medical simulator

Chapter 158 Can You Not Talk If You Can't Talk? ! (Second update, please subscribe)

Unobstructed blood supply is the guarantee for the success of severed finger replantation!
Blood is the source of life.

However, although Chen Tingye was very excited after seeing the blood, Zhou Cheng didn't let the blood flow for too long, but immediately clipped the artery near the heart with an artery clip after seeing the blood.

The remaining blood still flowed for a while, and the tiny blood pools formed were sucked up one by one by Zhou Cheng with the suction device.

Turning to look at the patient's blood pressure, it was still stable, and then he let out a sigh of relief.

Only then did Chen Tingye and Zeng Yi realize their gaffe.

This is a replantation of a severed limb. Although as a hand surgeon, he should be excited instinctively after seeing blood, he shouldn't be looking at it for so long.Let the blood flow and ignore it.

"Vascular sutures." Zhou Cheng directly asked the handwashing nurse to open the prepared sutures.

In fact, the best way to remove thrombus is to have a professional thrombus removal tool from vascular surgery. No matter how bad it is, a catheter can be used at any rate, which will save more time.

Thrombectomy, although cheap, does not require catheter money!
But in fact, the time wasted and the cost of anesthesia are not less than the money for the catheter.

However, Huang Shinan of the Eighth Hospital did not get the catheter into the operating room.

Purchasing new devices, even syringes, must go through the formal approval process of the hospital, and the hospital will purchase them uniformly!The procedure is trivial, although it is also for quality assurance and other corruption, but there will also be a certain degree of restriction.

Temporary purchases need to be signed by Huang Shinan, who is in charge of vascular surgery. Maybe Zeng Yi, as the chief director of the orthopedics department, can get Huang Shinan to sign, but Zhou Cheng will definitely not be able to do that.

Seeing that Zhou Cheng still had to suture the blood vessel to continue to remove the distal thrombus after incision and removal of the thrombus, Yang Yifeng frowned slightly.

Shaking his head slightly.

Now we are racing against time, but because of the equipment, we have to prolong the operation time.

But fortunately, Yang Yifeng saw that Zhou Cheng stitched up the blood vessels extremely fast, and within a short while, the artery he had just cut was stitched up by him.

Because it is not completely cut off, only part of the tubular vessel wall is sutured.

After finishing the beating, Zhou Cheng stuffed the blood vessel into the muscle tissue, but ignored it, and then opened the proximal arterial clamp again——

Finger along the shape of the artery, continue to touch the pulse of the artery with the pulp of the index finger (the index finger is the index finger, the index finger is the official term, because the index finger is mostly used to refer to objects).

The naked eye is neither CT nor X-ray, and has no penetrating ability.

Therefore, the specific location of the thrombus cannot be seen.

In fact, speaking of it, the reason why arteriotomy and thrombectomy is classified as a Class II operation is not that thrombectomy is so difficult, but it is very simple, as long as there is a CTA showing intravascular thrombus Location.

It can be done by a senior resident who is very familiar with surgical anatomy.

But the reason why limb salvage is quite difficult is how to recanalize the blood vessels without CTA. This is an urgent matter for vascular surgery.

Post-traumatic arteries have multiple embolisms, and the position of the thrombus is not fixed. It is basically unrealistic to search for the thrombus throughout the entire process of penetrating the artery.

At present, the blind extraction of thrombus is limited to one or two sites. If a catheter is used to remove the thrombus at a distance, it is life if it can be removed. If it cannot be removed, the limb must be amputated.

How much work can be done depends entirely on the level of the surgeon and the luck of the patient himself!

In other words, positioning is difficult.

In modern medicine, the most difficult thing is not the operation, but the diagnosis, which includes positioning and qualitative.

Sometimes it is difficult to locate, and sometimes it is difficult to identify.

Therefore, when Chen Tingye saw Zhou Cheng pull out the radial artery again as if he was catching a loach, he and Yang Yifeng finally saw something wrong with Zhou Cheng.

Chen Tingye himself is a giant in hand surgery, and has a deep connection with vascular surgery, so he knows a little bit about it.And Yang Yifeng's talent in vascular surgery is excellent, and he has made the professor of vascular surgery at the Affiliated Hospital of Shonan University sigh more than once.

