Zhang Fan is the chief surgeon, Chen Qiyi is an assistant, the operation of palm replantation is done on a table, the two surgeons sit face to face to do the operation, and the instrument nurse's instrument cart is parked opposite the patient, so the third doctor has no place! What to do, I can only let Tong Lili stand on Zhang Fan's left hand side, there is no way to put down the stool, I don't want to go to the surgery, I have to stand.

Because of the long duration of this operation, after the anesthesiologist asked Zhang Fan, he chose general anesthesia instead of brachial plexus block. Surgery, especially orthopedic surgery, attaches great importance to debridement, and the complete removal of contaminated and lifeless tissue is the basic principle of surgery, and this debridement is not performed at will.

It is necessary to carefully study the X-ray before the operation, and then determine the scope of debridement and the length of the bone shortening in combination with the specific situation of the palm, because it is a severed operation, the severed palm is like a flesh-colored rubber doll, without a little blood!

Because of the development of surgery, instrument nurses are becoming more and more important, a mature instrument nurse, without one or two years of training is not able to skillfully cooperate with the operation, the doctor is divided into specialties to do surgery, but the instrument nurse will not be divided into departments, so the instrument nurse must be proficient in all the instrument terms, but also proficient in surgical steps.

Because the doctor does the operation, which step to do, the instrument nurse has to prepare the instruments to be used in advance, and if he is not familiar with the surgical steps, he will be unlucky when he encounters a doctor with a big temper one day, and he can directly throw away the surgical instruments~!

The older instrument nurse and the table can see at a glance how good the doctor's level is, so the young surgeon is particularly deliberate to please some old nurses in the operating room, because if they don't please, they may be able to say something.

The debridement must be carried out according to the anatomical level, and the relevant nerves and blood vessels in the relevant level should be found while debridement, so as to prepare for the next operation.

For this simple debridement, the surgeon must think about the steps, which to do first and then which to do, just like a war, before the start of the war, the arrangement of troops must be clear in his mind.

The most important muscle of the palm is the large ichthys, this muscle is a unique human muscle, the gorilla is genetically the closest to humans, but these hairy animals do not have a large ichthys, which is how many times the human ancestors labored. Where's the big fish? It's the pimple muscle that connects the big finger.

After debridement of the muscles, the next step is the bone, and the most important thing in the metacarpal bone is the metacarpophalangeal joint, which must be preserved as intact as possible.

Zhang Fan lowered his head and did surgery with Lao Chen, and Tong Lili's job was to ensure the clarity of the surgical vision, which was to pull the hook and wipe the blood. Every surgeon comes over like this, first to see the operation, that is, the so-called third and fourth assistants, pull the hook to wipe the blood, use the suction device to suck blood, a surgery, first look at dozens of times and then slowly boil up from the second assistant and the first assistant.

This time period has slowly distanced some doctors from each other, and surgery is a combination of talent and hard work. Some doctors deliberately train surgical skills, such as using some laparoscopic techniques, and he will go home and train with two similar poles. A year can make a big difference, and that's the difference between working hard and not trying.

If you pay attention, a lot of surgeons often have these things in their hands and keep playing with them, which is not boring to play, maybe they are training some surgical technique.

After debridement, it is necessary to repair the fixed broken bone, this is a matter of principle, only after the bone is fixed can other organs be repaired, the fracture is not fixed well, a slight movement, the newly repaired blood vessel snapped, and broke again!

After the fracture treatment, it is the repair of the muscle, if it is a broken injury, the surgeon hopes most for a sharp weapon cutting injury, because it is easy to repair, if it is a rolling injury, it is estimated that it will be very, very troublesome, maybe there is no chance to repair, direct amputation.

The end of muscle repair is blood vessels, and Zhang Fan and Chen Qiqi began to operate under the microscope. Thick veins should be anastomosed as much as possible, which is a channel to ensure blood return, and arterial repair depends on the situation. The radial-ulnar artery is easier to do with an end-to-end anastomosis.

In general, the incidence of palm interrupt is the highest, and the survival rate after replantation is also the lowest, which is related to the difficulty of revascularization.

When the common digital artery breaks at the distal end of the two finger propria arteries, this is troublesome, and the surgical chief must be designed well, because a common artery can only anastomosis with the propria artery of one finger, and if the design is not good, there may be a lack of direct blood supply to one finger. Then it leads to poor terminal circulation, which is particularly prone to cause some sequelae.

In order to restore the function of the hand to the best state, the nerve must be repaired in the first stage in principle, and the disconnection of the sensory nerve, whether in the carpal tunnel or the palm, should be repaired in the first stage, which is too important.

The operation proceeded slowly, and time was lost little by little, because it was operated under the microscope, the more Tong Lili looked, the more boring it became, Zhang Fan, where they went, she didn't know, and she couldn't see what she was doing.

And it's been more than two hours, and I'm very tired after a sleepless night shift, but now I've been standing for more than two hours, my calves are sore, and my feet are numb. She couldn't hold it anymore, and she gritted her teeth and insisted until now.

Zhang Fan's surgery was quite fast, and in this way, it took three hours to complete the nerve stitching. The next surgical steps are simple, Zhang Fan and Lao Chen began to communicate, "Today you will worry more about snacks and pay more attention to the blood circulation of your hands." ”

"Well, good master. Lao Chen nodded.

"Give some antibiotics routinely. ”

"Well, okay. ”

"Doctor Tong, what is the biggest complication of this replantation?" Zhang Fan wanted to see if Tong Lili was a caring person, so he asked fiercely.

"Hmm, infection, necrosis?" said Tong Lili with some uncertainty. After more than three hours of standing, the boredom of the later operation, she was already a little brain wandering, because she didn't distract a little attention, she really couldn't stand, but when Zhang Fan asked fiercely, she couldn't get up.

"It is a vascular crisis, so the patient of this surgery must not smoke and in a smoking environment, and once the vascular crisis surgery occurs, antispasmodic drugs must be used first. If it doesn't work, you'll have to have a second operation!" Zhang Fan explained.

A severed palm replantation is considered to be done, and it is bandaged. Zhang Fan stretched his waist, looked at Tong Lili, who was still standing on the edge of the operating table, and said, "Let's go! ”

"My legs are numb! I feel like I can't walk!" Tong Lili's voice was full of crying, not because of the numbness in her legs, but because she felt that she couldn't adapt to this kind of work, not only was it boring but the operation took too long.

She is sad, sad, and blames herself, to be honest, if she doesn't really like microsurgery, this kind of intensity of surgery is really embarrassing for a weak woman to do, Wang Yanan is a special case, because hobby is her biggest motivation, and Tong Lili is different, she is to choose a good department. A department that can not be marginalized.

Life is so cruel, I can't adapt to it, I can't take it down, I can only let Xian leave, there is no love to talk about, and the hospital is not a place to talk about love!

The nurse helped Tong Lili out of the operating room with difficulty, and the moment she stepped out of the operating room, Tong Lili held on to tears for a long time, and finally rolled off the blue mask.

I'd rather have hope than despair! Tong Lili couldn't find the meaning of existence in the operating room! She was really discouraged! Her heart hurt like a knife!

.。 m.