Zhang Fan was the surgeon, with Chen Qiqi as an assistant. The palm replantation operation was performed on a table. The two surgeons sat face to face during the operation. The instrument nurse's instrument truck was parked opposite the patient, so the third doctor was not available. Location is up! What should I do? I can only let Tong Lili stand on Zhang Fan's left hand side. There is no way to put down the stool. If you don't want to go to the surgery, you don't have to do it. If you want to go to the surgery, you have to stand.
Because this operation took a long time, the anesthesiologist chose general anesthesia instead of brachial plexus block after asking Zhang Fan. Surgery, especially orthopedic surgery, attaches great importance to debridement. Complete removal of contaminated and vitalized tissues is the basic principle of surgery, and this debridement is not performed casually.
X-rays must be carefully studied before surgery, and then combined with the specific conditions of the palm to determine the scope of debridement and the length of bone shortening. Because it is a severed surgery, the severed palm is like a flesh-colored rubber doll without any blood. ! Place it on the ground, and if you don’t look carefully, you might be able to see it as the hand of a rubber doll!
Due to the development of surgery, instrument nurses are becoming more and more important. A mature instrument nurse cannot cooperate with surgery skillfully without one or two years of training. Doctors perform surgeries in different disciplines, but instrument nurses do not know how to specialize, so instrument nurses You must be proficient in knowing the terms of all instruments and be proficient in surgical procedures.
Because when a doctor performs an operation, the equipment nurse must prepare the equipment to be used in advance. If you are not familiar with the surgical procedures, you will be unlucky if you encounter a doctor with a bad temper, and you may throw away the surgical equipment~!
The slightly older instrument nurses and desks can tell at a glance how good the doctor is, so the young surgeons deliberately try to please some of the older nurses in the operating room, because if they don't please them, it may spread. What words come.
The debridement of the disconnection surgery must be carried out by two doctors at the same time, so as to save time and gain more time. The debridement must be carried out according to the anatomical levels. During the debridement, the relevant nerves and blood vessels in the relevant layers are searched for the next step. Prepare for one-step surgery.
For this simple debridement, the surgeon must think carefully about the steps, which one to do first and which one to do later. Just like in a war, the formation of troops before the war begins must be clear in their mind.
The most important muscle in the palm is the thenar. This muscle is unique to humans. Gorillas are genetically closest to humans, but these furry animals do not have thenar. This is how much time has passed for human ancestors. Earned by labor. Where is the thenar? It's the lump of muscle connected to the big thumb.
After debriding the muscles, the next step is the bones. Within the palm bones, the most important thing is the metacarpophalangeal joint. This joint must be preserved as intact as possible.
Zhang Fan lowered his head and performed surgery with Lao Chen. Tong Lili's job was to ensure a clear surgical field of vision. In layman's terms, she was the one who pulled the hook to wipe away the blood. Every surgeon comes here like this. They first watch the operation, the so-called third and fourth assistants. They wipe the blood with a retractor and suck the blood with a suction device. They first watch an operation dozens of times and then slowly watch it from the second assistant and the first assistant. Slowly work your way up.
During this period, some doctors gradually distanced themselves from each other. Surgery is a job that combines talent and hard work. Some doctors deliberately train surgical skills after performing operations. For example, if they need to use some endoscopic techniques, they will hold two similar poles and practice them when they go home. One year can make a big difference. This is the difference between working hard and not working hard.
If you pay attention, many surgeons often hold these things in their hands and keep playing with them. They are not just playing with them out of boredom, but maybe they are training some surgical skills.
After debridement, the broken bones must be repaired and fixed first. This is a matter of principle. Only after the bones are fixed can other organs be repaired. If the fracture is not fixed well, if you move it slightly, the newly repaired blood vessels will snap and pop again. broken!
After the fracture is treated, it is time to repair the muscle. If it is a dissection injury, the surgeon most hopes for a cut injury with a sharp instrument, because it is easy to repair. If it is a rolling injury, it is probably very troublesome, and there may not be a chance to repair it. Amputated.
The end of muscle repair is the blood vessels, and Zhang Fan and Chen Qifa began to operate them under the microscope. Large veins should be anastomosed as much as possible, which is a channel to ensure blood return, and artery repair will be decided based on the situation. The radial-ulnar artery is easier to perform end-to-end anastomosis.
Generally, the incidence rate of palmar interruption is the highest, and the survival rate after replantation is also the lowest. This is because of the difficulty in rebuilding blood supply.
When the common digital artery breaks at its distal end where it branches into the two proper digital arteries, this becomes troublesome. The surgeon must design the surgery well, because one common artery can only anastomose with one proper digital artery. If the design is not good, there may be One finger lacks direct blood supply. This then leads to poor terminal circulation, which is particularly likely to cause some sequelae.
In order to restore the function of the hand to its optimal state, in principle, the nerves must be repaired in the first stage. The severed sensory nerves, whether in the carpal tunnel or the palm, should be repaired in the first stage. This is so important.
The operation was carried out slowly, and time passed by little by little. Because it was operated under a microscope, Tong Lili became more and more bored as she watched. She didn't know where Zhang Fan and the others had gone, and she couldn't see clearly what they were doing.
And it has been more than two hours. I was already very tired after a sleepless night shift. Now I have been standing for more than two hours. My calves are sore and my feet are numb. She couldn't hold it any longer, and she was holding on with gritted teeth until now.
Zhang Fan performed the operation fairly quickly. It took him three hours to suture the nerves. The subsequent surgical steps were simple. Zhang Fan and Lao Chen began to communicate, "You should be more careful today and pay more attention to the blood supply in your hands."
"Yes, okay, master." Old Chen nodded.
"Give some antibiotics regularly."
"OK, all right."
"Dr. Tong, what is the biggest complication of this kind of reimplantation surgery?" Zhang Fan wanted to see if Tong Lili was caring, so he asked sharply.
"Hmm! Infection, necrosis?" Tong Lili said a little uncertainly. After more than three hours of standing and the boring post-surgery, she was already in a fuzzy state. Without distracting her attention, she really couldn't stand anymore. When Zhang Fan asked fiercely, she couldn't explain.
"It is a vascular crisis, so patients undergoing this kind of surgery must not smoke or be in a smoking environment. Once a vascular crisis occurs, antispasmodic drugs must be used first. If it is ineffective, a second surgery will be performed!" Zhang Fan explained .
One severed palm and replanted are considered completed and bandaged. Zhang Fan stretched his waist, looked at Tong Lili, who was still standing beside the operating table, and said, "Let's go! It's over."
"My legs are numb! I feel like I can't walk!" Tong Lili said with a hint of crying. It was not because of the numbness in her legs, but because she felt that she could not adapt to this kind of work. Not only was it boring, but the operation time was too long. Long.
She was sad, sad, and blamed herself. To be honest, if she didn't really like microsurgery, it would be really embarrassing for a weak woman to perform such an intensive surgery. Wang Yanan is a special case, because her hobby is her biggest motivation. But Tong Lili is different. She chooses a good department. A department that can avoid being marginalized.
Life is so cruel. I can't adapt to it and can't take it off. I can only let Xian leave. There is no mercy at all, and the hospital is not a place to show mercy!
The nurse helped Tong Lili walk out of the operating room with difficulty. When she stepped out of the operating room, the tears that Tong Lili had been holding on for a long time finally rolled down on the blue mask.
It is better to have hope than despair! Tong Lili can't find the meaning of existing in the operating room! She was really discouraged! My heart hurts like a knife stirring!
.. m.