Yang Yifeng entered the wrong line.

Seeing Zhou Cheng's technique, Yang Yifeng's mind was moved.

It seems that Zhou Cheng's arteriotomy and thrombectomy is no longer just a skill, but a skill.

Skills, skills are skills, ability is ability, know this skill.

Skill is art.

He can feel the location of the thrombus and the pulsation of the artery with his fingertips. He is the most clear about the difficulty and extent of this.

The reason why Yang Yifeng dare not go to the operating table anymore is because of his nervousness, and the trembling of his hands caused by his nervousness.

For a good surgeon, hands are extremely important!

To a certain extent, cognition determines the upper limit of surgery, and the volume of surgery, or the honed surgical skills, is another guarantee for the quality of surgery.

If he could have Zhou Cheng's hands, wouldn't it be possible that his parents wouldn't die?

……

Another thrombus was pulled out by Zhou Cheng. When the dark red long blood clot was pulled out of the blood vessel, there was a sense of stagnation. It seemed quite decompressed. The whole long strip was unbroken and pleasing to the eye. .

Great for relaxing your mind.

Perhaps Li Changhong had seen Zhou Cheng take thrombus before, so he was not surprised, but the faces of Zeng Yi and the others were quite strange.

This almost showed Zhou Cheng's kung fu to the extreme.

Although they have not had much experience with thrombectomy in vascular surgery, they have all eaten hot pot. The duck blood in the hot pot is often ordered.

Dried duck blood is very hard, and it may rot if you pick it up, let alone wet duck blood that has solidified?

PS: (If it is difficult to understand, use chopsticks to pick up duck blood or pig blood when you are in the hot pot!)

Zhou Cheng was busy but not chaotic, concentrating on it.Did not pay attention to other people's eyes and expressions.

Although arteriotomy and thrombectomy is only a simple level II skill, in order to practice this skill well, he spent a lifetime immersed in the simulated copy before reaching the perfect level. Naturally, there are reasons and ways.

And it's not the time to teach.

After sewing again.

Zhou Chengcheng also took out a thrombus in a communicating artery!
After releasing the proximal arterial clamp, blood was seen.

After suturing, continue to test the blood supply of the distal limb.

simple.

Then he called up a syringe and poked the pulps of five fingers with the needle.

It wasn't torture, and the patient was already anesthetized. By the time he regained his senses, the punctured needle hole had already healed.

I saw that the blood vessels of the thumb, middle finger, ring finger and little finger were all unblocked, and a little bit of blood slowly seeped out.But the pad of the index finger is still peaceful, no blood is seen.

At this point, Zhou Cheng immediately said: "Professor Chen, the proper artery of the index finger is probably thrombused, let's ignore it for now, you deal with this hand first, and I will go to the opposite side to get the thrombus!"

"The blood coagulation status of this patient is probably not very good. The incisions I made to remove the thrombus will not be closed for the time being, shall we keep them?" This is a suggestion.

Chen Tingye nodded immediately, before he had time to sigh with emotion, and said, "Okay, thank you for your hard work, Doctor Zhou."

"I'll start suturing part of the vascular bed right away. If this patient is fixed, then use external fixation." Chen Tingye said rather excitedly.

For amputated limbs with long-term ischemia, the vascular bed is sutured afterward. The vascular bed is another name for the muscle. In fact, it can also be called the nerve bed, whichever it is.

As a doctor of hand surgery, Chen Tingye encountered a big problem in limb salvage surgery because he did not have a top vascular surgeon to cooperate with him.

In fact, although the hand surgery in Attachment [-] is slightly more famous than that in Attachment [-], its development is a bit slower, because there is no good partner.

If Professor Shu, the vascular surgeon of Attachment [-], was in Attachment [-], Chen Tingye thought, how could Deng Lianggen, a latecomer, catch up with him?

Chen Tingye felt that Deng Lianggen was a post-scholar, not because he wanted to make a big contribution to Deng Lianggen, thinking that he was his junior, but that Deng Lianggen himself was not a hand surgeon, that's all.

But attached one, the sub-specialty of hand surgery has been inherited for a long time.

If a good team can be built, that is the most comfortable thing.

It is impossible for Chen Tingye to go beyond his own hospital to ask for foreign aid in the vascular surgery department, the hospital does not allow it.Vascular surgery will not allow it, and Professor Shu will not come.

