Nineteenth Century Medical Guide

Chapter 312. 308. Wire Saw Craniotomy

Because Xie Basto has been in a coma, Carvey did not give Xie Basto any ether from the beginning.

Firstly, it is not necessary, the coma state is very insensitive to pain, and the operation area of ​​the skull surgery is not large, so local anesthesia can be chosen.

Secondly, for the safety of general anesthesia, one would go through a series of performance processes when entering the ether anesthesia zone from a normal state, but the coma erased all these processes, making it impossible to judge the depth of ether anesthesia.

If it is shallow, it is useless, and if it is deep, it will inhibit breathing. In this case, it is better not to use it.

Even if the local anesthesia effect of ether is not good [1], it can still block part of the pain sensation. In addition, the remaining alcohol in the body and the newly infused tincture of ya tablets can keep Xie Basto in a basically painless state. surgery in the state.

Kavi tightened the wire saw with his left and right hands, and demonstrated to Peon and Sedieu: "The cutting angle should be large, and at the same time, rotate the wrist back and forth so that each strand of the saw wire can play a cutting role."

Under his control, the wire saw shuttled back and forth between the two holes, and slowly cut open the skull along the established route.

It has been a long time since Cedieu saw a craniotomy. Compared with the last time his teacher was in a hurry, Kawei was quite calm in terms of the steps and techniques of the operation.Even such a difficult operation, which was built temporarily and would produce various variables all the time, seemed to be under his control.

However, now is not the time to envy (ji) (du) Kavey, the drill hole in his own hand is still halfway through, so he has to speed up.

Because in Cedieu's cognition, his position has fallen behind Pion.The number of wire saw cuts was originally limited, and now he has done one with Kawei, and in the end, he might be able to get the chance to practice wire saw cutting before himself.

As long as the hole is punched before it's fully cut, he can take the initiative and demand that Kavi
wrong!

Thinking of this, Cedieu suddenly frowned, and a different voice appeared in his mind: Why should I compete with Paion for the opportunity to practice mobile phones?He is just a young doctor who has just been working officially for two years. I am the head of the department. Why?
The words must be correct. Even if Kawei is regarded as the top three in the countryside to help the poor, the first to teach is the boss of the local department, and Sediyo is definitely the first choice.

But the reality is that Paion seems to have lost his director, and is full of Kawei's shadow.In this kid's heart, he and himself are both ordinary doctors who started from scratch, and should be of the same class.

and many more! ! !

Why do I have to ask Carvey to practice mobile phone opportunities? ? ?
It's just a craniotomy, and it doesn't look very complicated.After mastering the operation steps, find a few corpses to learn and consolidate, and I can also work on one when I have a chance in the future.

In fact, Cedieu still thought too much, and Kawei didn't trust them that much.

The reason why he gave him the last drilling opportunity was to appease his mood as an assistant. In fact, Kawei's eyes have been wandering around the position of the drill bit for fear of problems.

He couldn't control Cedieu's little thoughts colliding randomly in his mind. He only knew that this uncomplicated operation in the eyes of others was full of traps and dangers.This is also one of the reasons why Carvey asked Xie Basto to stay awake: "Mr. Director, if you feel any discomfort, please tell me as soon as possible."

Xie Basto's hands had been freed, and he did not forget to make a gesture of nothing: "No problem, I'm fine now!"

Drilling and wire-sawing were methodically moving forward, and Carvey wasn't letting go at all when he was doing sheet metal guidance, as Cedieu thought.

"When using the guide plate, you must pay attention to it, sticking to the inner plate of the skull, and slightly shaking it from side to side while pushing forward. The tactile sensation transmitted back can let you know what the front end of the guide plate encountered, and it can also avoid damage to the dura mater."

He demonstrated while talking, but several guide plate piercings were not handed over to them.

The main problem is that even the metal guide plate may puncture the dura mater when he is guiding. At this time, if it is not handled properly, it will easily damage the cerebral cortex below the meninges [2].The only thing that can be entrusted to them is the last step of wire saw cutting, which has almost no technical difficulty.

"What if the hard guide plate at the front accidentally punctures the meninges?" Suddenly Carvey asked, "How will you solve this trouble?"

"Take it back and wear it again."

