Start From Emergency Doctor

Chapter 267

The academic speech has a characteristic, simple to the extreme, but the summary is very concise, and the topic of the whole speech can be seen from the title.

And this title, “Toe Transplantation and Reconstruction of Fingers and the Basic Perfection of Reconstructed Fingers and the Concept of Finger Modification Reconstruction”, anyone with a discerning eye can see that it contains three things.

Toe transplantation and reconstruction of fingers everyone knows, after all, everyone came for this technology, but…what the hell is the perfect foundation of reconstructed fingers?

We haven’t figured out your remanufactured finger yet, you have already started to perfect it!

It feels like the experts are just preparing to learn the one-dimensional linear equations, and have not yet figured out the concepts and solving methods. Zhou Yuan directly proposed the second and third solutions of the one-variable linear equations!

And the last “finger modification concept”, just the two words concept, experts can see that this is a brand-new field, and it is still in the theoretical stage… This feeling is given when the first equation of one yuan You made a linear equation in two unknowns…

“Does he… think we have mastered the finger of reconstruction?”

“Did he alone push the remanufactured finger to a new stage of development?!”

Some people with a keen sense of smell can no longer sit still, and each of their eyes seems to be shining.

“All of you here are here to listen to the finger reconstruction surgery. I must have a lot of questions about this operation. Then I will skip the others and talk about this process directly…”

Zhou Yuan pressed the laser pointer, and the ppt turned down.

“First of all, it’s the choice that everyone cares about the most. According to the principle of selection of dominant blood vessels, rebuilding the index finger must choose the second toe of the foot. If you rebuild the middle finger, you can choose the second toe on both sides. If you rebuild the ring finger, choose the same side. Second toe…”

“The debridement of the hand is an ordinary debridement, which removes foreign bodies and removes inactivated and contaminated tissue. Skin tissues that cannot be judged as viable should be removed. In addition, the fracture must be flattened to clean up the wound. Fragments of bone to facilitate the reconstruction of the thumb after the toe transplantation~ˇ.”

“During the cleaning process, find the flexor and extensor tendons and mark them and fix them. In this process, the wound is cleaned again with dilute iodophor and normal saline, and this time the cleaning must be performed under a microscope!”(Read more @ wuxiax.com)

The experts froze.

Why do we need to debride twice? And also need a microscope?

The most important thing for finger reconstruction surgery is time. The longer it takes, the lower the success rate of replantation of the severed limb and the worse the postoperative healing. Will the waste of time on debridement cause the inactivation of the severed limb…

Zhou Yuan clearly recognized the experts’ concerns and said, “Everyone, please pay attention, this is a toe transplantation and thumb reconstruction operation! That is to say, there is no severed finger waiting for transplantation. Let’s clean the finger first. The toe is still on the patient’s body, so there is no need to worry about inactivation of the severed finger at all!”

“The operation of toe transplantation to reconstruct the thumb is more demanding than the replantation of a severed limb. The use of a microscope to remove foreign bodies and contaminated tissues that are invisible to the naked eye, and at the same time, the blood vessels and nerves that require gentle separation and marking can be improved. Helping.”

John Joe was taken aback: “That’s it…”

Shen Yuanjing glanced at the unknown son next to the gate, and found that his disciple was meditating and seemed to have his own thoughts, but after all, he did not stand up to ask questions.

Zhou Yuan turned to the next page and said: “Then is the preparation for the palm transplantation. Cut the skin 0.5 to 1 cm between the first and second metacarpal bones on the back of the hand-of course, this needs to be remade according to the fingers you need. Adjust the incision, such as reconstructing the middle finger and ring finger, choose to cut between the third and fourth metacarpal bones.”

“After cutting the skin on the back of the hand, free one or two dorsal palmar veins, mark them and set aside. After that, cut about one centimeter between the webs of the fingers to free the common artery of the first finger and set aside. Intrinsic nerves, mark and spare.”

At this moment, the gate unknown child stood up with fiery eyes, “I just want to know how your toes are cut!”

Another difficulty in reconstructive finger surgery is to intercept the toes and expose the various blood vessels and nerves.

Normal limbs are protected by various tissues. How does Zhou Yuan remove them and select blood vessels and nerves for anastomosis?

Dean Fang, Shen Yuanjing, Richard and others all stared at Zhou Yuan, looking forward to his answer.

Zhou Yuan smiled and glanced at the door unknown.

Sure enough, he is someone who doesn’t care about anything but cures… It’s very impolite to suddenly stand up and ask questions during a speech.

However, not many people were disgusted at the scene, and they also wanted to know the answer to this question.

“Okay, you sit down, next I will talk about toe cutting.”

Zhou Yuan turned the page, and the anatomical picture of Wang Dong’s operation appeared on the screen.

A V-shaped incision has been made on the bloody toe, and a scalpel falls on it, carefully cutting the shop.

Zhou Yuan: “¨ Design a small V plus a small S dash on the dorsal side of the second toe, which will facilitate the subsequent resection. The skin of the dorsum of the foot is cut according to the two design lines, from the dorsal side of the metatarsophalangeal joint Make an incision of about two centimeters toward the proximal end, a small V-shaped incision at the bottom of the toe, and free 1-2 dorsal plantar veins in the superficial fascia of the dorsal incision. After the veins are freed, they are gently pulled to one side for protection.”

“Next, find the second toe tibial dorsal digital artery in the incision between the webs of the first and second toes-this is an important blood vessel for connection, and the effect of separation must be ensured. Then it is determined that it has entered the toe body and its tube diameter More than 0.5 mm, follow the artery to the proximal end to the first dorsal metatarsal artery about 2 cm, ligate each branch along the way, block the blood supply, prevent excessive bleeding (nono is good), and prevent blood obstruction The surgical field hinders the operation.”

“At the same time, continue to make the previous incision, in which the proper tibial plantar artery of the second toe, the proper plantar artery of the fibular toe of the second toe, and the tibial plantar of the second toe can be easily separated from the incision. The communicating branches between the proper arteries and the common plantar artery of the first toe. These are the main blood vessels we need to use. The lack of one will cause blood supply obstacles, affect the results of the operation, and even cause the operation to fail.”

“In addition, when the first dorsal metatarsal artery or the tibial dorsal digital artery is mutated, the arteries I mentioned above can be used as alternative arteries. Sharply separate and cut the bilateral proper toe nerves, and cut the toe flexor and extensor tendons according to the tendon defect. Finally, the toe was severed from the metatarsophalangeal joint capsule.”

Zhou Yuan combined pictures and texts and explained while pressing the laser pointer.

At this step, the toes except the arteries and veins have been completely free. .