However, this is the first time Chen Tingye felt that with a good partner in vascular surgery, replantation and limb salvage would actually be much easier. He only needs to worry and think about how to do the surgery well. !

Zhou Cheng didn't think about and point out the steps of replanting Chen Tingye's severed limb, but went straight to the opposite side.

Wang Yongjin and Zeng Yi immediately went to help Chen Tingye start the follow-up operation, and Li Changhong brought two subordinates to continue to assist Zhou Cheng!
Li Changhong still said: "Xiao Zhou, I have to work hard for you again today."

Li Changhong knew very well that the patient himself had no status, but his company did not know why he came forward. Not only did Chen Tingye invite him for a consultation operation, but the hospital probably also paid close attention to this operation.

I just don't understand why the company doesn't directly transfer the patients to the Affiliated Hospital of Shonan University, but insists on sending them to the Eighth Hospital.

Zhou Cheng smiled and said nothing.

It's his job, but it's really hard. He's actually a little tired, but he's still going on.

But what made Zhou Cheng quite happy was that the blood flow on the side he was dealing with now seemed to be better than that on the opposite side.So after Zhou Cheng found two arterial thrombus, the blood flow immediately became smoother.

In this way, Zhou Cheng completed the step of smooth blood circulation in just 45 minutes.

That's it.

After finishing, Zhou Cheng can actually step down.

Li Changhong also let out a long breath, and said, "Xiao Zhou, you have worked hard, you should step down and rest for a while."

The blood supply is smooth, at least the possibility of replanting the severed limb is preserved.As long as the blood supply continues to slowly penetrate, the timeline of the operation can be slowly lengthened, and there is no need to worry too much about ischemic necrosis of the distal limbs.

I gave them more time to finish, but while observing Chen Tingye's operation, although it was a bit hard, they had to stay up late.

But when studying, everyone came here like this.

At the very beginning, Li Changhong stayed in the ward day and night in order to learn debridement, just to wait for the emergency department in the hospital in the middle of the night, learning surgical anatomy while debridement.

Zhou Cheng was about to nod his head slowly, but he could see that after Chen Tingye temporarily fixed the radius and ulna with Kirschner wires, it was no problem doing tendon suturing, but.

The severed end of this limb is just near the joint, and most of the joints are the starting and ending points of the muscles, and most of the muscles are damaged, so the starting and ending points must be reconstructed.

If you suture randomly, you can step down, and the second phase of skin grafting will be done.

But ah.

If the starting and ending points of the muscles in the first stage are not rebuilt, the recovery after surgery will be very troublesome.

Before coming down, although Zhang Zhengquan didn't confess anything, he also told him personally that this is Zhang Zhengquan's brother's friend.

Zhou Cheng is not familiar with Zhang Zhengquan's elder brother, but the word Quanzi is enough for him to try his best.

So after frowning slightly, he suggested, "Director Li, why don't I help Professor Chen and replace Director Zeng here to start stitching?"

Chen Tingye has already done a perfect job in the early stage of careful debridement. Although there are still some decorations, there is no need to spend so much effort.

The flaws do not hide the goodness, this flaw is irrelevant, the suturing and reconstruction of the muscles are obviously more important.

Zhou Cheng's suggestion was not greedy for merit, and the previous blood vessel incision and thrombus removal was affirmed by everyone. Zeng Yi raised his head and glanced at Chen Tingye.

At his age, he already had a solid foundation. The main thing he learned from Chen Tingye was his thinking. Now that he understood that it would be of great benefit if he could do it himself, he was quite moved: "What do you think, Professor Chen?"

"Director Zeng, let's go. We will open the stage at the same time, so the operation will end sooner." Chen Tingye naturally knew something about Zeng Yi.

After all, as a major director of a party, he still has the name of hand surgery. Although he also took care of messy work such as spinal fractures, but if he can be the director, at least he will be able to step down from the surgery.

The purpose of his coming here is to save his limbs. It is not a problem for Zeng Yi to complete some finishing work and side jobs.

So Zhou Chengcheng and Zeng Yi switched places.

