Back to the time after Mendelstein had just left the operating room.
He did not expect that he could also contribute to this operation. Although this method of "contribution" was once again beyond his understanding like the tracheotomy just now, he was still willing to follow Kawei's request. Do.
"Captain, how is Craig?" A Prussian soldier asked anxiously when he saw Mendelstein walking out of the operating room.
"The situation is not good, they are still operating."
"Just let them operate like this?" The soldier was also doubting the identity of these people, "What if..."
Mendelstein shook his head slightly and winked at him. The direction in which his eyes turned was towards a doctor who accompanied him: "I believe in Dr. Kawei's professional ethics and his ability. Now Craig The situation is not good and the surgery needs our help.”
The soldier quickly understood what he meant: "How can I help?"
"It's very simple, just draw some blood." The doctor held two glass bottles in one hand and a rubber tube and syringe in the other. He walked forward with a smile and said to them in standard German, "Everyone has to draw some blood." a little, and then determine who can give this patient a blood transfusion."
It was another term that he had never heard of or seen before. Mendelstein even began to worry whether Prussia's surgical medicine had fallen far behind other European countries.
"What does blood transfusion mean?"
"Craig, is that your name?" the doctor continued to explain to them, "Craig had a blood vessel that was interrupted by a bullet and the bleeding was very serious, so he needs to be transfused with some blood."
"Isn't it usually bloodletting? Why did it become a blood transfusion?"
The doctor smiled: "The treatment method is not absolute. It depends on the situation. Because there are many types of blood, the same type of blood can be injected into his body, so I need to collect your blood for matching."
For the soldiers of the reconnaissance company who often lick blood from the tip of a knife on the front line, the blood collection itself is neither painful nor itchy. What really makes them nervous is the true identity of these doctors.
"Are you also a student of Dr. Kino?"
"Yes, that's right."
"Italian too?"
"Yes, we are both doctors at the Central Hospital of Florence, Italy."
"With your pure German, I almost thought you were Austrian."
Mendelstein mentioned it suddenly and watched his reaction. Unexpectedly, the other party was not surprised, but smiled even more happily: "My mother taught me German. She is Prussian, and my father is Florentine."
"Oh, by the way, I haven't introduced myself yet." At this point, he changed back to Italian: "My name is Bottini."
This was the only doctor in the room who was truly from Italy, and he spoke more natural Italian than the Latin others used. Of course, the other party doesn't understand Italian at all, as long as he can speak a few sentences and add an Italian accent to the German.
The entire camouflage operation was initiated by Kavi, and it was no longer the combat experience of the escort, but the identity of the doctor and the advantage of mastering multiple languages. After all, French and Latin are both languages that doctors must learn.
The convoy soldiers and nurses pretended to be locals here and stayed here on the grounds that they had no horses and were sick.
Kawei also paid attention to diseases, but did not use cholera and the Black Death. Because the former needs to go to the toilet all the time, while the latter is too contagious and pathogenic. It is impossible for more than ten people to die from the Black Death. Even considering the contagiousness, these Prussian soldiers might directly choose "humane destruction".
After much deliberation, Kawei chose tuberculosis, which was better disguised and only required him to lie in bed and cough.
If it weren't for the fact that the research on tuberculosis was almost zero, no one would know how tuberculosis bacteria are transmitted, and perhaps even questioning would be avoided. Fortunately, the people in the escort team are experienced, and the nurses who were selected by Kawei are also smart people. After several rounds of questioning, no flaws were revealed.
But it is not easy to completely deceive the other party, especially this kind of group deception, and the preparation time is extremely limited. It is almost impossible to achieve perfection.
Considering that Mendelstein had always suspected that the phlebotomist faced all the soldiers, he would definitely become a loser, and the person who could easily pass the test was none other than Bottini.
Things were just as Carvey thought. After hearing his Italian, Mendelstein immediately gave up asking: "Do you think the operation can be successful? Can Craig survive it?"
"The operation is difficult, but I believe in Kawei..." Bottini habitually mentioned Kawei's name first, and then immediately added, "...and Teacher Chino's skills, They are the strongest surgeons in our hospital."
