Chinese medicine: When you do things to the extreme

Chapter 77: Not Enough Manpower (Subscription Request)

Zhou Yanqing's original intention was to report his own shortcomings, but he did not notice that he had directly broken through the defenses of Liu Wanqing and Tian Chao without any preparation.

I quickly calmed down and pretended nothing had happened. After fixing the distal end of the tendon in the same way, the rest was the relatively familiar suture.

Liu Wanqing had a deeper knowledge reserve. He hesitated for a moment before asking, "Yanqing, what suturing method are you going to use?"

"Let's use the Tang method." Zhou Yanqing replied after carefully examining the stump of the tendon.

"What about the tendon periarthritis?" Liu Wanqing asked.

When it comes to tendon suturing, we only talk about it in general terms, such as the Tang method, modified Chung method, and many other suturing methods. However, these suturing methods are actually all aimed at the tendon core.

In the eyes of truly professional hand surgeons, tendons can be divided into peritendinous areas and tendon cores.

"Tendon circles are usually inverted or cruciate. Use whichever is more convenient. Brother Ning Zhu never gave any special instructions."

"Master, which type of suture do you usually focus on?" Zhou Yanqing asked Senior Brother Liu Wanqing based on the principle of asking when you don't understand.

After Zhou Yanqing arrived at the hospital, he had fewer opportunities to perform on stage and basically followed Brother Ning Zhu.

The technical core of this group is Professor Tan Zhongyu. If Professor Tan Zhongyu has other recommendations, Liu Wanqing may not be able to implement them but will remember them, and Zhou Yanqing will naturally choose them.

Tian Chao answered this question first: "Master said that interlocking horizontal mattress suture would be more useful."

"Brother, I read in a book that sutures of zone II tendons usually use 4-strand or 8-strand thread for tendon core suturing. Isn't the Tang method generally done with 6-strand thread?" After Tian Chao answered, he raised a question that was difficult to answer.

When professionals communicate with each other, they are naturally more professional.

Tian Chao's question must have been based on the book. Zhou Yanqing himself did not have such a deep understanding, so he could only explain: "You can ask Master about this question. If you can figure it out, you can ask Master about it."

"We can be considered half-hand surgery experts..."

Is it the job of a young doctor to answer questions based on the basic principles of suturing, which are not given in the books?

No, young doctors should learn first, slowly accumulate theory and hands-on experience, and when they have reached a certain level, they can then ask about the unknown in their hearts.

At present, what Tian Chao said has not been recorded in textbooks, but the modified M-tang method is indeed inconsistent with the 4-strand and 8-strand sutures recommended by textbooks. However, in actual clinical operations, the M-tang suture method is easy to use.

Then you can only use it first.

Zhou Yanqing can only use his own operations to answer the technical blind spots that Liu Wanqing and Tian Chao cannot operate. Knowledge and theoretical blind spots still need to be continuously accumulated.

This is the profoundness of medicine.

Of course, Tian Chao didn't mean to embarrass Zhou Yanqing. He just thought of this doubt and asked casually.

If you can get the answer, you will gain something; if you don’t get the answer, you won’t suffer any loss.

Then, Tian Chao and Liu Wanqing carefully observed Zhou Yanqing's improved M-tang suture technique.

Inside the door to see the door, the layman to watch the fun.

Liu Wanqing has already reached the level of tendon suture. Tian Chao considers himself a genius. He has already passed the half-layer suture of orange peel and is now working hard on the suture of tofu. Naturally, his sights are also on the tendon suture corresponding to the stretching cuff.

Tendon suture has a very high suturing threshold.

The reason why many people easily tear tendons when suturing them is because they fail to control the strength, angle, and method of suturing, and even where to sew and where not to sew, are all the contents that hand surgeons have experienced and studied for a long time...

While watching Zhou Yanqing suturing the superficial flexor tendon of the digitorum, Liu Wanqing said to Tian Chao: "Tian Chao, when you start trying to sew tendons in the future, you must pay attention to one problem, that is, the 'spiral' of the superficial flexor tendon of the digitorum. You must not be careless."

"After bifurcation at the metacarpophalangeal joint, the flexor tendon of the digitorum superficialis wraps around the extensor tendon and crosses over to insert on the palm side of the middle phalanx."

"At this time, the two ends of the superficial flexor tendon of the digitorum rotate 90 degrees in opposite directions. If you are not careful enough, after the tendon is sutured in a seemingly satisfactory alignment, it will cause compression of the deep flexor tendon of the digitorum."

"You must pay attention to this point. When you can start suturing the tendons in the future, your superiors will brainwash you over and over again."

"Now the brainwashing process can begin..." Liu Wanqing, upholding his identity as a senior doctor, began a relatively professional teaching 'endorsement'.

Liu Wanqing really means memorizing when he memorizes. He applies the knowledge in the textbook to clinical practice and breaks down every small operation in detail.

Zhou Yanqing did not reply. He followed the book's recommendation very standardly, repairing the superficial flexor tendon first, and then the deep flexor tendon...

After the superficial flexor tendon and the deep flexor tendon are repaired, the distal interphalangeal joint is stretched and the tendon repair electricity is sent to the intact distal flexor tendon sheath. In this way, the cross-tendon sheath in the C1 area has been repaired.