Moreover, Chen Tingye's surgery level is already extremely advanced, and the speed is not slow. When Zhou Cheng took out the thrombus on the opposite side, he was already suturing muscles and tendons.Of course, during this period, he had already found out the severed end of the nerve, and after resting, he only needed to be stitched up.

For the suture of the nerve, it is best to suture it in one stage, but it can be delayed for two or three months at the latest, which is no problem. Instead, it can not be rushed for a while.

Zhou Chengxian only took over Zeng Yi's position as assistant, and pulled hooks with Wang Yongjin.

However, after Zhou Cheng stood still, he found that Wang Yongjin's hand pulling the hook was shaking slightly now and then, and even the magnitude of the shaking affected Chen Tingye's operation to a certain extent.

Although Chen Tingye didn't say much, he just glanced at Wang Yongjin's hand occasionally, and then continued the operation.

Zhou Cheng looked at the time, and it was already [-]:[-] in the morning.

Wang Yongjin was re-employed and admitted to the hospital after retirement. He is close to 70 years old, so staying up late is naturally not as good as young people.

He lowered his voice and asked, "Mr. Wang, would you like to step down and rest for a while?"

It is difficult for Chen Tingye to bring this up, but after Zhou Cheng said it, he immediately responded: "Yes, Director Wang, look at me, I didn't notice at all, you are so old, you should take a break Already, another young man will come over?"

The operation started at ten o'clock, and Wang Yongjin was already in a bad mood when he was called over.

At this moment, he was all on his own. Hearing what Chen Tingye said, he blinked his eyes a little, and his eyes were obviously complicated.He is actually very tired, but as a surgeon, he can be regarded as a master of orthopedic surgery in the Eighth Hospital for a lifetime.

Now that he can't even stand on the platform, he feels quite uncomfortable in his heart, but Wang Yongjin also knows that if he stays on the platform, not only will it not help the operation, but it will affect the normal operation of the operation.

Zeng Yi immediately shouted: "Wang Yaoxiang, go and replace Director Wang."

Then he said to Wang Yongjin: "Teacher Wang, you should go back to rest first, and you will continue to work tomorrow. There are a few of us young people here, and you have really worked hard today."

The tone is sincere, and he really thinks about Wang Yongjin's body.

Wang Yongjin just sighed and nodded: "Professor Yang, I've worked hard for you in the future. People don't rely on their muscles and bones. I really can't hold on a little bit."

Chen Tingye immediately said: "Director Wang is serious. You are still young and strong. I don't know if I can be on the operating table at the age of 60."

This is the truth, a surgeon is actually a job of selling one's body.

Between the ages of 40 and 60 is the golden age. After this age, it is estimated that the physical strength is exhausted.It really looks like Wang Yongjin 67 is still active on the operating table, not many.

At least those professors in the Affiliated Hospital of Shonan University have long been in outpatient clinics.

Wang Yongjin silently got off the stage, twisted his waist, and left the operating room.

When he was at the door, he looked back at the incandescent lamp and shadowless lamp in the operating room with great reluctance, his eyes were complicated, and there was reluctance and helplessness in his eyes.

This used to be his battlefield, and now he must hand over the battlefield to others.

This is for their own consideration, but also for the safety of patients.

……

In the operating room, after Wang Yongjin left, Chen Tingye was still saying: "Director Zeng, Director Wang in your department is really in good health. Can he still be on stage at this age? Are you still leading the team?"

Zeng Yi said guiltily: "Yes, Professor Chen, I'm not afraid of your jokes. Teacher Wang should have reached the age of retirement long ago, but there are not enough staff in the department. Now only Teacher Wang is left alone in the older generation. Active in the department."

"We young people can't handle it, so we can only continue to support Director Wang through exhaustion."

This is a joke, and of course it proves that the current operation process is relatively smooth, otherwise, everyone must have kept silent, not to mention that Wang Yongjin has stepped down, and the words are simple and cold.

Li Changhong said: "Yes, we are too unworthy to say it. Director Wang is considered to be the senior generation of Professor Wu and Professor Li."

Chen Tingye immediately opened his mouth when he heard the words, then Wang Yongjin is really awesome!

So old people.

He also knew that the Professor Li that Li Changhong was talking about was probably the Professor Li who was the director of orthopedics department and the vice president of the Second Affiliated Hospital of Shonan University. As for Professor Wu, he must be the boss of his department.