Mendelstein had seen too many soldiers who died tragically due to thigh injuries, and he was still unsure: "Will he survive?"
Bottini held the syringe in his hand and said, "It depends on whether you have enough blood."
...
Blood vessels are a network of hollow tubes throughout the body, and vascular surgery is like a plumber.
In the early days, due to theoretical deficiencies in materials and blood flow, vascular surgery focused on detecting leaks, filling gaps, and repairing duct deformities, mainly dealing with trauma, hemangioma, and varicose veins of the lower limbs.
As the understanding of blood gradually increases, thrombosis has become a new topic in vascular surgery.
From the early treatment of varicose veins, vascular repair in the late 19th century, and hemangioma bomb removal in the early 20th century, to thromboendarterectomy to treat peripheral arteriosclerosis obliterans in 1946, and then to the use of catheters to dilate stenotic femoral arteries to create blood vessels in 1965 Endovascular technology, followed by balloons, stents, autologous vascular transplantation, artificial blood vessels...
Vascular surgery is to modern medicine what blood is to the body. Although it cannot be seen on the hospital department list, let alone wards, it has long been integrated into various surgical departments.
Science continues to advance, allowing vascular surgery to extend into various branches, and the innovative thinking and methods of surgeons can allow these branches to display unexpected brilliance.
At this time, the church was actively collecting blood to match blood types, while a very new thing was being tried in the confessional.
"The femoral vein defect exceeds 8cm..." Kawei measured the distance with a ruler again, "Lengthen the incision to 20cm. I want to take more of the great saphenous vein and double it!"
"Double?"
Berget was too inexperienced, Herman was experienced but had very little understanding of blood vessels, and the others around the operating table were even less able to keep up with Kawei's ideas. The only person at the scene who saw his intention was Yingenatz, who was standing at the first aid position.
In fact, he wasn't sure, because the operation that came to his mind was too difficult.
"Are you going to join the two blood vessels together?"
"Teacher Yingenatz is still amazing." Kawei's approach is extremely rare even in modern surgery. Yingenatz's ability to guess is enough to prove that he also has talent in this area. "The blood vessel diameter is not enough, then Enlarge its diameter. If one is not enough, use two."
"Expand the diameter of the tube? Two?"
Herman seemed to have reacted. He raised his empty fists and used them as cross sections of two blood vessels. His fingers slowly separated to form two semicircles, and then the fingertips of both hands came together. The original two semicircles merged into a larger circle: "Are you going to cut open the blood vessels and sew their sides together?"
"right."
Kawei cut the skin and muscles downward, made an irregular and slightly oblique incision, and used a retractor to expose the great saphenous vein running beside the knee: "Don't talk about this now, separate the great saphenous vein as soon as possible Come out, the ischemia time is not short." [1]
The great saphenous vein has many advantages. It is straight enough in shape and long enough in distance. It can be easily accessed and used. This makes it the first choice for autologous transplantation in vascular surgery [2]. But there are many disadvantages, such as small diameter, unique valves of veins, and many branches.
In addition, the length required for this autologous transplant is nearly 20cm. In addition to cutting off the branches, we also need to separate the surrounding tissues, remove the valves in the lumen, and remove the blood vessels. The technique is not difficult, but it is time-consuming.
The group of four carefully separated the great saphenous vein from the distal end to the proximal end of the lower limb. Unlike coronary artery bypass grafting, Kawei wanted to merge the blood vessels and cavities, and the surrounding tissue must be separated cleanly without any residue [3].
Otherwise, there will definitely be misalignment during the combined suturing, and there will be blood leakage during the suturing, which will be more than worth the gain.
While separating the surrounding tissue, they cut and ligated any small branches. Free the entire great saphenous vein, then use hemostatic forceps to control the upper and lower ends, and cut out a spare blood vessel about 20cm long.
Kawei tried his best to increase the speed, but the quality of the equipment was not enough, the number of branches was too large, and the assistants were not yet skilled in the operation, so the dissociation process that originally only took 20 minutes was extended to 45 minutes.
Amol's second anesthesia has worn off, and time is passing quickly.