Only after doing all this did Zhou Yanqing breathe a sigh of relief.

The treatment of tendon position ends here!

However, there is then something more troublesome to deal with, namely vascular damage.

When Zhou Yanqing saw the blood vessel damage, he actually felt a little overwhelmed.

Originally, according to the standard treatment principle, the blood vessels should be treated first, and then the tendons, but there was no other way. Zhou Yanqing's current blood vessel suturing skills were not up to the standard of regular blood vessel suturing in Xiangya Hospital. He was given the task at a critical moment.

Considering that this is only a trauma in zone II and not a severed finger, the tendon should be treated first, then the blood vessels. Changing the order of treatment will not have any impact, after all, the tendon does not cover the anatomical position of the blood vessels.

However, I have already handled it, and my superior has not yet stepped down to take over.

It seems that I really have to bite the bullet and suture the blood vessel myself.

Vascular suturing in clinical operations is not the same as animal testing!
If the blood vessels in animal experiments are broken, it will only be a mouse, or even just a segment of the blood vessels of a mouse that can no longer be operated or used.

In clinical practice, if the suture is not performed properly, Zhou Yanqing's tendon suture would be in vain.

Zhou Yanqing looked up at the timer on the operating panel.

00:40:21!

00:40:22!

The constant flashing of the seconds made Zhou Yanqing's mind a little more confused. He then glanced at Liu Wanqing and said, "Senior Brother Liu, I'll go to the next room and ask, how long will it take for those teachers to leave the stage?"

"If it takes too long, we can only sew it up first, barely sew it up, and if it doesn't work, let the teacher go back to the palace for the second time!"

Zhou Yanqing said this and left the operating table.

In case the teachers next door have free time and only need to wait half an hour or an hour, they will definitely do the suture and the effect will be better.

Zhou Yanqing needs to practice his skills, but he won’t ask for operations that are beyond his ability or that are difficult for him!
However, Zhou Yanqing soon came back with a gloomy face.

Liu Wanqing said, "Master and Professor Huang can't come?"

The superiors in the department who are particularly capable of suturing blood vessels are Professor Tan and Associate Professor Huang Xianming. Even Ning Zhu, who is more capable than Chief Attendant Liu Qingshan, is not actually a complete master!

Associate Professor Huang Xianming's vascular suture technique is not at the top level, but it is estimated to be slightly better than that of Zhou Yanqing's own teacher, Gong Yi from Hengda Affiliated High School.

The standard for vascular suture at the First Affiliated Hospital of Hengda University is lower than that of Xiangya Hospital.

"The severed limb over there is expected to take more than four hours. We can't wait for them to step down."

"Even if we complete the vascular suture first, it will take more than two hours. It has been more than three hours since this patient was injured, so it is difficult to directly determine the absolute threshold of six hours for blood circulation recovery."

“But there’s still no surgical microscope available, so we’ll have to wait a little while!”

The requirement clearly stated in the textbook for the severed finger replantation team is that it must be undertaken by a surgeon who has at least mastered reliable vascular anastomosis technology (with an expected patency rate of 90% or higher)!
From this we can see how important vascular suture is in hand surgery.

There is no emphasis on physicians who can suture nerves.

For all surgeries, the patient must be able to survive first.

The diameter of the proper digital artery in an adult is about 0.2mm~0.5mm, which is much smaller than the range that can be directly operated through the eyepiece, and a surgical microscope is required.

It is generally recommended that a surgical microscope be used if the diameter is less than 2 mm.

There are only three surgical microscopes for hand surgery, and they are all currently in use!

Surgical microscopes are expensive to purchase, and even for Xiangya Hospital, it is not possible to have as many surgical microscopes as it wants.

After Zhou Yanqing finished speaking, Liu Wanqing and Tian Chao were also helpless.

Liu Wanqing said, "If we can only wait, then there is nothing we can do. Let's loosen the tourniquet first!"

"A little bleeding is okay."

There are also requirements for the application time of the tourniquet. It cannot be applied all the time. Even for continuous surgery, the tourniquet needs to be applied for 90 minutes, then released for a period of time and wait for 15 minutes before continuing the surgery.

It took about 20 minutes for two circulating nurses to push the surgical microscope over and, with the help of Zhou Yanqing and others, skillfully put on the sterile handle bag again!

It is convenient for Zhou Yanqing and others to adjust the height and angle of the viewing lens to complete the operation.

"Teacher on patrol, in the operating room next door, is there still no teacher who can step down?" Zhou Yanqing asked at last.

The roving teacher nodded: "Yes, when I came here, I was just dealing with a middle artery injury. A middle artery injury can be treated without a surgical microscope for the time being, so there is a chance to push it over."

"From what Professor Tan said, let Dr. Zhou in the operating room perform the vascular suture operation, and you can judge it yourself."

"If you really feel it is difficult, just go downstairs and call for help from the next room." After Xun Xin said this, he assisted Zhou Yanqing and others to inflate the tourniquet again, and then walked directly out of the operating room.

In the operating room, Zhou Yanqing and others no longer hesitated: "Continue the operation, tissue scissors!~"

(End of this chapter)