The head of the orthopedics department has long since stopped undergoing surgery frequently, and I heard that he only performs one operation every month or half a month.A group of people below are helping him with surgery, and are now focusing on scientific research and teaching.

Chen Tingye said with emotion: "Then Director Wang really deserves to be old and strong."

When she said this, Wei Wei felt sorry for Wang Yongjin. At such an age, she still has to run around in the department. This may be due to her different choices.

If he had continued his graduate studies before and stayed in Attached One Attached Second, he would have been full of disciples and grandchildren by now, instead of what he is now, just an old director of orthopedics in the Eighth Hospital.

Maybe even his teacher.

The platform is different, so?
However, it doesn't seem right to think so. Isn't Zhou Cheng just the blue out of the blue and better than the blue?
Chen Tingye glanced at Zhou Cheng, feeling that there was something wrong with this young man.

Surgery continues.

Chen Tingye suddenly discovered that since Wang Yaoxiang came to work as an assistant, his operation has progressed very smoothly.In the process of tendon suturing, every time, every stitch can have just the right suture point delivered to the door.

Just like the girl who went to the ancient "Jiyuan", she delivered it to her door very actively. (Intentionally typo.)
The operation went quite smoothly, and the suturing process was naturally very smooth.

But Chen Tingye is a man, man, too passive and smooth sailing is not good.

Roughness and folds can make people the driving force for continuous sprinting.

Very similar to the reader's mentality——

Too dry is not good, too dry feels uncomfortable.Too much water doesn't work, I always feel like a water hyacinth.

Frowning slightly, he temporarily interrupted the operation, his eyes lingering on Zhou Cheng and Wang Yaoxiang.

Either Zhou Cheng or Wang Yaoxiang took away the refreshing feeling that should belong to him.

He himself is like a tool machine.

The stick that stirs the water, the sound of the water is unpleasant.

Finally, when there was only the last muscle that needed to be sutured, he focused his attention on Zhou Cheng.

Yixin asked slightly: "Can Xiao Zhou know how to suture? Why don't you come and try?"

In fact, there is no need to guess, it is either Zhou Cheng or Wang Yaoxiang, just ask someone to go on stage to sew it up and you will know who is responsible.

And because the blood flow is smooth now, and the time is not so tight, he is happy to pursue the final "culprit".

When Wang Yaoxiang heard the words, his face immediately pulled, he bit his mouth, a little disappointed.

It's not as good as last week's co-authorship. Chen Tingye obviously wanted to teach and give advice on the spot.It's just that the opportunity was earned by Zhou Cheng himself, not by Chen Tingye.

Zhou Cheng was slightly surprised, nodded and said, "Okay, Professor Chen."

Both Zeng Yi and Li Changhong heard Chen Tingye's arrangement, but they didn't even raise their heads. Whether it was Wang Yaoxiang or Zhou Cheng, they were all from the department. They didn't care who Chen Tingye liked to teach.

I'm afraid Chen Tingye doesn't want to teach.

Then Zhou Chengcheng took the suture from Chen Tingye's hand, heaved a sigh of relief, and turned into a machine-like dexterity again, and started to move.

During the period when he just pulled the hook, he only needed to be an assistant, and he took a break for a while, so at this moment his physical strength has recovered a little.

bark.The needle tip penetrates the muscle surface.

puff.The needle tip penetrates the surface of the muscle.

In this way, several stitches were completed in no time.

Wang Yaoxiang was expressionless, and he was still wondering why Chen Tingye didn't choose him to stitch, but Chen Tingye's expression gradually became serious.

Experts look at the doorway and know it at a glance.

The 'culprit' was found, and it was the little guy Zhou Cheng, who pretended to be a pig and ate a tiger, and watched him for a long time, wondering if he wanted to stab him in the back.

Because from the angle of Zhou Cheng's injection and injection, Chen Tingye felt an extremely professional style.

And the action is fast, without stopping at all, and the technique is sophisticated!

What is old and what is spicy, in fact, it is simply and decisive.

In a short while, a muscle with a long axis of less than two centimeters was tightly stitched by Zhou Cheng, and Zhou Cheng also tested the tension of the stitches. It was just right, even slightly better than Chen Tingye's stitching. Little Diu Diu.

If the tension is wrong, it will be easy to cut.

