"Start!" Liu Yaowen said dullly. Because your hands are so contaminated, you need to disinfect them first. There can be no problems with this kind of surgery from the beginning, especially the disinfection, because it requires skin grafting, and if there is an infection, the transplanted skin may rot and become necrotic. So disinfection here is so important.
Zhang Fan, wearing gloves and using a brush, kept brushing soapy water on Wang Laosan's hands. The bloody water was accompanied by black engine oil, and the soap foam was all flowery, colorful under the shadowless lamp.
"Povidone iodine!" After cleaning with soapy water, they started disinfecting with iodophor. The nails on Wang Laosan's index and middle fingers were also peeled off. After disinfection, the subcutaneous tissue can be seen very clearly. Some of the white tendons have been broken, and some have been cut in half. The thin parts of the skin are directly bone.
"Baoyin, cut the remaining nails shorter as well." Zhang Fan told Baoyin.
"Okay." Sometimes, the job of a nurse is really difficult. If you don’t say it, you can’t let the world understand it.
In the past half month, Zhang Fan's surgeries, especially those involving general surgery, have steadily increased. But when it comes to surgery, I don’t have much idea when I do it.
But after the operation, Zhang Fan felt a little awkward looking at the system's operation progress. How should I put it, I don’t want to have more surgeries, it seems a bit like duplicity, I want to have more surgeries, but I feel like I can’t bear it, it’s really awkward.
But when it came to the surgery, although Zhang Fan was not overjoyed, he was still very excited, as if all the cells in his body were excited. This surgery is the same as fitness. Even if Zhang Fan loses his system, he will still be so excited because this thing is actually addictive.
Skin grafting surgery, especially on the hands, is very demanding. First of all, you should choose wear-resistant skin, because your hands move too much, and if your skin is thin, it will be worn out after just three or two strokes. And the functionality of the fingers must be ensured.
"Doctor Lu, prepare the skinning knife. Baoyin, come and share the sheets with us."
"Okay." Both girls replied at the same time. Zhang Fan and Baoyin laid out the sheets, while Lu Shuyan prepared the skinning knife. This skinning knife, let alone skinning, can ooze in your hand.
This thing seems to be born with an evil spirit. The simplest one is to hold the blade between two iron bars. One end of the iron bar is a rocker, shining with cold light. It is very sharp and close to the skin. Just shake it with your hand and the skin will be thinned directly. You can make the skin as thick or thin as you want.
"Let's begin." Zhang Fan and Lu Shuyan sat down face to face, luckily it was their hands. If their feet were such a narrow place, Zhang Fan and Lu Shuyan would probably have to kneel down for the surgery.
"Doctor Zhang, come here and let me put a piece of gauze on you." The circulating nurse said and gently placed a piece of gauze on Zhang Fan's forehead. The surgical cart is still a small space and the temperature adjustment is slow.
The skin of Wang Laosan's two fingers was damaged. The other fingers suffered intermittent injuries, and the index and middle fingers were directly scratched by the wheel.
"The middle finger can't be saved." Zhang Fan said softly to himself while gently pulling at the muscles with tweezers to detect the damage.
"Aren't the bones intact?" Lu Shuyan asked in confusion. During this period of time, she had been trained by Zhang Fan, and her kung fu had also improved a lot. The girl now has no idea whether she is evil or not, but she already respects Zhang Fan very much.
"The bones are intact and good, but look at this muscle. It's a direct combination of burns and crushing injuries. It's a typical injury. The central tendon bundle and lateral bundles are completely damaged." Zhang Fan kept pointing with tweezers. The injured area was explained to Lu Shuyan.
This finger, the most classic thing about human fingers is the muscles surrounding the finger. beautiful. If you look at a fresh autopsy, the muscles in other parts of the body are not that interesting. Pigs, horses, cattle, sheep, and humans are all about the same. It’s just that one has more and the other has less.
Just this finger, only people have it, it’s so classic. Open it layer by layer, cut through the interosseous muscles and lumbrical muscles, and it will appear directly in front of you like a fighter jet or a medieval two-handed sword.
Various tendons surround the extensor tendons. It's too complicated to talk about. To put it simply, a muscle that flexes or extends a finger has several muscles involved.
"Can't it be repaired?" Lu Shuyan asked innocently. After all, she was not a microsurgery person, so Lu Shuyan really didn't know much about this aspect.
"This kind of injury is a doctor's nightmare. There is almost no complete tissue system. There is no way. Let's bury the stump! There is still some hope for the index finger. The function of the hand will be relatively complete in the future. Let's start." , Zhang Fan and Lu Shuyan lowered their heads to work at the same time.