Paion did not think much without thinking, and soon received a blank stare from Cedieu: "What are you thinking, the angle of the oblique penetration of the guide plate, and the withdrawal will also cause brain damage."

"Then send in another guide plate at the original position."

"No, a rupture in the meninges has already appeared, and the second guide plate that goes in may still get into the rupture."

"The professor is right." Carvey affirmed his two responses, but he was not satisfied, "But repeated negations cannot solve the problem."

Sedieu has never even drilled a hole, so he definitely doesn't know how to solve the problem when the wire saw is threaded: "If this problem occurs when I do the threading, as long as the patient is still alive, I will choose to temporarily put it aside." .First solve the cutting in other positions, and then deal with it last, maybe you can think of a solution when dealing with other positions.”

The idea is correct, it is lucky that there is no forced processing.

"In fact, it's very simple to deal with, because there are two holes in the cutting line." Carvey pointed to the hole made on the other side, and said, "This is a wrong thread, then use another guide plate to pass through the other side. That's it." 【3】

The five holes were cut with a wire saw to form a circle, and the bone flap was formed.

"Come on, each person takes a stripper and pokes it in." Carvey demonstrated again, "Don't pry it up violently, but simply rotate it to a certain angle to break the bone flap at the root."【4 】

The three of them worked together to lift the bone flap, and Carvey used a stripper to separate the adhesions between the meninges and the inner plate of the bone flap: "Give me the ointment and gauze."

After craniotomy, the internal barrier vessels will be damaged, and the bleeding will definitely be severe.In modern surgical treatment of bleeding after fractures, bone wax is used to seal and apply hemostasis. In the 19th century, only trauma ointment could be used.

As the first country to use ointment to stop bleeding, the hemostatic ointment used in the surgery of the Main Palace Hospital is much better than that of Austria, and it even smells like flowers.

"Apply it around, and use gauze to protect it." Kawei covered the edge of the incision with gauze, which acted as a scalp clip and could absorb part of the bleeding. "Give me the rongeur."

The function of the pliers is to bite off the surrounding irregular bone, and start to cut the meninges after processing.

"Tweezers and sewing needles."

Carvey changed the set of tools, clamped a small piece of meninges with forceps, and lifted the dura by piercing the outer layer of the dura with a suture needle.Handing them over to Paion and Cedieu, he cut a small piece of gauze sliver, cut it with a scalpel, and stuffed the sliver into the brain tissue for protection. 【5】

Bleeding is naturally associated with cutting, and the dura is no exception, where the middle meningeal artery runs.Carvey did not have bipolar coagulation in his hands, and sutures were not suitable. The only thing he could use was a soldering iron stick for treating hemorrhage from liver incision margins.

It's just that this time the wire is thinner and the fire is more intense.

"It's quite warm." Xie Basto lay on his side on the cold operating table, wearing a single shirt, only felt the warmth behind his back, and his mood improved, "Although the operation was a bit brutal, it was indeed considerate. "

"The next operation will enter a critical step. Mr. Director must not move." Carvey has already picked up the red-hot wire, and explained with a smile, "If you really want to move, you must tell me in advance."

"Understood." Shebasto felt his nose itch as soon as he finished speaking, "Can I touch my nose?"

"please hurry."

".All right."

"Stop moving!"

"Ok."

The red-hot wire is very effective in dealing with bleeding from the small blood vessels at the cutting edge of the liver, but when dealing with brain tissue and meninges, such firepower seems too fierce.If it is placed directly on the bleeding site, coke will be scalded in both places, and even if the temperature is not up to standard, it will cause large-scale shrinkage of the tissue.

"Old method and new use." Cedieu was dissatisfied in his heart, but he still couldn't help admiring, "It can still be used like this."

"What we have to do is to let it have a local dehydration effect. The power must be well controlled, not too big or too much. Sometimes we can't even approach it directly, just rely on the temperature emitted from the surrounding. The high temperature causes the tissue to stick to the wire, exacerbating the damage."

Carvey made a demonstration: "It's like when grilling meat, without oil, just put the meat directly on the grill."

Suddenly Xie Basto smiled and said: "Barbecue? Ah, I only thought about drinking at the dance, and didn't eat anything. I'm hungry after hearing what you said."