It's easy to imagine why the tofu is broken when stitched with sutures. In fact, it is cutting, but it is possible to sew the tofu together through techniques and skills. This is kung fu. (To make a metaphor, I won’t go into in-depth discussion and popular science. If you are interested, you can go to Xingyin to search for knife skills, which is even more incredible.)
Zhou Cheng put down the suture and needle holder.

Then he looked at Chen Tingye and said, "Professor Chen, shall we continue suturing the nerve and rebuilding the insertion point of the muscle? Or should we suture the opposite side first?"

After the operation has reached certain steps, and after breaking through all the difficulties, you can actually play freely to a certain extent!

Both can be sour.

Difficult to open for the first time to break the narrow forbidden area!

Blood vessels are the source of life, and muscles are the source of movement and the vascular bed.Contain and protect blood vessels!
Chen Tingye raised his brows slightly, and Zhou Cheng's answer was very intuitive, saying, "Let's sew up the nerves first."

The muscles and tendons on the opposite side are stitched by your director. Should I drive them off now or you and Wang Yaoxiang?It's not suitable for me to go, you two are looking for death.

"Can you suture nerves?" Chen Tingye asked again.

I want to find out Zhou Cheng's bottom line.

But one thing Chen Tingye got wrong is that men are no better than women, and there is no way to find out——

"A little bit." Zhou Cheng didn't refuse.

Because nerve anastomosis is a second-level operation, he has second-level surgical authority.

No matter how bad it is, Chen Tingye authorized it to be written by Chen Tingye as the chief surgeon. He performed level IV surgery, and he was not afraid that no one would take the blame.

"Then sew together to save time." Chen Tingye said at the same time.

"Those two nerve sutures. Weiqiao 6-0!" Then he ordered the equipment nurse.

"Okay, open it right away, antimicrobial micro Joe 6-0!" The roving nurse replied, and then hurried to find the sutures.

Chen Tingye didn't expect that Zhou Cheng would really dare to answer, but this was just right.

Although nerve suturing and tendon suturing are the same level II surgery, the difference is not small, and it is not as simple as muscle and tendon suturing.

Looking at Zhou Cheng for a while, his eyes narrowed, and the smile on his mouth was covered.

This Zhou Cheng doesn't look very old, but he seems to have solid basic skills. If he can come to the Eighth Hospital, at least he can prove that he is not a doctor. Let's see if he can get it back.

And if he can get Yang Yifeng's attention and recommendation?
Huh?Will this guy be watched by Lao Ding?

Ask later.

However, after getting the nerve suture and the attached microsurgical needle holder, Zhou Cheng didn't ask the roving nurse to ask for glasses, and started to use it directly.

Well, there is only one set of microsurgery instruments, two glasses, one is at Chen Tingye's place, and the other is on Chen Tingye's head now.

Before Zhou Cheng sewed up the muscles, they were quite big, so there was no need for them, but now?
It was not easy for Zhou Cheng to ask these two people for their needs. Moreover, the nerve branch he sutured was not small, so Zhou Cheng soon worked on the nerve, provoking the needle tip.

The suture of the epineurium was quickly completed.

Of course, Zhou Cheng did not stitch all the stitches together, because the suturing of nerves, unlike muscles, cannot be sutured all at once.

The anatomy of the nerve can be divided into the epineurium and the nerve fascicles.

Orthodox nerve anastomosis can be divided into interfascicular anastomosis and epineurium anastomosis!

The suture of the epineurium is to draw the symmetrical point of the epineurium with a 5-0 silk thread, and then gently turn it over to both sides in a sleeve-like manner to expose the nerve bundles at both ends. After correctly identifying and aligning the nerve bundles at both ends, use 9 ~ 11-0 fine silk thread or nylon thread and 2 ~ 3 needles of perimerial suture.

The anastomosis between fascicles should preferably not be on the same plane to prevent adhesion between adjacent nerve fascicles.

Finally, with 5-0 silk thread, after aligning the axis, perform 6 to 8 stitches of interrupted sutures of the epineurium, that is, the perineurium and the epineurium are sutured at the same time.After the suture is completed, it is wrapped with polyester or chitin membrane and placed in the normal muscle space or fascia.

