My medical path

Chapter 163 Discussion of Combined Surgery

Today is Friday, and the early shift is in progress.

Lu Degan, the director of Trauma Hand Surgery who was taking over his shift, received a call from the medical department asking him to participate in a multidisciplinary seminar on tumors.

Director Lu Deqian agreed, and then he asked Zhu Bin to pull out the patient's information by the way, so that everyone can see what's going on.

The patient to be consulted is laryngeal cancer.

It is reasonable to say that this kind of patient has nothing to do with orthopedics. Even if there is bone metastasis, as long as there is no fracture, there is basically no chance of surgery.

Therefore, in the past, there was no habit of inviting orthopedics for such consultations.

But this time Director Zhang Daming of the Department of Otorhinolaryngology specially invited Director Lu Deqian.

It is because Director Zhang Daming saw related reports that someone used a skin flap to make a leather tube to rebuild a throat, and the effect was quite good, which is why today's invitation came about.

Director Lu Degan is a well-known expert in the field of orthopedics in the provincial medical department.

Director Lu Degan of Trauma Hand Surgery specializes in skin flaps, Professor Ding Wei specializes in brachial plexus, and Professor Ning Qiang specializes in amputation of fingers and replantation of severed limbs, with a clear division of labor.

The patient to be consulted is a patient with laryngeal cancer. According to the operation plan, a total laryngectomy is to be performed.

After total laryngectomy, the patient will lose the function of eating and swallowing, and will be fed by a nasogastric tube, which is very painful.

Flap surgery can help with eating problems.

Skin flap reconstruction of laryngeal function has actually had a long history.

In the past, ENT departments also performed similar operations, most of which were based on the transfer of local musculocutaneous flaps.

However, most of these patients have undergone high-dose radiotherapy, which weakens the growth ability of local muscles and skin, and necrosis occurs from time to time in the transferred skin flap, causing esophageal fistula.

Of course, it is more popular to replace a section of jejunum or colon, but the patient needs an open surgery, and there are a series of potential complications after the intestine is cut.

With the continuous development of skin flap surgery, some people also try to use myocutaneous flaps such as pectoralis major and latissimus dorsi to repair, but this kind of flap is relatively thick, and it will be very bloated after reconstruction.

According to Director Zhang Daming of the Department of Otorhinolaryngology, he is considering taking a forearm flap to replace the larynx.

According to the principle of specialized treatment, the forearm flap should of course be performed by traumatic hand surgery.

Although it was a trivial matter for Director Lu Deqian to take the flap from this part, because it was multidisciplinary cooperation, Director Lu asked the department to discuss it first, and after the department's opinions were finalized, the opinions were brought to the consultation discussion meeting.

"Do you think we should accept this operation?"

Director Lu got straight to the point and said the key point directly.

Normally, if Director Lu and his department feel that the operation is not worthwhile, they can stop it.

After Director Lu's question was asked, everyone present behaved differently.

The nurses who took over the shift definitely didn't know what was going on with the operation, so they were just listening in, looking around, hoping to hear the opinions of the experts present to open their eyes.

Of course, the young doctors in this hospital and the doctors who came to study also belong to the category of ignorance.

Unlike nurses, they still have a little understanding of their professional skin flaps. Even if they haven't done it, they probably know what's going on.

But basically that's all there is to it...

So when Director Lu looked over, a large number of doctors chose to bow their heads.

Chen Bo also mixed among this group of people, doing a salted fish that has nothing to do with himself.

After Director Lu's eyes swept over Chen Bo and the others, they first lingered on the boss Zhu Bin and Dr. Li Chonghuan.

The meaning is obvious. As representatives of young doctors and the backbone of the department, they want to express their opinions.

This is a bit like a preoperative discussion.

Doctors at each level express their opinions, and after summarizing, it becomes the collective decision of the department.

As the boss, Zhu Bin knew that this was an inescapable responsibility, so when he saw the director's eyes sweep over him, he was the first to speak:
"I think the plan should be determined by the ENT department. It is not a big problem for us to take the skin flap or do the flap anastomosis..."

After Zhu Bin expressed his opinion, Li Chonghuan added something:
"I think Boss Zhu is right. We just need to evaluate the condition of blood vessels before surgery. Allen's test and ultrasound are still necessary to evaluate the condition of blood vessels..."

Director Lu nodded after listening to Zhu Bin and Li Chonghuan's opinions, then looked at the two deputy directors Ding Wei and Ning Qiang, waiting for their opinions.

"I don't think there is a big problem with cutting the skin flap, but the problem of where the blood vessels are anastomosed... Normally, we usually choose the superior thyroid artery, transverse carotid artery and facial artery for the arteries, and the anterior jugular vein and the external jugular vein for most of the veins... ..."

Professor Ning Qiang said this, picked up the teacup and took a sip of tea, and continued:
"However, the blood vessels in these parts have undergone high-dose radiotherapy. Are the blood vessels allowed? Another core issue is that the blood vessels in the neck must be freed and protected when the incision is made, so who is responsible for this incision?" Do it? Us or them?"

Professor Ning is indeed an expert in microscopy. Although he does not specialize in skin flaps, he is also familiar with these classic operations.

In particular, being able to name the target anastomotic vessel requires a lot of knowledge and a solid anatomical foundation.

Director Lu nodded in satisfaction after listening to Professor Ning's opinion.

Although the young doctors and trainee doctors below only knew the blood vessels mentioned by Professor Ning, they had no idea where the specific blood vessels were or how to do the surgery.

But it didn't stop them from looking at Professor Ning full of admiration...

After Professor Ning finished speaking, Director Lu looked at Professor Ding again with a questioning look.

The latter waved his hand and said:

"Director Ning has made it very clear. You are experts in this area. I will listen to you..."

When Director Lu heard what Professor Ding said, he nodded, knowing that no one would express his opinion, so he finally expressed his opinion:
"I think if they invite us to join the operation, we can do this operation... But as Director Ning said just now, we must find high-quality blood vessels..."

Director Lu paused, and continued:

"For the incision, I think they can complete the tumor resection first, and emphasize our target blood vessels to them in advance, and try to protect them as much as possible during the operation..."

"What's more, the dissociation of blood vessels must be done by ourselves. We don't feel relieved if they do it..."

"Director Lu, I would like to add one more point, which is the issue of assistant candidates. Next week, Chong Huan and I have received an arrangement from the Medical Association to go to the hospital below to give lectures. Boss Zhu will pay more attention to the department work. It's..."

Professor Ning added:
"If Boss Zhu is too busy at that time and the director needs help, I think Dr. Chen Bochen can help..."

Everyone present was in an uproar because of Professor Ning's words...

　Another chapter half an hour late

　　
　
(End of this chapter)