Whether it is the aorta or esophagus, repairing it is very troublesome.
The esophagus may be better, as it is located close to the heart. After expanding the incision and then lifting the apex of the heart, it can be seen with a little separation of the soft tissue, and there is still room for operation. However, the thoracic aorta is much deeper. Once it is hit by a bullet, it is difficult to block it with just fingers, and the difficulty of treatment increases exponentially [1].
Of course, there are many injured soldiers in Austria every day. Although such a situation is rare, as long as the sample is large enough, there will always be a few "Rogelini". However, it is impossible to mass-produce the surgeons needed to cure these "Rogerini", at least in a short period of time, there is only one surgeon.
There were many people standing around the operating table. The voices that were negative about heart surgery had long since dissipated, leaving only endless curiosity.
Unfortunately, the surgical window on Rogelini’s left chest was limited. After being observed by the four people operating the surgery, it has become very narrow and cannot accommodate too much sight.
This means that only the few people standing at the front can really see the operation clearly. If others want to see the picture clearly, in addition to being tall enough, they must also have a pair of good eyes and a good observation angle.
This includes Bill Rotter, who just banned heart surgery.
He never denied the feasibility of heart surgery because he himself had tried it on animals and the success rate was low, but not zero. He had done this type of experiment himself and knew that the success rate of surgery was low, so he questioned the necessity and safety of cardiac surgery.
In the inherent understanding of most surgeons, extremely high-risk cardiac surgery is the limit of surgery. No method can overcome this difficulty, just like Massimov originally believed that abdominal surgery was the limit of surgery.
Just a few years ago at the Paris Surgical Congress, Billroth and several surgeons set the tone for cardiac surgery. These contents are still echoing in his mind to this day...[2]
"Teacher Billrot..."
Billroth stared at the open surgical incision: "Don't look at me, I don't agree with heart surgery."
"Even if Rogerini is successfully treated by me, you don't agree?"
"That means his cardiac trauma is not serious and he can still survive with conservative treatment."
Kawei smiled and explained: "Without blood pressure and heart rate values, it is indeed difficult to judge the severity of his injury by just looking at the symptoms. But his vital signs are not stable, and there is a trend of further deterioration. To be honest, the pericardium There are so many blood clots in the cavity and the blood is constantly leaking out. If it were delayed for half an hour, it might be too late."
Bill Rotter is very stubborn, so stubborn that he still refuses to admit Carvey's "On Microorganisms". ….
But surgery is different. The surgical scene and anatomical structure are much more intuitive than microorganisms. Coupled with the vital sign values that should not have appeared in 1866, the definition of shock, and the anomaly Kawei, these are all causing Billrot's perception to change.
Although he would not admit it, in the past half hour, his belief and understanding of surgery had been shattered once again. Bill Rotter was no stranger to this wonderful experience that completely subverted his cognition, because he had already experienced it four months ago on the surgical stand in Michelplatz.
As for how long it will take to put it back together again, it depends on whether the operation can really be completed and how Rogelini recovers after the operation.
In Vienna, Billroth could still suppress Kavi with his title of vice president, but now Kavi doesn't care about his opinion. He had the final say in the fortress hospital. The thoracotomy operation went smoothly and the effect was obvious. There was no need to stop.
He dropped the lead slug into the bend,
Asked: "Blood pressure and heart rate?"
"90/48, 127."
"It seems our great Imperial soldiers are recovering."
Kawei looked at the dazzling array of glass bottles on the IV stand and slightly reduced the dripping speed of the posterior pituitary gland extract: "The bullet decelerated significantly after penetrating his left upper arm, so the injection position was not deep and there was no sign of explosion. . Now that the bullet has been removed, the operation can be completed by simply suturing the heart and placing a drainage tube."
"It's crazy that I actually have to do stitches!"
"It's unbelievable. It's so difficult to sew on such a heart."
"Can this really be done?"