Chen Tingye chose to use 6-0 sutures, which actually increased the difficulty of the orthodox epineurium, but this did not bother Zhou Cheng.

Zhou Cheng didn't have too many fancy skills in nerve suture, but he was familiar with it, and he made the current suture method to the extreme.

After Chen Tingye fixed the epineurium, Zhou Cheng shouted to the itinerant nurse: "Teacher, take a 10-0 suture, it's also Weiqiao."

The nerve membrane is sutured first, then the nerve bundles, and finally packed!
One step ahead of Chen Tingye, Chen Tingye glanced at Zhou Cheng's stitching position.

Well, no problem.

Is the young man single? His hand speed is very steady and fast.

As we all know, fast is for fun, and steady is for proper strength——

After Zhou Cheng got the micro-qiao suture, he quickly found the perineurium.

The epineurium is not difficult to find, but the epineurium is really hard to imagine.It's not too thin as a cicada's wing.

Even Wang Yaoxiang didn't understand, Zhou Chengcheng had already laid the needle!

The movement was a little slower than before, but Zhou Cheng's stitching process made Yang Yifeng frown, can he do it?

Going to the epineurium without microsurgical glasses is actually not much different from closing your eyes.

In the forearm, there are only three important nerves.

Ulnar nerve, radial nerve, median nerve.

Zhou Cheng sutured the ulnar nerve, while Chen Tingye sutured the radial nerve.

The ulnar nerve, where it ruptures, is where the elbow and forearm travel.

The suture in this position is difficult, not the most difficult, but certainly not the easiest.

Our ordinary nerves are made up of epineurium and nerve bundles.

The ulnar nerve originates from the medial bundle of the brachial plexus, where there are 11 inner bundles of the ulnar nerve, mainly mixed bundles.

The number of inner nerve bundles of the ulnar nerve in the upper arm increased to 16!Among them, there were 13 mixed nerve bundles mainly composed of motor nerve fibers, and 3 mixed nerve bundles mainly composed of sensory nerve fibers.

at the elbow!The ulnar nerve then descends to the ulnar nerve groove between the medial epicondyle of the humerus and the olecranon, where there are 12 internal nerve bundles of the ulnar nerve, including 4 mixed nerve bundles mainly composed of motor nerve fibers, and 2 nerve bundles mainly composed of sensory nerve fibers. There are 6 fiber-based mixed nerve bundles and [-] mixed nerve bundles.

In the forearm, there are 18 nerve bundles in the trunk of the ulnar nerve, including 3 mixed nerve bundles mainly composed of motor nerve fibers, 5 mixed nerve bundles mainly composed of sensory nerve fibers, and 10 mixed nerve bundles!
And the diameter of the ulnar nerve is just that little!A few millimeters!
Divided by eighteen, is the diameter of the nerve bundle.

And the epineurium is a small part of it...

Does Zhou Cheng have any special attachments and skills in finding films this week?

Then he quickly shook his head, carefully considering the gap between Zhou Cheng's skill level and his own, and at the same time constantly scanning the gap between Zhou Cheng's and Chen Tingye's nerve stitching.

Nerves can be divided into epineurium, nerve bundles.

The nerve bundle is wrapped by the perineurium. Therefore, the suture of the nerve is not the suture of the nerve, but the suture of the epineurium and the perineurium. The nerve itself cannot be dropped.

If the needle is dropped, the person will go numb.

And the knots need special treatment——

Because only after special treatment can the nerves be better protected, thread knots may cause nerve compression symptoms, and compression of different nerve bundles will cause different results.

The ulnar nerve is in the forearm. Although there are eighteen nerve bundles, their functions are different——

The 2 motor nerve bundles make up the muscular branch.

The ulnar nerve continues to descend between the flexor carpi ulnaris and flexor digitorum profundus, medial to the ulnar artery, and gives off the dorsal branch of the hand above the radiocarpal joint.

The trunk of the ulnar nerve here is composed of 5 mixed nerve bundles and 1 mixed nerve bundle mainly composed of motor nerve fibers.

The dorsal branch of the hand consists of 4 mixed nerve bundles mainly composed of sensory nerve fibers, distributed in the ulnar half of the dorsum of the hand and the skin on the back of the little finger, ring finger, and ulnar half of the middle finger.Its stem descends along the radial side of the pisiform bone.

