Start with an emergency physician
Chapter 178
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Yuan was still concentrating on stitching and did not notice Dean Fang's gaze.
""It's done."
Finally, Zhou Yuan put down the needle holder and breathed a sigh of relief.
The blood vessels and nerves are very thin, about the same size as a hair, or even smaller. This is the most difficult part to sew.
However, it is better than the capillaries that are only 0.0076 mm.
If it is to sew capillaries, Zhou Yuan can announce the time of death on the spot.
That thing is exactly the same diameter as a red blood cell, and it is impossible for a human to sew it. The thinnest suture is thicker than a capillary.
"The perfect docking suture method can't suture capillaries, right?"This thought suddenly popped up in Zhou Yuan's mind.
However, he quickly got rid of the distracting thoughts and said,"Continue the cross-suturing of muscles and tendons."
Blood vessels ensure blood circulation and provide nutrition and power to the entire palm. Nerves ensure that sensations and reflexes can be transmitted to every place.
To complete the movement, muscle tissue traction, flexion and extension, etc. are needed.
Without muscles, it's like being paralyzed by the devil. You have feelings and are alive, but you can't move.
Different muscles have different ways of connection. For example, tendons with similar diameters at both ends are sutured directly. Tendons with greater tension require steel wires to be inserted into the muscle tissue and sutured in the auxiliary connection of the steel wire.
The incision left by Zhou Yuan when he sutured the nerves before was still kept for this step.
In order to minimize the damage as much as possible, the incision Zhou Yuan chose not only exposed the nerves, but also provided a good surgical field for the current muscle suture.
Since muscles are subcutaneous tissue, absorbable risk is generally used.
"Dean Fang, please help tighten the two proximal ends of the tendon."
The first step is to suture the proximal ends of the tendon.
Dean Fang has experience. He took the hemostatic forceps, clamped the two ends of the tendon, tightened them and sewed them together.
The suture of the tendon does not need to be tension-free. The tension of this thing itself is very high. Any movement will cause muscle contraction, so the suture used is relatively strong. As long as there is no strenuous exercise, it will generally not break. As for the finger part, there is not much strenuous exercise, so the possibility of rupture is very small.
"30cm silk thread." Zhou Yuan said.
It was time to challenge the difficult suture again.
Muscle suturing is different from nerve suturing. If this thing is intermittent suture, it will be time-consuming and laborious, and because there are too many suture threads, muscle activity will be affected. Therefore, continuous lock-edge suture is the best way. Of course, it tests the technique.
Because muscles are changing at any time, the patient has lost consciousness. As long as the muscle is still alive, it will twitch from time to time like a dead fish with its head slapped.
Zhou Yuan put a thin pointer on both sides of the long silk thread, and then, he penetrated the tendon horizontally 1.5 cm away from the stump of the tendon, making the silk thread equal in length on both sides.
Then, Zhou Yuan inserted the needle again next to the place where the needle was just inserted, and crossed the tendon symmetrically at an angle to the stump of the tendon. He repeated the cross-needle insertion three times in total, and finally inserted the needle 3 mm proximal to the tendon tightened by the hemostat.
""Scalpel."
Zhou Yuan held the two thin pointers in one hand, and with the other hand, he took the scalpel and cut the tendon along the proximal part of the hemostat.
"Dean Fang, please flip the hemostat over."
Dean Fang held the hemostat in his right hand and twisted it to the side. After flipping it, the cross section of the tendon was revealed.
The upper tendon has been sutured, and the next step is to suture the proximal tendon.
The suture this time is the same as the previous operation. Finally, after Zhou Yuan cross-sutured several times, he passed the needle again 3 mm proximal to the hemostat, which was symmetrical with the suture line above.
There is still some redundant tendon at the suture point, which cannot be avoided. In order to ensure the quality of tendon suture, the two parts of the tendon must be crossed a little.
After all, the overlap of tendons can enhance the strength of the tendon, but if the tendon is missing, the pressure on the entire tendon will become, and it may collapse if it bears the pressure it should not have.
After removing the excess tendon, Zhou Yuan tightened the suture and completed the proximal tendon suture.
"Next, suture the distal end of the tendon."
The initial steps were similar. Dean Fang clamped the stump with a hemostat, tightened the tendons on both sides, and partially overlapped them.
Zhou Yuan did not suture directly, but picked up a scalpel and cut off a part of the tendon along the inner surface of the hemostat, then turned the hemostat over to expose the section.
Zhou Yuan looked at the tendon that had been sutured on the proximal side and adjusted the tendon axis. The purpose of removing the tendon is to ensure that the distal tendon axis is consistent with the proximal end. Only in this way can the tendon be evenly stressed.
After adjusting the tendon axis, Zhou Yuan sutured the distal section and the proximal section.
The needle was inserted obliquely and cross-stitched at the position corresponding to the suture line point of the section, and the suture was led out 3 mm away from the distal surface.
Using the same method, Zhou Yuan performed three consecutive oblique cross-symmetrical sutures at the distal tendon.
Finally, he penetrated the tendon and pulled out the suture.
He inserted the needle again with his other hand and pulled it out along the needle hole of the previous needle.
After completing the distal suture, Zhou Yuan picked up the scalpel again and removed the excess tendon at the distal anastomosis.
During the suture of the proximal tendon and the distal tendon, Zhou Yuan did not tie a knot on the suture. At this time, Zhou Yuan pulled up He inserted a suture with his hand, and with his other hand pressed the distal tendon, slightly pulling the curled suture straight to eliminate the looseness of the suture inside the tendon and affect the movement of the muscle.
On the other side, Zhou Yuan also tightened the sutures in the proximal section to tightly connect the severed surface of the palm with the tendon of the toe.
After finishing the finishing work, Zhou Yuan began to ligate the sutures.
Zhou Yuan picked up the needle holder and ligated the two adjacent sutures, then flipped the knot so that it sank into the surface of the tendon.
Dean Fang was silent.
Even the details are handled so well...
Generally speaking, in In such a high-intensity precision surgery, after completing an extremely difficult operation, the surgeon will relax and miss some inconspicuous details.
This is human nature, even Dean Fang sometimes forgets.
At this time, Dean Fang is just a fixator, so he can observe and think carefully, while Zhou Yuan's attention is all on the operation of his hands, how can he think about other things...
In other words, Zhou Yuan pressed the knot into the surface of the tendon, which was a subconscious behavior! _Feilu reminds you: Three things to do when reading - collection, recommendation, and sharing
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