People around him made various exclamations. Who would have thought that cardiac trauma, which was originally outside of surgical operations, would become a surgical treatment item in the blink of an eye.
Unlike Billroth, who worked in big cities, many surgeons did not come from civilized and elegant Vienna. The Austrians they came into contact with often chose daggers or table knives when quarreling, with the heart being the key target.
"If cardiac trauma could be successfully treated, many people might not die."
"This is truly an indescribable day, so magical..."
This is what Kawei wants, but suturing the heart is not easy. At least he can't let Lucius do it now: "Doctor Lucius, let's switch hands and let me seal the rupture."
Lucius was highly concentrated, and his fingers kept feeling the rapid beating of his heart. He had previously questioned the rationality and feasibility of opening a thoracotomy and suturing the heart, but now that the surgeon's professional pursuits had occupied all his brain nerves, these were no longer a problem.
So exciting!
It’s so exciting!
I don’t want to let go, I really don’t want to let go! If he could, he would just press the crack and keep pressing it.
After all, the heart is not an abdominal organ. It can stay in its original position and let the doctor handle it. The heart in a living person is beating all the time, especially those with ruptured hearts. The number of beats must exceed 100. The frequency is so high that it has a great impact on surgical operations. It goes without saying that it can be felt with just two eyes.
A cold corpse cannot reproduce the beating of the heart, and it is impossible to feel the beating of the heart on a corpse. There was no extracorporeal circulation in the 19th century. If you wanted to learn how to suture the heart, apart from extensive use of animal experiments, you could only practice repeatedly on the operating table. ….
For Lucius and the majority of surgeons accompanying the army, there was no chance of contact with animals, only wounded soldiers.
In fact, even when he returned to Grants, he didn't have much spare money to keep buying live animals for experiments on heart repair.
If they want to gain experience, they need to directly perform heart repair surgery, but they have no experience in heart repair. Only by handing over the surgery to Kawei can the wounded soldiers survive, so this will be an endless cycle in a short period of time.
Nowadays, any operation that touches a beating heart is a valuable experience and an important process of accumulating experience. I don’t know if I will have to wait until the next time I encounter heart repair surgery...
"Doctor Lucius, Doctor Lucius!" Kawei interrupted his thoughts, "I know it feels very interesting to press on the heart, but for Rogelini's health, I have to suture the rupture as soon as possible. OK."
Lucius finally came to his senses: "Um, I'm sorry..."
The rhythm of exchanging fingers this time was very fast, and the proficiency gained by Kawei’s years of emergency care training was beyond their reach: “Sarson continued to stare at the incision of the xiphoid process, and Goram rinsed the surface of the heart with warm saline. "
"good."
"Lucius, use your fingers to help bring the two sides of the heart tear together, just like I did just now." Kawei waved to the nurse in the distance, "Give me the needle holder and needle and thread, just use Just the chrome cotton thread used to sew muscles together.”
The heart is very important, but the tissue structure is still mainly muscle. Apart from the need to get used to the beating of the heart, there is nothing special about the suture itself.
The only thing that needs to be taken care of are the blood vessels that supply the blood to the heart, which is
coronary arteries.
The heart provides blood supply to the whole body and is also responsible for its own blood supply. The coronary artery is different from other organs and blood vessels in that its course floats on the surface of the heart. If the heart rupture touches or is close to the coronary artery, the difficulty of suturing is different. 【3】
This is also the main reason why Kawei needs to flush the heart with saline. He needs to remove the blood stains on the surface and expose these coronary arteries as much as possible.
The result was pretty good. The tangential injury above the apex of the heart rubbed the distal edge of the left anterior descending artery and did not damage the blood vessel. However, the wound is very close to the blood vessel, so special care is needed to suture it.
"Heart suturing is not that simple." Bill Rotter suddenly asked, "How are you going to handle suturing? Do you just use needles and threads? If you really want to do this, I advise you to give up as soon as possible..."
Kavi knew what he meant: "Of course, no."
