What?

Compartment syndrome?

Li Hua was completely shocked.

Compartment syndrome is very dangerous and must be cut to decompress as soon as it is detected during extraosseous surgery.

Failure to do so results in irreversible ischemic muscle contractures, and the patient can only be saved by amputation.

Oh my God, it's a very ordinary fall, how can compartment syndrome happen!!

At this moment, Li Hua suddenly understood why the other party had made such an incision just now.

Fascial decompression, in which a medial incision is usually made, is made in a straight line from the anterior edge of the medial malleolus to the posterior edge of the medial malleolus, divided into quintiles.

Take its 2nd and 4th segments as the incision, so the incision is often sieve hole-shaped.

And pay attention to avoid the saphenous vein at the front edge of the incision during the process.

After the skin is incised, it is also necessary to sneak between the subcutaneous tissue and the fascia to the 1st, 3rd, and 5th segments.

Care should also be taken to protect the subcutaneous nerve and the superficial peroneal nerve.

This kind of incision, even if he came, was very laborious.

Previously, Li Hua only thought that the patient had an ordinary fibula fracture, and did not think about compartment syndrome at all.

That's why...

Wait a minute

"How did you know he had compartment syndrome?"

Li Hua looked at Li Xiyang with a strange expression.

Li Xiyang didn't respond, but stretched out his hand to him, "No. 3 blade!" ”

Li Hua was stunned for a moment, and then hurriedly handed it over.

Taking the blade, Li Xiyang raised his head and smiled at him, "Are you ready?" ”

"Huh?"

Without waiting for Li Hua to react, Li Xiyang found the right position and cut the blade along the fascia without hesitation.

At the same time, the fast track:

Pull away the skin ahead...

Exposure of the anterior compartment fascia...

Pull away the skin at the back...

Exposure of the posterior compartment fascia...

Traction of the lateral compartment to the anterior...

Release the soleus muscle from the fibula...

Revealing the deep fascial compartment...

Mobilize the patient's right big toe and confirm that the compartment is opened...

Pay attention to the posterior tibial vascular nerve bundle behind the muscles...

Vaseline gauze loose stuffing...

Topical sterile dressing preparation...

Li Xiyang quickly dissected the periostheascial compartment, and his movements were many times more skillful than when he opened the knife.

Li Hua stood opposite, watching Li Xiyang's operation, and his heart had already set off a monstrous wave.

It's too strong!

The operation lasted only ten minutes, and Li Hua felt unprecedented pressure.

The other party is too fast, too silky.

Many times he didn't have time to cooperate, so Li Xiyang did it himself without saying a word.

Before this, Li Hua never thought that he would one day be unqualified as an assistant.

Is this guy really human?

Li Hua played 120 points of spirit and fully cooperated.

Slowly, he began to keep up with Li Xiyang's rhythm.

At this moment, he even enjoyed it a little, and he was a little satisfied...

The previous shame and embarrassment of beating the resident doctor are all gone.

At the moment, in his eyes, there is only a fascinating surgical operation.

This is the art of the operating room that he has been pursuing!

He stared at Li Xiyang's every movement, hoping to write down more details.

Li Xiyang naturally noticed the change in Li Hua.

With a slight smile, he said, "The patient's skin is slightly red, the temperature is slightly high, the leg joints are swollen, there is severe tenderness, and the intraventricular tension can be felt on palpation.

These are all ancillary manifestations of compartment syndrome.

Although the patient's distal pulse and capillary filling time are normal.

However, special attention should be paid to the increase in intracompartmental tissue pressure to a certain extent, such as 8.66 kPa in the forearm and 7.33 kPa in the lower leg, which can close the arterioles that supply muscle blood vessels.

However, this pressure is much lower than the patient's systolic blood pressure, which is not enough to affect the blood flow of the main arteries of the limb, so it is easy to be ignored by the surgeon.

When I was in the ward, I noticed that although the patient's distal arterial pulse was present, the fingers and toes were flexed, which was a sign of muscle weakness and ischemia. ”

Li Hua suddenly, it turned out to be like this!

However, this observation is too terrifying!!

After a slight groan, Li Hua asked, "What about yesterday's patient?" Did you also find out that he had an aortic aneurysm through observation? ”

"Aortic aneurysm!"

Li Xiyang smiled and said, "Generally, patients with chest injuries, because of the rupture of the diaphragm, often have symptoms of chest tightness, shortness of breath, difficulty breathing, and cold sweats.

However, I noticed at the scene that the patient did not have the above characteristics except for hemorrhagic shock, and his breathing even stabilized abnormally.

In this case, it can only be said that the knife relieves the patient's intrathoracic pressure,

In addition, there is significant venous distension in the neck and shoulders with edema.

This is obviously caused by the aorta being in a state of high pressure for a long time, compressing the superior vena cava.

So I guessed that the patient should be atherosclerosis, or cystic medial necrosis, caused by intra-aortic hypertension! ”

While speaking, Li Xiyang had already completed the periophysis antihypertensive surgery.

Li Hua looked at the other side with a shocked expression, and at this moment he seemed to understand his uncle's intentions.

This guy is incredible!

Su Xintong was also listening in a daze beside him, and secretly said in his heart that Dr. Li is too handsome!

"Alright, now for the fibula fixation!"

Li Xiyang spoke, and Li Hua and Su Xintong immediately cheered up.

Vascular clamp...

Separation layer by layer...

Hand thyroid retractor retracted...

Aspirator prepares...

Removal of blood and fluid bone fragments...

Curette clear callus...

Bone rongeur bites off sclerotic bone...

Bone holder repositioning...

Screw-fastened...

C-arm fluoroscopy...

Flushing the wound, placing an orthopedic drain...

Sterilize the suture incision...

Gauze, gauze pads, dressings, bandages, bandages, incisions...

Loosen the tourniquet!

So far, Li Xiyang's first real chief surgery has come to a perfect end.