Then, Yang Yifeng seemed to notice that Zhou Cheng's knots seemed to be pointing in the direction of certain nerve bundles.

A rather absurd idea unfolded in his heart.

Zhou Cheng, did he know which nerve bundle is purely motor branch, which nerve bundle is purely sensory branch, and which one is mixed nerve bundle?
Yang Yifeng's evaluation was very professional, because he was a professional himself.

Maybe Wang Yaoxiang couldn't even understand, couldn't figure it out.

That's because he didn't read the book thoroughly, didn't read it carefully, and didn't study it in more detail.

Clinical medicine is not traditional western medicine, it is modern medicine, which can explain the truth thoroughly and clearly.

Yang Yifeng knows that there are some top limb salvage masters who can discard part of the sensory nerve bundles, and then make room for the motor branches!This trick is called losing the car to protect the handsome man, and it can still be used in medicine.

It seems that this is what Zhou Cheng meant when he turned the direction of the thread knot there.Moreover, Zhou Cheng's orientation is different from that cut off.

The microjob nerve sutures are absorbable. After a few months, when the nerve bundles grow up, the sutures will fall off naturally, and the knots will also disappear. Once the outer membrane is healed, the compression will be relieved naturally.

However, a very professional question popped up and entered Yang Yifeng's mind.

"Brother Zhou Cheng, if you sew up all the perineurium alone, how can you avoid the occurrence of neuroma and epineurium adhesion?" Yang Yifeng asked the most critical question.

Neuroma is not a malignant tumor, but it grows between the epineurium and the nerve bundles, and is compressed, causing various symptoms.

The more knots you suture, the higher the pressure in the nerve bundle, and the easier it is to entrap!

Under stimulation, the neuroma will pop out.

A question actually involves many aspects of knowledge, which is Yang Yifeng's knowledge background.

Zhou Cheng frowned slightly, not to say that Yang Yifeng's question was so difficult to answer, but because the suture of the epineurium is not very likely to cause neuroma, compared to long-term chronic stimulation, the probability is much lower. much smaller.

Therefore, Zhou Cheng had never considered this problem even in the simulated copy before, but he had thought about the problem of adhesion a long time ago: "The firm suture of the perineurium is conducive to early recovery, because sutures on different planes , so the chances of sticking are not great."

"It can be as early as five days after the start of small passive movements."

Exercise is divided into active and passive. Active means moving by oneself, and passive means moving by others.

"As for the issue of neuroma, this can be discussed."

"I can't control so much now, the most is to grow and then cut." This question is beyond Zhou Cheng's knowledge blind spot. This may be a question that should be considered when redefining perfection above the perfection level of nerve suture.

At the level of perfection, this need not be the case.

But Zhou Cheng's weak words made Chen Tingye, who was standing opposite, frowned fiercely, frowned and said, "Can I start passive activities five days after the operation?"

"When we usually encounter patients, the most courageous ones will wait ten to twelve days."

"Director Zeng, do you do five days regularly or five days occasionally?"

The speaker had no intention, but the listener had intention, Chen Tingye looked at Zeng Yi!

That look seems to be saying, Director Zeng, the replantation of amputated limbs on your side is more courageous than us, and you can move in five days?
Hearing this, Zeng Yi immediately rolled his eyes, was taken aback, and hurriedly apologized and said with a smile: "Professor Chen, Xiao Zhou may have made a mistake. We usually start activities in three to five weeks. It's safer. Every month."

At the same time, he also took a look at Zhou Cheng, and didn't dare to stare at him, because Zhou Cheng's operation of suturing the epineurium with the naked eye just now was too coquettish, so he noticed that Chen Tingye had interrupted the operation, and kept looking at Zhou Cheng.

So I asked the roving nurse to pass the microsurgery glasses to Zhou Chengyong first. He was still stitching up the muscles anyway, and he was not so old and dizzy yet.

When Yang Yifeng heard Zhou Cheng's words, he suddenly realized something in his heart, and then he heard Zeng Yi's words, and at the same time cast a complicated look at Zeng Yi——

In fact, Director Zeng, we know that you can speak, but if you don't understand, can you not speak?

We are seriously discussing academic issues, not playing with you in the system of giving favors, steps, etc...

(End of this chapter)