Zhang Fan is the chief surgeon, and Chen Qifa is an assistant. The palm replantation operation is performed on the same table. The two surgeons sit face to face to perform the operation. The instrument nurse's instrument cart is parked opposite the patient, so the third doctor is not there. location! What to do, I can only let Tong Lili stand on Zhang Fan's left hand side, there is no way I can't put down the stool, if I don't want to have the surgery, I don't have to have the surgery, if I want to have the surgery, I have to stand.
Because the operation took a long time, the anesthesiologist chose general anesthesia instead of brachial plexus block after inquiring about Zhang Fan. Surgery, especially orthopedic surgery, attaches great importance to debridement. The basic principle of surgery is to completely remove contaminated and lifeless tissues, and this debridement is not performed at will.
It is necessary to carefully study the x-ray before the operation, and then combine the specific conditions of the palm to determine the scope of debridement and the shortened length of the bone, because it is a severed operation, the severed palm is like a flesh-colored rubber doll, without any blood color ! Put it on the ground, if you don't look carefully, you might be able to see it as the hand of a rubber doll!
Due to the development of surgery, equipment nurses are becoming more and more important. A mature equipment nurse cannot cooperate with surgery proficiently without one or two years of training. Doctors perform operations in different departments, but equipment nurses do not know different departments. You must know the nouns of all instruments proficiently, and you must also be proficient in surgical procedures.
Because the doctor performs the operation, no matter what step to take, the equipment nurse has to prepare the equipment to be used in advance. If you are not familiar with the operation steps, you will be unlucky to meet a doctor with a bad temper one day, and you can just throw away the surgical equipment~!
The slightly older equipment nurses and desks can tell at a glance how good the doctor is, so young surgeons deliberately try to please some old nurses in the operating room, because if they are not pleasing, they may spread the news what to say.
For the debridement of the isolation operation, two doctors should carry out the debridement at the same time, so as to save time and gain more time. The debridement must be carried out according to the anatomical level. One step surgery ready.
For this simple debridement, the chief surgeon must think about the steps, which one to do first, and which one to do later, just like a war, the formation of troops before the war begins must be clear in mind.
The most important muscle in the palm is the thenar. This muscle is unique to humans. The gorillas are genetically the closest to humans, but these furry animals do not have the thenar. This is how much time passed by the human ancestors. earned by labor. Where is the thenar? It's the lumpy muscle attached to the thumb.
After debridement of the muscles, the next step is the bones. Inside the metacarpal bones, the most important thing is the metacarpophalangeal joints. This joint must be preserved as complete as possible.
Zhang Fan lowered his head to perform the operation with Lao Chen. Tong Lili's job was to ensure a clear view of the operation. In layman's terms, she was pulling the hook to wipe the blood. Every surgeon comes here in this way, first to see the operation, the so-called third and fourth assistants, pull hooks to wipe blood, use suction device to suck blood, one operation, first watch dozens of times, and then slow down from the second assistant to the first assistant. Boil slowly.
This period of time gradually distanced some doctors. Surgery is a job that combines talent and hard work. Some doctors deliberately train surgical skills after surgery. For example, they need to use some laparoscopic techniques. When they go home, they will hold two similar poles and keep training. A big distance can be opened in one year. This is the difference between working hard and not working hard.
If you pay attention, many surgeons often hold these things in their hands and play with them non-stop. This is not just to play for boredom, maybe they are training a certain surgical technique.
After debridement, the broken bone should be repaired and fixed first. This is a matter of principle. Only after the bone is fixed can other organs be repaired. If the fracture is not fixed well, just move it lightly, and the blood vessel that has just been repaired will pop again. broken!
After the fracture is treated, it is the repair of the muscles. If it is a severed injury, the surgeon most hopes for a sharp cut injury, because it is easy to repair. If it is a rolling injury, it is estimated to be very, very troublesome. Maybe there is no chance to repair it. amputated.
After the muscle repair is completed, the blood vessels are formed. Zhang Fan and Chen Qifa began to operate under the microscope. The thick veins should be anastomosed as much as possible, which is the channel to ensure the return of blood, and the repair of the arteries should be decided according to the situation. The radial-ulnar artery is easier to do end-to-end anastomosis.
Generally, the incidence rate of palm interruption 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 is broken at the place where it branches off from the two proper digital arteries, it will be troublesome. The main surgical knife must be well designed, because one common digital artery can only anastomose with one proper digital artery. If the design is not good, there may be problems. One finger lacks direct blood supply. Then it leads to poor terminal circulation, which is especially easy to cause some sequelae.
In order to restore the function of the hand to the best state, the nerves must be repaired in the first stage in principle. The disconnection of the sensory nerve, whether in the carpal tunnel or the palm, should be repaired in the first stage. This is too important.
The operation was carried out slowly, and the time was lost bit by bit. Because it was operated under a microscope, Tong Lili became more and more boring as she watched it. She didn't know how far Zhang Fan and the others had progressed, and she couldn't see clearly what they were doing.
And it has been more than two hours. I was very tired after a sleepless night shift, but now I have stood for more than two hours, and my calves are sore and my feet are numb. She couldn't bear it any longer, she still gritted her teeth and insisted on standing up to now.
Zhang Fan performed the operation fairly quickly, and just like that, it took three hours to suture the nerve. The subsequent surgical steps were simple, and Zhang Fan and Lao Chen began to communicate, "Today, you should take care of yourself and pay more attention to the blood supply in your hands."
"Well, good master." Old Chen nodded.
"Routinely give some antibiotics."
"OK, all right."
"Doctor Tong, what is the biggest complication of this replantation?" Zhang Fan wanted to see if Tong Lili was caring, so he asked abruptly.
"Hmm! Infection, necrosis?" Tong Lili said a little uncertainly. Standing for more than three hours, and the boring post-operative surgery, she was already a little mind-wandering, because she really couldn't stand up because she didn't distract her attention, but when Zhang Fan asked fiercely, she couldn't speak.
"It's a vascular crisis, so patients with this kind of surgery must not smoke or be in a smoking environment. Once a vascular crisis occurs, antispasmodic drugs must be used first. If it doesn't work, a second surgery will be required!" Zhang Fan explained .
The replanting of a severed palm is finished and bandaged. Zhang Fan stretched his waist, looked at Tong Lili who was still standing beside the operating table and said, "Let's go! It's over."
"My legs are numb! I feel like I can't walk anymore!" Tong Lili's voice was full of tears, not because of the numbness of the legs, but because she felt that she couldn't adapt to this kind of work. Not only was it boring, but also the operation time was too long. long.
She is sad, sad, and blames herself. To be honest, if she didn't really like microsurgery, it would be really embarrassing for a weak woman to do this kind of surgery. Wang Yanan is a special case, because her hobby is her biggest motivation. Tong Lili is different, she is to choose a good department. Departments that cannot be marginalized.
Life is so cruel, I can't adapt, I can't take it down, I can only let Xian leave, there is no sympathy to talk about, and the hospital is not a place to talk about sympathy!
The nurse helped Tong Lili out of the operating room with difficulty. When she stepped out of the operating room, Tong Lili held on to tears for a long time, and finally rolled down on the blue mask.
Rather have hope than despair! Tong Lili couldn't find the meaning of being in the operating room! She is really discouraged! My heart hurts like a knife stirring!