My medical path

Chapter 151
When Chen Bo saw the patient's finger, he knew that his replanted finger had an arterial crisis, that is, ischemia caused by an arterial blood supply disorder.

For patients with early ischemia after surgery, if it is not vasospasm, it is estimated to be vascular embolism...

If the ischemia does not improve after a long time, then the replanted finger may be necrotic, leading to the wastage of previous efforts!

Chen Bo questioned the patient, and he had never been in contact with a smoker. After the operation, he stayed on the bed obediently except for going to the toilet.

In other words, it is the most likely operation to fail.

Reembolization of vessels is also common with such procedures.

Chen Bo was not in a hurry to make a conclusion on the patient, but returned to the nurse's station and asked the nurse in detail about the condition of the nurse's skin observation and medication.

After the operation of this kind of patient, the general nurse will visit the patient at least two hours.

For medication, papaverine and low-molecular-weight dextran are routinely used to fight vasospasm and anticoagulation.

The nurse on duty replied that she had just checked the patient an hour ago, and the patient's fingers were still rosy and full.

Papaverine is also used every six hours according to the doctor's advice, and the low-molecular-weight dextran has been used today...

After receiving the positive answer from the nurse, Chen Bo knew that the patient had the greatest possibility of arterial thrombosis.

As a front-line soldier, Chen Bo must be the first to call the boss Zhu Bin at this time.

Briefly reported the condition to Zhu Bin.

If other doctors in training reported their condition, Zhu Bin would have to ask a few more questions to see if the doctor on duty was accurate or not.

But it was Chen Bo who reported, so there was no need for Zhu Bin to ask any more.

After all, Chen Bo's technology is there, so there is definitely no problem in judging this kind of patient.

Zhu Bin stated that he would come over immediately and asked Chen Bo to prepare for the emergency operation, and then hung up the phone.

Zhu Bin hung up the phone, and made another call to the doctor who performed the operation last night to learn more about the operation.

Lei Chengjin, a young attending physician in Zhu Bin's department, performed the operations on both of them.

Although young, in a hospital of the provincial level, young doctors go out early to receive formal microscopic training.

Therefore, Lei Chengjin shouldn't have too many technical problems, and what Zhu Bin wants to know is only some details.

For example, is there any vasospasm during the operation?

Was there any low blood pressure during the operation?
Did the anesthesiologist use vasoconstrictors?

Also, how many blood vessels did Lei Chengjin anastomose?

How about finger implantation after anastomosis...

Lei Chengjin on the opposite side answered Zhu Bin's questions one by one.

Zhu Bin knew that there was nothing abnormal during the operation, but when Lei Chengjin anastomosed the blood vessels, he only anastomosed one artery...

Normally it doesn't matter, if one artery is open, the blood supply will definitely be enough.

But it became a single-plank bridge, and the blood supply to the replanted finger was cut off when the only bridge was broken.

So in the past when Chen Bo underwent severed finger replantation, he was still used to connecting the arteries on both sides, so that he could sleep peacefully as an extra insurance.

But not everyone can kiss a few veins like Chen Bo...

And if you kiss two arteries and only two veins, there will be too much blood supply, and the return will not be timely, and venous crisis may occur...

If this is the case, it is necessary to bleed the patient's finger, or even if the bloodletting can't solve the problem, a new operation is required, which is very troublesome...

........................

Chen Bo's time for surgery preparations was very tight.

Because the patient just didn't have dinner, there is no contraindication for anesthesia, so Chen Bo issued a doctor's order, applied for surgery, and signed the informed consent form for the surgery...

Half an hour later, the patient was sent to the operating room.

Chen Bo was on duty, so the boss took him to do the operation.

"Dr. Chen, thanks to your carefulness on duty, you discovered the abnormality in time, or the patient's fingers are probably choking..."

Zhu Bin expressed appreciation for Chen Bo's serious work attitude.

Zhu Bin knows that many doctors now hide in the duty room when they are on duty, and have no habit of patrolling patients.

Usually it is up to the nurse to discover the problem and then report the situation to the doctor.

This time it was actually Chen Bo who discovered the problem and notified the nurse.

Although it is only a small change, it just reflects Chen Bo's excellent quality.

So Zhu Bin felt at this time that Chen Bo's excellence was not unreasonable, and that he might have paid more than ordinary people imagined.

"Mr. Zhu, don't praise me, I'm easy to drift... Even if I didn't find it, the nurses would definitely find it when they patrolled the patients. I just happened to meet..."

Chen Bo didn't take credit for it, and what he said was true.

In this case, the nurse will definitely find out during the next inspection. Of course, the time will be longer, and the ischemia time of the finger will be longer, which will definitely increase the damage to the finger...

Zhu Bin nodded to Chen Bo, expressing his satisfaction with Chen Bo's humility.

The operation officially begins.

Since the operation was just done yesterday, Zhu Bin opened the wound directly along the original wound without opening another wound.

After a round of investigation, both Zhu Bin and Chen Bo had a clear idea.

It's really clogged!

In this case, Zhu Bin had no choice but to remove the sutures on the blood vessels again.

After all the threads were removed, Chen Bo could see clearly under the microscope that there was a small thrombus in the blood vessel, and more importantly, the color of the intima at the distal end of the fracture had changed...

What does this mean?
This shows that the embolism of the blood vessel is probably caused by the injured intima.

As for the blood vessels that were injured in the first operation, many of them did not change in color. How to judge that there is an injury is the time to test the basic skills of the surgeon.

After Zhu Bin cleaned up the thrombus in the blood vessel, and cut off the injured part of the blood vessel, he pulled the broken ends of the blood vessels on both sides and gestured. He could barely lean on them, but there was tension.

"Doctor Chen, do you think you need a transplant?"

At this time Zhu Bin asked.

It is time to test the surgeon's experience whether to do a transplant or not.

If other people were there, Zhu Bin must have made up his own mind long ago.

But now that Chen Bo is his assistant, Zhu Bin thinks it is necessary to discuss it.

"I think it's better to have insurance for blood vessel transplantation..."

Chen Bo looked at Zhu Bin and said:
"First of all, there is already tension in the blood vessel itself, and it may cause suture failure if it is barely sutured...Secondly, the blood vessel has already undergone a round of suture operation, which may cause damage and risk of re-embolization..."

Chen Bo paused and continued:

"In the end, the blood vessels on the other side were not anastomosed, but ligated, which means that the length is probably not enough, and a transplant is needed... Let's do the transplant together, and it won't waste much time..."

After listening to Chen Bo's analysis, Zhu Bin nodded in agreement.

(End of this chapter)