Chinese medicine: When you do things to the extreme

Chapter 76: I regret not having enough books when I need them (Subscription required)
"Okay, Brother Zhu, I'll be right there."

"Then who will take me to the surgery?" Zhou Yanqing asked casually.

Professor Tan and Professor Huang both went on stage, and Ning Zhu was also going to go on stage. Could it be that Liu Qingshan was leading him? Although Liu Qingshan was the attending physician, it might be a bit difficult for him to deal with vascular injuries!
It is not certain who will lead whom.

"I don't know what happened today, but suddenly there were three people with severed limbs and two with severed fingers... All the people from the three groups who were able to go on stage have already gone on stage."

"Now, there are only you and Liu Wanqing left. You can call one more person."

"If there are similar diseases in the future, we can only refer them to other hospitals!" Ning Zhu explained quickly.

Zhou Yanqing, who was jogging, paused when he heard this, and his tone became stagnant: "Brother Zhu, you are not kidding, right? Senior Brother Liu Wanqing and I are going to perform the hand injury surgery in Zone 2?"

His eyebrows flickered.

After Zhou Yanqing's theory was improved, it became very clear that hand injuries were not just simple injuries to tendons, blood vessels and nerves.
The handling of tiny structures such as the tendon sheath, pulley, ligament, and digital artery perforators will make many doctors who have truly entered the field of hand surgery feel numb.

Suturing tendons and blood vessels can only barely enter the threshold of hand surgery.

"It has to be done. I have examined your basic skills before, and you are familiar with the basic anatomical structure of the fingers. You have been with me for a month, so you should have a general idea of ​​how to deal with the subtle structure of zone II."

"If it doesn't work, just hold on for a while and sew up the blood vessels first..."

Ning Zhu said this and then asked, "Yanqing, I should have told you about the two basic sources of nutrition for tendons, right?"

"I know, Brother Zhu!" Zhou Yanqing calmed down and started jogging again: "The synovial fluid produced by the synovial sheath of the tendon, the longitudinal blood vessels of the peritumoral membrane, the bone blood vessels at the attachment of the tendon, and the tendon ligament circulation."

"Then go and learn how to deal with it. Special situations require special treatment. You all have to grow up. Dr. Liu Wanqing will graduate soon, and he should be able to master the other most basic procedures..." Ning Zhu said here and hung up the phone.

Afterwards, Zhou Yanqing received a call from Senior Brother Liu Wanqing. It seemed that Ning Zhu had already called Liu Wanqing and made other arrangements.

After Liu Wanqing got through, he breathed a sigh of relief: "Yanqing, it was Brother Zhu who called you just now, right? Were you on the phone the whole time?"

Liu Wanqing didn't wait for an answer: "I'm in emergency operating room 5 now. The patient has been pushed in and received a brachial plexus block. I'm tying a tourniquet in Hotan Chao now. You should hurry over as well."

"Brother Ning Zhu originally said that you had something to do and didn't want you to come, but given the current situation, you have to come and help!"

"Okay!" Zhou Yanqing only had time to reply with one word before the call was hung up.

Zhou Yanqing carried his schoolbag directly into the locker room of the emergency operating room. Fortunately, it was November and not that hot.

Therefore, Zhou Yanqing, who came jogging, did not sweat too much.

After taking off the long-sleeved shirt and casual pants, the heat gradually dissipated under the coolness.

When Zhou Yanqing ran to the door of the emergency operating room that Senior Brother Liu Wanqing mentioned again, Liu Wanqing and Tian Chao were already washing themselves inside.

Zone II injury of the tendon is also called the pulley critical area, and is also known as the 'no man's land'.

Before Verdan and Kleinert's contribution to zone II tendon injuries, there was controversy over whether the flexor tendon should be repaired in zone I in the 'no man's land' defined by Bunnell.

A large number of scholars and top orthopedic experts have failed here.

The main reason for failure of primary repair of zone II tendons is adhesions in the trochlear area.

The injured area of ​​the patient was not large and the degree of injury was not particularly serious, so flushing was particularly simple.

However, after washing, Liu Wanqing looked at Zhou Yanqing nervously, waved his hand and took Zhou Yanqing to the side: "Yanqing, can you treat this kind of wound?"

Dealing with one type of damage individually and performing a single operation from a higher level are two completely different concepts.

When following their superiors in performing surgery, all they have to think about is which part of the operation they can help with, without having to control the entire operation.

"Let's try it first. If it doesn't work, we will do the debridement first, then suture the blood vessels. As for the tendon treatment, we will wait for our superiors to come." Zhou Yanqing didn't see the specific situation, so it was hard to say for the time being.

After all, if the superior judged it to be a simple tendon injury, the patient would definitely not be taken to the operating room. Instead, the patient would be treated directly under local anesthesia in the operating room of the ward.

Then, Liu Wanqing and Zhou Yanqing began to wash and disinfect their hands. After quickly disinfecting and laying the towel, they stood on opposite sides of the operating table.

As a senior brother, Liu Wanqing said responsibly: "Yanqing, let's deal with the blood vessels first."

"The patient's proper digital artery is damaged. Let's sew it up first!"

"Okay!" Zhou Yanqing nodded.

When I usually perform surgery with my superiors, I basically don’t have to spend much time thinking about some difficult operations. However, when I actually have to perform the operation myself, I feel that my knowledge system is not complete enough.