"Beget, as before, put the blood vessel into the normal saline, add a little sodium citrate, and clean it." Kawei gave him the blood vessel and changed his hands to perform the femoral artery and vein anastomosis, "Teacher and I Connect the femoral arteries first, and even if the backflow is not smooth, it will be temporary, and at least it can now get enough blood to its lower limbs."
At this moment, Bottini walked into the operating room with two bottles of whole blood: "I got the blood. There are five people with matching blood types. I got 1000ml first."
"Hang it up."
"How are you doing?"
"Young people are strong and can hold on."
"What about the blood supply of the lower limbs?"
"Still making preparations." After checking that there was no valve in this section of the femoral vein, Kawei placed it into the defect of the femoral artery, and then gave his seat to Bottini, "The length and diameter are very good, you can directly Sew it up.”
It is not difficult to anastomose such a large blood vessel. As long as the suturing method is mastered, a doctor with a profound surgical foundation like Yingenatz can complete this operation well. Bottini's skills were not bad either, and he had proven himself in the four months before the war, otherwise Kawi would not have kept him by his side.
During the time when he was giving up his position as the surgeon, Kawei was not idle either. He needed to help Bergt deal with the great saphenous vein.
Compared with the femoral vein that was less than 5cm just now, the difficulty of treating this great saphenous vein has suddenly increased. It cannot be solved by flushing with normal saline alone.
The first thing to do is to use scissors to further clean the tissue around the lumen, then put the blood vessel on clean gauze, use a syringe to inject saline into it, and check whether there is any leakage at the disconnected and ligated locations of the surrounding branches.
"Pinch that end with your hands." Kawei sucked in the saline solution with sodium citrate to completely inflate the blood vessels. "Very good, there is no leakage from the sutures."
"What to do next?"
"Give me the silk thread and blood vessel suture needle, and then go look for it in my box. There should be a magnifying glass." Kawei looked at the blood vessel repeatedly. After finding no problem, he picked up the scissors and divided the blood vessel into two, and then Cut open the lumen lengthwise, "Hold the mirror later, I have to prepare the two-in-one vein first."
The diameter of the great saphenous vein is only 3 mm. The silk thread and suture needles are specially customized and can be used barely. However, Kawei's naked eye vision is limited and it is difficult to be precise.
Modern surgery has the help of microscopes, but in the 19th century, crude magnifying glasses could only be used as a substitute. Thanks to Kawei's excellent technology, two great saphenous veins with a diameter of 3mm were merged on the side to become a femoral vein substitute with a diameter of 8mm.
"We're done here," Yingenatz said. "The arteries are unblocked and you can feel the pulse on the instep."
"good!"
Kawei continued to infuse the newly made blood vessels with normal saline as he had just done: "Don't leak, don't leak... Just do it, it should work."
The suturing of the side of the blood vessel is not the anastomosis of the tube orifice. The quality of the suture needle and thread in Kawei's hand is not high, so there will definitely be a gap in sealing. Now we are only transplanting the femoral vein. Venous blood is much easier to deal with than arterial blood, as long as the leakage of normal saline is not obvious.
"Can we continue the anastomosis?"
"Yes, first cut the severed end of the femoral vein and peel off the outer membrane." Kawei carefully drained the saline and then placed the carefully made brand new blood vessel on the operating table. "The diameter is only smaller than that of the femoral vein." It’s a little smaller, but I removed the valve inside, so it’s not a big problem.”
Ingnatz, Hermann and Bottini all stared at the blood vessel: "It's so delicate..."
"how did you do that?"
"Rely on the magnifying glass." Kawei said, "When I return to Vienna in the future, vascular surgery will definitely be necessary. I have to move the microscope into the operating room."
"The sides are all sutured, is that really possible?"
"Don't worry, I tried it just now and the leakage is not obvious." Kawei said, "The flow rate of venous blood is slow and the viscosity is higher than that of water. Even if it does leak, it will soon be blocked by blood clots. ,,,,,"
He knew very well that such an operation would require very high postoperative requirements. With the current shortage of doctors and medicines, there was still a big question mark as to whether it could really be successful.
But the matter has come to this, and the time for anesthesia is coming soon. Kawei has no other choice: "Needle and thread, let's make an anastomosis!"