Repairing tendons, repairing blood vessels, and bones is not a big deal. Under Zhang Fan's gentle guidance, Lu Shuyan performed the operation painfully.
The noodles she ate were a bit hard at first, but due to the sour wind and sitting in a fixed position for a long time, Lu Shuyan's stomach felt like a pain in the stomach. Now the girl was really breaking out in a cold sweat. She gritted her teeth and cooperated with Zhang Fan without saying a word. .
"Rongeur!" Zhang Fan raised his head and said to Baoyin.
"Dr. Zhang, do you really need to embed the stump?" Baoyin had never been on the table for hand injuries, so she asked curiously. After asking, she seemed a bit rash and quickly lowered her head to pack the equipment.
Although Zhang Fan didn't care, he still explained: "Shortening the injured finger is not necessarily worse than repairing it with a flap. Especially in this case, combined with the age of the patient, embedding the stump is the best choice. Forcibly retaining the finger for the sake of beauty The length and loss of function of the fingers may still be a drag for the patient.”
"Oh! I'm just curious." Baoyin explained awkwardly. On the operating table, unless it is an unlicensed doctor, the average nurse will not question the doctor. These are industry rules, not regulations.
After cleaning up the damage to his hand, the whole hand looked pleasant to the eye. Zhang Fan had already cleaned out what should be removed and repaired what should be repaired. This was already the case.
"Skin it off!" Zhang Fan said energetically. The long march of thousands of miles is finally over halfway. Lu Shuyan gritted her teeth and almost staggered when she stood up.
"What's wrong?" Zhang Fan looked at Lu Shuyan and asked. The mask and hat were tightly wrapped, and he couldn't see the other person's expression clearly.
"It's okay." Lu Shuyan said in spite of the pain. No matter how painful it is now, there is nothing I can do about it. Zhang Fan cannot do this surgery alone. Even if other doctors and nurses take the stage, they can't help Zhang Fan because they are not surgeons, so now Lu Shuyan can only fight hard!
Opening up the surgical drape with the hole, Wang Laosan's white thighs were exposed, and the leg hair was pushed cleanly. Just looking at the surgical drape, someone who didn't know better would have thought that the person lying down was a beautiful woman. It was too white. .
When peeling, whether you are peeling with bare hands or peeling with a peeling machine, you must be close to the skin, press it tightly, and adjust the distance between the blades. This distance represents the thickness of the skin to be peeled. Then as the roller rotates bit by bit, the skin is peeled off gently like tofu skin.
If the peeled skin does not contain subcutaneous tissue, it is exactly the same as the layer of skin that was pulled off the table tennis racket. After the leather surface of the table tennis racket is pulled off, there are dots of yellow or red dots on it.
The same goes for the skin. The inside of the skin thinned by the peeling knife is also lined with little fat particles or hair follicles, almost exactly the same. Of course, the skin peeled off by doctors with poor skills will vary in thickness.
Zhang Fan is so skilled that his skin is almost as thin and square as the shadowless lamp.
"Beautiful!" Zhang Fan couldn't help but praise himself. Cruel art.
"Don't be ashamed!" Zhang Fan spoke, and the operating car came alive. Everyone started talking, and Baoyin laughed and joked quietly.
"Zhang Fan is the number one skin peeler in our hospital, haha!" Liu Yaowen said with a smile while adding more anesthetics. The operation time is too long, and the patient will wake up from the pain without adding a little more.
"Haha! Warm salt water gauze." Zhang Fan ended the chat. Then he gently wiped the peeled soft tissue with saline gauze. The operation time was too tight and there was no time to handle it carefully. For larger bleeding, Zhang Fan directly used electrocautery to coagulate. Then the skin was pulled up and sewn together using large needles and threads.
In many surgeries, the patient's skin is sutured very roughly and not meticulously at all. It feels like it's being fooled. In fact, this is to prevent necrosis. Small needles and fine lines are beautiful, but it can easily lead to necrosis due to ischemia. Fortunately, the wound was on the thigh, so it didn't matter. Old men don’t wear super short clothes!
The skin that was peeled off was half the size of a piece of A4 paper. Zhang Fan took it in his hand and put it on the affected hand. After comparing it lightly, he said to Baoyin: "A sharp knife."
Then he said to Lu Shuyan: "Fix it." Lu Shuyan had never had skin grafting surgery, so she didn't understand very well. She was stunned for a moment and asked embarrassedly: "How to fix it."
"Use Alice forceps to flatten the four corners and fix them!" Zhang Fan was a little impatient, but after thinking about it for a while, he agreed. He is a gynecologist, not an orthopedic surgeon, not a general surgeon!