Zhou Yanqing's current basic theory of hand surgery has reached a certain level (specialization 2/5), which is definitely not for show.

"It's a sharp weapon injury. The tendon is shortened, and we may need to use the Strickland repair technique." Zhou Yanqing just briefly explored for a while and said this to Liu Wanqing.

The Strickland repair technique is one of the commonly used techniques for repairing the flexor tendon of finger II. It is widely used and easy to understand.

"Okay! Let's start extending the flap!" Liu Wanqing also knew that now was not the time to waste time.

"Yanqing, you do it. Your incision technique is better than mine." Liu Wanqing admitted defeat. The difference between a real lead surgeon and a supporting surgeon is still too great.

You have to complete the whole process yourself.

Surgery for zone II tendon injury generally requires extending the incision. After Zhou Yanqing confirmed the operation, he carefully dissected and lifted the skin flap through a Z-shaped incision.

"The anatomy of the digital nerve is intact!"

"This is the A2 pulley, and this is the A4 pulley. I've seen these two things when I was reading a book. You definitely can't touch them." As a junior fellow student, Tian Chao could only follow Zhou Yanqing and the others in his thinking. While following the stage, he reviewed the knowledge he had learned from reading the book.

Zhou Yanqing said: "The tendon is located in the C1 cross pulley area, and we need to open the tendon sheath."

As Zhou Yanqing spoke, he made another lateral incision without hesitation, and then after lifting the small triangular flap of the cruciate pulley-tendon sheath, he could see that the flexor tendon of the finger flexor tendon system had retracted a long distance.

"Yanqing, the tendon has retracted. What should we do now?" Liu Wanqing frowned instantly.

Being the main surgeon and being the assistant surgeon are two completely different concepts.

When patients are sick, they seldom follow the textbook treatment. The wound in the C1 cross pulley area sounds a bit difficult to understand. With Liu Wanqing's current knowledge, it is still a bit difficult for him to deal with such a disease.

But fortunately, the level of expertise will never be bad.

Zhou Yanqing said: "Brother, don't worry. I have learned from Brother Ning Zhu before that the tendon retraction at this position can be done using the method recommended by Lister."

"But you need to use a pediatric nasogastric tube or an intravenous infusion connection catheter."

"Circuit teacher, circuit teacher!~" Thinking of this, Zhou Yanqing hurriedly yelled.

For emergency surgeries at this time, one patrol officer is usually responsible for multiple operating rooms. If you need to patrol and open something, you will need to use your voice.

"Itinerant teacher in room 5, open something!~" Zhou Yanqing shouted.

According to Lister's recommendation, the proximal tendon can be easily passed through the tendon sheath and the superficial flexor tendon of the digitorum using an infusion set connected to the catheter.

As for why it was recommended by a foreign teacher, Zhou Yanqing is not the one to explain.

Learn to apply what you have learned. Learn anything that is useful.

When the circulating nurse arrived, she opened a catheter and went on stage.

Then ask, "Are you going to prescribe anything else? Besides the IV and sutures?"

"Not for now, thank you!" Zhou Yanqing nodded, and then after getting the catheter, he still recalled with a bitter face.

Although Zhou Yanqing is not bad at the specialized level of theory, he is not able to master all the operations, techniques and theories of surgical operations with ease.

After getting the catheter, he also has to recall the subsequent operation procedures very carefully. At this step, the operation cannot be supported by just basic operating skills.

"Then me!" the circulating nurse was about to speak.

Zhou Yanqing seemed to remember something again and said, "Open two 25mm hypodermic needles. I will fix the tendon later, and then, it will be gone for now."

Xunxuan shook his head up and down, his eyes slightly resentful.

"Brother, are you a student or a doctor in our hospital? Why do you look so unskilled and unsure?"

"If you don't know, you'd think you're an intern. You look pretty." The circulating nurse looked at Zhou's good looks and began to tease him.

Liu Wanqing and the others remained silent.

Because all three of them are 'fake doctors in this hospital', they are all students.

Of course, the superiors gave the authorization, and the operation of three people was completely in compliance with the rules, but there was no need to worry about the touring sales.

After the tour, Zhou Yanqing finally recalled the subtle operations other than the key basic skills of tendon suture.

After inserting the catheter between the two bundles of the superficial flexor tendon of the digitorum, pass the traction wire of the proximal end of the tendon into the catheter. After clamping the catheter and the traction wire, the tendon can be easily guided through the tendon sheath along the catheter made of the infusion set and merge with the distal tendon.

However, at this point, the operation is certainly not complete.

After the distal tendon retracted, it was pulled to the repair area and needed to be temporarily fixed. This was the use of the two syringes that Zhou Yanqing had asked Xun to open.

A syringe is passed through the tendon and inserted into the tendon sheath upright like killing an eel, and it becomes a temporary device.

Only when the operation reached this stage did Zhou Yanqing slowly become familiar with the subsequent contents.

Because, usually Ning Zhu would try every possible way to push the operation to this step, and then Zhou Yanqing would start to take action!
"Alas, I only regret not having read enough books when I need them!" Zhou Yanqing sighed.

However, Liu Wanqing and Tian Chao cast murderous glances at him.

As if to say, what else do you want?

(End of this chapter)