Start From Emergency Doctor

Chapter 180

Zhou Yuan was still focused on stitching, and did not notice Dean Fang’s gaze.

“finished.”

Finally, Zhou Yuan put down the needle holder and let out a long sigh of relief.

The blood vessels and nerves are very small, similar to hair, or even smaller. This is the difficult part of stitching.

However, it is better than a capillary of only 0.0076 mm.

If the capillaries were sutured, Zhou Yuan could announce the time of death on the spot.

That thing is exactly the same as the diameter of red blood cells, and it’s not something that humans can sew. The thinnest sutures are thicker than capillaries.

“Isn’t the perfect butt suture method able to suture capillaries?” Zhou Yuan suddenly thought of this.

However, he quickly got rid of distractions and said: “Continue to cross stitch the muscles and tendons.”

The blood vessels ensure blood circulation and provide nutrition and power for the entire palm. The nerves ensure that the sensations and reflexes can be transmitted to every place.

To complete the exercise, what is needed is the stretching, flexion and extension of the muscle tissue.

Without muscles, it is like a ghost press, feeling and alive, but unable to move.

Different muscles have different ways of connecting. For example, the two ends of the tendon are similar in diameter, and they are directly sutured. For tendons with greater tension, steel wires need to be inserted into the muscle tissue and sutured in the auxiliary connection of the steel wires.

The incision left by Zhou Yuan when he sutured the nerves was still left for this step.

In order to minimize the injury, Zhou Yuan’s choice of incision not only exposed the nerves, but also provided a good surgical field for the current muscle sutures.

Since muscles are subcutaneous tissues, absorbable risks are generally used.

“President Fang, help tighten the two proximal ends of the tendon.”

The first step is to suture the proximal end of the tendon.

Dean Fang has experience, took hemostats, clamped the stumps of the tendons on both sides, tightened and anastomosed them together.

The suture of the tendon does not need to be tension-free. The tension itself is very large. Any exercise will cause the contraction of the muscle. Therefore, the suture used is relatively firm. As long as there is no strenuous exercise, it will generally not break.(Read more @ wuxiax.com)

As for the finger part, there is not much violent exercise itself, and the possibility of breaking again is very small.

“30cm filament thread.” Zhou Yuan said.

It’s time to start challenging difficult stitches again.

Muscle suture is not the same as nerve suture. If this thing is intermittent suture, it is time-consuming and laborious, and it will cause too much thread to be sutured, which will limit muscle activity, and may cause muscle stiffness after healing.

Therefore, continuous seaming is the best way. Of course, it also tests technology.

Because the muscles change at any time, even if the patient has lost consciousness, as long as the muscles are still alive, they will twitch twice from time to time, just like a dead fish patted on the head.

Zhou Yuan pierced a slender pointer on both ends of the long silk thread, and then ran the needle through the tendon at a distance of 1.5 cm from the stump of the tendon, making the silk thread equal length on both sides of the tendon.

Next, Zhou Yuan was close to the place where the needle was just inserted, and again inserted the needle next to it, crossing the tendon diagonally and symmetrically through the tendon, repeatedly crossing the needle for a total of three times, and finally tightening the proximal side of the tendon with the hemostat This needle was pierced at 3 mm.

“Scalpel.”

Zhou Yuan held two slender pointers in one hand, and with a scalpel in the other hand, he incised the tendon along most of the proximal part of the hemostatic forceps.

“President Fang, please turn over the hemostatic forceps.”

Dean Fang held the hemostatic forceps in his right hand and twisted it to the side. After turning it over, the section of the tendon was revealed.

The upper tendon has been sutured, and now it’s time to suture the proximal lower tendon.

This time the suture is the same as the previous operation. Finally, after Zhou Yuan crossed the suture several times, he pierced the needle 3 mm proximal to the hemostatic forceps again, just symmetrically distributed with the upper suture line.

There are some tendons in the suture that are redundant. There is no way to avoid this. In order to ensure the quality of the tendon suture, it is necessary to make the two tendons cross a little bit.

After all, the occurrence of tendon overlap can increase the strength of the tendon, but if the tendon is missing, the pressure on the entire tendon will become, and it may collapse under the pressure that it should not have.

After removing the excess tendon, Zhou Yuan tightened the sutures and completed the suture of the proximal tendon.

“Next, the distal end of the tendon is sutured…”

The first steps were almost the same. Dean Fang clamped the stump with hemostatic forceps, tightened the tendons on both sides, and partially overlapped them.

Zhou Yuan did not suture directly, but took a scalpel and cut a part of the tendon along the inner surface of the hemostatic forceps, and then turned the hemostatic forceps over to expose the cross section.

Zhou Yuan looked at the sutured tendon on the proximal side and adjusted the tendon axis. The removal of the tendon is to ensure that the axis of the distal tendon is consistent with the proximal end. Only in this way, the tendon will be uniformly stressed.

After adjusting the axis of the tendon, Zhou Yuan crossed the needle diagonally at the position corresponding to the suture point of the far section and the near section, and led out the suture at a distance of 3 mm from the distal surface.

In the same way, Zhou Yuan performed three consecutive oblique cross-symmetric sutures on the distal tendon, and finally penetrated the tendon, pulled the suture out, and inserted the needle again with the other hand, following the needle entry port of the previous needle. Wear it out.

After finishing the distal suture, Zhou Yuan picked up the scalpel again and removed the excess tendon at the distal anastomosis.

In the suture of the proximal tendon and the distal tendon, Zhou Yuan did not tie the suture. At this time, Zhou Yuan pulled up a suture and pressed the distal tendon with his other hand with a little force. Straighten the curled sutures to eliminate the slack of the sutures in the tendons and affect muscle movement.

On the other side, Zhou Yuan in the proximal segment also tightened the sutures, making the palm off the face and the toe tendons tightly connected.

After finishing the work, Zhou Yuan began to tie the sutures.

Zhou Yuan picked up the needle-holding forceps, ligated the two adjacent sutures, and then turned the knots so that they sink into the surface of the tendon.

Dean Fang was silent.

Even the details are handled so well…

Generally speaking, in such a high-intensity precision operation, after completing an extremely difficult operation, the surgeon’s mood will be relaxed, which leads to the omission of some inconspicuous details.

This is human nature, even Dean Fang sometimes forgets it.

At this time, Dean Fang is just a fixer, so he can observe and think carefully, while Zhou Yuan’s attention is all on the operation of his hands, how can it be possible to think about other…

In other words, Zhou Yuan pressed the knot into the surface of the tendon, which was a subconscious behavior! .