"Let's eat after the operation is over."

"I don't know if I hit my head. Why do I always smell a smell of meat?" Xie Basto was very obedient and didn't move, but simply shrugged his nose, "It's quite fragrant, could it be a hospital Restaurant outside?"

Carvey patted him on the shoulder with a smile, and brought the topic back: "But this method is only suitable for small bleeding spots. As for the arteries, they still need to be ligated."

If skull drilling is the basis of craniotomy, then meningeal treatment is the first advanced operation.It does not help the craniotomy itself much, but it will affect the recovery after the operation. If it is not handled well, the whole operation will be useless or even counterproductive.

After all, Cedieu has worked in surgery for many years, and has profound basic skills. Although he is not proficient in operation, at least he will not be impatient. One word stands out: stable.

In comparison, Paion was not so relaxed, and his technique was much worse.

"Doctor Peon, you should be responsible for the bone flap and the surrounding skull." Carvey took over the suture thread in his hand, "The cut bone flap needs to be drilled, and the surrounding skull also needs to be drilled. There are awls and screws on the preparation table." and connecting iron pieces. Six small holes are made around the bone flap and on the corresponding skull, and it will be fixed at the end of the operation.”

Peon knew that this was driving him away, but there was no other way.

There are not many assistants needed for craniotomy, and more are to do other auxiliary work.The operation officially entered the cranial cavity. If you can’t keep up with the rhythm, it’s better to leave before you make a mistake. Besides, the opening itself is also training his hand feeling and preparing for the formal drilling in the future: “I know.”

Peon was in charge of drilling the skull, firstly to fix the bone flap after surgery, and secondly to suspend the dura mater.

The dura mater flap after incision is turned over and fixed on the inner side of the previously opened flap, and the remaining dura mater cutting edge is suspended along the edge of the bone window to make it fit closely with the inner plate of the skull to prevent postoperative hardening. Extramembranous hematoma formation. 【6】

The reason why Peon was withdrawn was because the suture needle must be gentle when passing through the meninges, and care must be taken to avoid damaging the underlying brain tissue.

In this respect, Cedieu is definitely more reliable than Paion, who just got out of the internship.

The meninges were completely cut open, and what caught everyone's eyes was a large area of ​​blood clots and spilled blood.From the perspective of the area alone, the amount of bleeding in the frontal lobe does not seem to be a lot, but Xie Basto just lay there without symptoms.

"I'm responsible for blood accumulation and blood clots, you hang the meninges." Kavi only demonstrated once, then handed over the work to Cedieu, and he picked up the suction device again, "Under control Handle speed, don't go too fast."

Kavi blocked the hole of the suction device with his finger, feeling the suction force: "Just a little more. Lighter, that's it! Prepare gauze and wire."

The blood clot of acute bleeding has just formed, the hematoma area is limited, and the brain tissue has not been stimulated to ooze to form a hematoma membrane.It is much simpler to deal with than chronic hematoma. It does not need to peel off the blood clot, and only needs to be washed to achieve the purpose of removal.

But relatively, fewer blood clots means that the bleeding has not stopped, which is much more dangerous than chronic.

"Let's deal with the outer edge, the weaker hematoma first, so as to avoid the bleeding point in the central area." Carvey used a syringe to drip saline into the hematoma area, "After continuous flushing, we began to go to the thicker central area .”

While explaining to those two, the syringe in Carvey's hand also began to approach the center, and everything seemed to be developing in a good direction.

But suddenly, a thin blood clot in the central area was suddenly washed away, and then the veins hidden below began to gushe out crimson blood as if the gate had been opened.

This is the scene that Kavey least wants to see, but he has already prepared to deal with it. Before Paion and Cedieu can react, he uses gauze and wire together to freeze the bleeding point: "Mr. Xibasto ,how do you feel?"

"Feeling? It feels good." Xie Basto lay down quietly, "It's just that the shoulders are not comfortable after lying down for a long time, and the bed is too hard."

"Well, it's okay, it'll be over soon." Carvey motioned for the nurse to get two cushions, "I'll put the cushions on you when I'm done here, and you'll be more comfortable by then."

"Thank you."

(End of this chapter)