Then he added: "It must be stretched, otherwise the positioning will be deviated later."
Lu Shuyan's face turned red. Although she shouted in her heart: "My stomach is turned into a lump, you are still cruel to me, I am a gynecologist, I am a gynecologist!" But it was just a shout in her heart, who let her She is a doctor. Who told her to be a surgeon?
After it was fixed, Zhang Fan took the knife and started embroidering. Yes, it's embroidery. Because it was an avulsion injury, there was no skin left on the surface of the finger. If you wanted the transplanted skin to survive, you had to make a glove for it.
After choosing the location, Zhang Fan slowly drew a few small holes on the peeled skin with a knife. The holes should go through the fingers and should not be too big or too small.
If it's too big, the subcutaneous tissue will leak out, and if it's too small, the blood supply won't be able to pass through, so it's very particular. Moreover, this skin graft is just one piece, so there can be no mistakes. If you make a mistake, you can only do another skin graft! Is skin grafting possible again? impossible. So Zhang Fan was particularly cautious.
After the hole was completed, Zhang Fan breathed a sigh of relief. Although this was a small detail, it was very critical and could be said to determine the success or failure of the operation.
"The gloves are ready, let's try them on for size." Zhang Fan said to Lu Shuyan.
"The size should be okay. It looks almost the same at first glance." Liu Yaowen couldn't help but interjected.
Baoyin was extremely bored the whole time. When Lao Liu spoke, she hurriedly asked, "Can you tell the size at a glance?"
"Haha, actually I am more knowledgeable about shades!" the old man said without shame.
"Rogue." Baoyin didn't know if she was shy and laughed and cursed. She also knew that he was an old man, but she still liked to tease him.
Zhang Fan grabbed both ends of the peeled skin. When unfolded, the skin is stretchable and contractible, and it can shrink into a fruit peel without force when unfolded.
Lu Shuyan grabbed Wang Laosan's two fingers, held them straight, and gently pulled them down bit by bit. With a little friction, Zhang Fan pulled the skin on.
"OK! The size is right." Zhang Fan looked at the gap and said easily.
"Look, I'm right!" Old Liu said with a smile. Baoyin ignored him again.
After covering his fingers, Zhang Fan covered the back of his hand and fingers with skin, then cut the skin into long strips on his fingers, and then wrapped the strips around Wang Laosan's two fingers in a spiral shape.
"Suture." Zhang Fan gave the order, and several people started to move. The anesthesiologist was preparing to wake them up, the nurse inserted the needle, and Lu Shuyan used scissors to cut the thread and tie the knot.
A hand surgery takes almost longer than a femoral fracture surgery, because the hand muscle division is too detailed, and if it is done a little sloppily, the patient's finger function will suffer after the surgery.
Suturing, pressure bandaging, and the operation is over. "Be sure to pay attention to infection after surgery. We can't do it here. I guess we have to send it to the county hospital." Zhang Fan said while bandaging.
Finally, Zhang Fan started to knot the gauze, and Lu Shuyan staggered and fell. "Plop!" Suddenly the girl fell on the operating table.
"I'll go!" Zhang Fan was shocked. He immediately put Wang Laosan's hand on his chest and said to Baoyin: "Hold on!"
After Baoyin immediately grabbed Wang Laosan's hand, Zhang Fan rushed over and ripped off Lu Shuyan's mask. When he saw it, the girl clenched her teeth and looked like she was in pain.
"What's wrong?" As he spoke, he stuffed his hands into Lu Shuyan's clothes.
Zhang Fan was not here to take advantage, but to touch the girl's carotid artery. The pain on Lu Shuyan's face frightened Zhang Fan into thinking she was having a heart attack.
"It's okay! I'm okay. I just have a stomachache. I feel a little uncomfortable and dizzy after standing for a long time." After a moment of relief, Lu Shuyan opened her eyes and said weakly.
"Are you sure? Let me do a physical examination for you." Zhang Fan said.
"Uh! No need, I'm really fine." Upon hearing that Zhang Fan was going to have a physical examination, Lu Shuyan's originally blue face turned red. During the physical examination, the abdomen must be lifted up for the abdominal examination. She was shy.
"Oh, I'm scared to death. Hurry up and lie down for a while. If you don't wake up, Zhang Fan will probably give you artificial respiration." Old Liu was quite frightened. Although he said it easily, he still had a look of horror on his face. It hasn't disappeared yet.
"Come on, hurry up, come here and give her a hand, I'll carry her down." Zhang Fan ignored his slander and said to Lao Liu.
Wang Laosan was pushed down, Lu Shuyan was carried down, and the five-hour operation was over!