"Oh? Do you have any good ideas?"
The success rate of Billroth's heart suturing experiment was not high. Firstly, the beating of the heart brought great difficulties to the suturing, and secondly, the suturing itself would cause damage.
In the 19th century, the operation time was short and it was difficult to deal with massive bleeding due to cardiac trauma, so the operation was very rough. However, surgery in the 21st century has already solved this problem. Kawei called Sarson, who had been helping to look at the incision under the xiphoid process: "You and Golam, take the surgical scissors, open the incision under the xiphoid process, and take out some pericardium."
The two were confused and didn't know the reason for doing this.
"You want to use the pericardium to cover the wound?" Lucius was more experienced than them, and seemed to understand the role of the pericardium. "This may be easier to prevent blood from leaking out, and it will also be more conducive to repair."…
"No, the suture repair of the myocardium can completely block the blood."
Billroth realized Carvey's true purpose: "Do you want to use the pericardium to block the sutures and cut the heart?" [4]
Kawei smiled: "The teacher is right. The heart is beating constantly, and the sutures need to withstand a certain amount of tension. It is easy to damage the tissue at the suture site. After all, it is the heart. If there is a problem with the suture site itself, what will happen after the operation?" It is very likely that we will win the second rupture.”
"Using the pericardium as a gasket..." Bill Rotter had never thought of this method, "Is it really possible?"
"It's feasible. I've tried it on animals (actually I haven't)." Kawei said, "The experiment has been done." Hu got over, "After you cut off the pericardium, cut it into small squares of 0.3*0.3. I They need to be padded over the seams.”
The pericardium itself is not soft and needs to be flattened, sandwiched between gauze, soaked in carbolic acid for five minutes, and then rinsed three times with saline before use.
And then threading them into the sutures piece by piece was also a delicate job, which took several assistants a lot of time.
"We perform interrupted mattress sutures of full-thickness myocardium." Kawei carefully held the needle holder in his hand, and with the help of Lucius to close the rupture, he slowly moved his fingers downward, exposing one end of the rupture. The distance between the mouth should not be too close or too far, and the surrounding coronary arteries should also be taken into consideration..."
The tip of the suture needle penetrated the surface of the heart as the heart beat, passed over the underlying myocardium, and penetrated into the muscle on the other side of the tear. Lucius's skills were very good. Knowing that Kawei didn't have an auxiliary left hand, he immediately pressed the pliers against the heart to help the needle tip penetrate the muscle.
Kawei's left index finger needed to stabilize the tear while his right hand was suturing, so he had to leave the suture to Ichisuke: "You do the suturing."
Lucius knew that this was his opportunity to practice.
He gently leaned the sterilized gasket against the wall of the heart, relaxed his hands, and followed the rhythmic beating of the heart, entwined the two sutures together, tightened them, entangled them again, and tightened them again: "One knot... ...Two knots...Three knots, done.”
Carvey looked closely at the surgical knot, which was beautifully done.
He quickly moved his finger downwards, revealing the middle of the crack: "Strike while the iron is hot, continue..."
The surgery started with the wrong incision and was completed in just an hour. compared to
The abdominal surgery started in three hours, and the intensity and difficulty of cardiac repair were very high. This time seemed unreal.
Rogelini got rid of the crisis caused by cardiac tamponade on the day he was admitted to the hospital.
"The suturing is good." Kawei looked at the three surgical knots on the surface of the heart, praised it, and continued, "Get some saline and rinse it to see if there are any other ruptured wounds."
The next step was simple finishing work. Kawei listened to the vital signs three times and checked the stock of the drugs used. After making sure that Rogelini was fine, he got off the operating table.
"The heart repair is completed and the operation is over."
He took off the leather skirt and gloves in front of him and walked towards the door of the operating room: "Don't look, the rest is just suturing the muscles and skin. If you are okay, you can follow me now. While there is still time in the morning, we It’s a good time to review this surgery.”
96.
West wind
