Chinese medicine: When you do things to the extreme

Chapter 78 Patient's Gratitude (Subscription Request)
How long is a 0.3mm diameter?

It’s hard to describe, but the diameter of a thick hair is 0.4mm.

This shows how difficult it is to deal with such blood vessels.

The operation has reached this stage, and even if it is difficult, it must be performed.

The severance of blood vessels in trauma is definitely different from the suturing of the severed tail artery of a mouse.

The wound is uneven, but the wound caused by cutting the coccygeal artery is relatively flat.

Therefore, during the operation, the outer membrane of the blood vessels needs to be cut off after trimming!

"Cut a piece of rubber from the glove!" After Zhou Yanqing carefully dissected and exposed the proper digital artery, he instructed Tian Chao beside him.

Zhou Yanqing is the main operator, Liu Wanqing is the assistant, and the rest of the chores naturally need to be assisted by Tian Chao.

The reason for using colored rubber is to pad the bottom of the blood vessels to facilitate observation of the blood vessels. Otherwise, the color on the tissue surface will be the same as the blood vessels, making it difficult to observe even with the help of a surgical microscope.

The artery itself has few obstructive collaterals and does not need to be burned with electrocoagulation.

"The rubber sheet is here. Heparin Ringer's!" Tian Chao handed over a rubber glove sheet and placed the Ringer's solution with heparin next to the operating table. He then drew out a portion of it with a small syringe.

Start flushing the surgical field continuously with heparin solution!

This step is very critical, as it can clean the surgical field while allowing local thrombus to break down under the action of heparin.

Then, Zhou Yanqing used the method of circumcision to pull the vascular surgery and cut it horizontally until it was flat, leaving the vascular endothelium almost undetectable.

After trimming, Zhou Yanqing flushed the surgical field many times with heparin Ringer's solution.

"Tian Chao, go call Xun and ask him to help us adjust the magnification!" Zhou Yanqing said.

When processing the adventitia of the blood vessel, a magnification of 6X-10X is sufficient for the operation, but in subsequent operations, a magnification of 40X is required to observe the blood vessel wall until the blood vessel end appears normal.

After the circulating nurse came over and adjusted the magnification, Zhou Yanqing used the vascular closer to bring the broken ends of the blood vessels together.

At this point, you can start sewing!

For blood vessels of this diameter, only the 120° separation blood vessel cutting and suturing method can be used, and each stitch must be left long as a traction line!

At this point, Zhou Yanqing briefly explained: "When suturing blood vessels, the margin should be slightly larger than the thickness of the blood vessel wall! So when we suturing in the early stages, we must practice controlling the margin of the suture."

“This is especially important when practicing suturing pig blood vessels in the gym.”

After completing the two stitches, Zhou Yanqing turned the vascular closeer again, exposed the back wall of the blood vessel, and then continued to suture again at about 120°!
To be honest, Zhou Yanqing felt his hands trembling slightly while suturing the last stitch of the traction thread.

If the suture is damaged, the whole operation may have to be reshaped, and even if a superior comes to repair it, a vascular transplant will have to be used.

Fortunately, Zhou Yanqing's current suturing level is not just at the threshold of vascular suture, but has gone a step further. He can perform relatively mature operations in two-segment and three-segment suture.

Once the lead stitches are complete, all that remains is to add stitches in the remaining gaps to complete the stitch!

Add three more stitches between the three points, and the vascular suture at six points and sixty degrees intervals is completed.

Of course, Zhou Yanqing very carefully used the tip of the microscopic forceps to gently dilate the blood vessels, and then used diluted lidocaine locally to relieve vascular spasm...

After opening the distal vascular clamp first, Zhou Yanqing removed the proximal vascular clamp.

Soon, the blood vessels began to fill up slowly!

Three pairs of six eyes looked at the severed ends of the blood vessels nervously, much more nervously than any previous vascular suture operation.

After seeing that there was no blood leakage, Zhou Yanqing breathed a sigh of relief and laughed: "It should be considered above standard quality. As long as we check that the anastomosis is unobstructed, we can end this minor operation."

If he wasn't on the operating table, Zhou Yanqing would definitely wipe the sweat from his forehead.

But now, Zhou Yanqing could only let it slip between his brows and pretend that nothing had happened.

The task of checking the patency of the anastomosis had already been snatched away by Liu Wanqing.

Zhou Yanqing watched Dr. Liu Wanqing clamp the proximal vascular clamp again.

Clamp the proximal end with forceps, expel the blood from near to far, then block the blood vessel at the distal end of the anastomosis with forceps and release the proximal vascular clamp.

The blood rushed in again, filling the empty blood vessels quickly, and there was still no leakage...

Seeing this, Liu Wanqing smiled happily: "Yanqing, can we sew up the skin next?"

Whether you are a PhD or a Master's degree holder, this amount of surgeries needs to be accumulated slowly.

After all, clinical practice is different from the gym. The more you practice and the more surgeries you perform, the more mature your skills will become.

Liu Wanqing had already spoken, so Zhou Yanqing naturally couldn't even give him a chance to sew his skin...

More than twenty minutes passed before the patient's hand was finally sutured.

After the sterile dressings were packed and processed, when they lifted the sterile cloth, Zhou Yanqing and others realized that the patient was under brachial plexus block anesthesia, and his eyes were bulging as he looked at the three people.

His face flickered.

After Zhou Yanqing told him to sit up, he looked at the bandage on his left hand and grinned under the mask: "Doctor, thank you! ~"

"How come there are so few people in your Xiangya Hospital who can do this kind of technology?" the young man complained.

Liu Wanqing said, "Brother, of course you are right. You don't think we are targeting you and that's why we don't let the professor operate on you, do you?"

"You heard it too. We invited him three times. The professor himself was so busy that he was overwhelmed."

"Originally, your superiors wanted you to go to a sister hospital for treatment, but you refused to go and insisted on staying in our hospital for treatment."

"Our hospital cannot refuse treatment, so we can only handle it with reluctance." "I told you before the operation that the operation might fail, but fortunately, the result is good. It seems that the blood circulation has been restored and the tendons have been sutured..."

Liu Wanqing explained in detail and also briefed Zhou Yanqing on the content of his previous conversation and signature with the patient.

The young man sat up, turned over and got out of bed, carefully protected his left hand, and slowly stood up: "I really didn't understand what you said just now."

"But it's really black."

"It seems like I only had about a hundred stitches, but it cost more than two thousand yuan?"

The young man's eyes bulged slightly, obviously shocked.

Zhou Yanqing did not participate in the conversation, so it was inconvenient for him to talk nonsense.

Liu Wanqing laughed and said, "Brother, you are wrong. The most expensive part of your operation is the six stitches that suture your blood vessels. Each stitch costs about two hundred yuan."

"The most valuable thing is the tendon suture, which costs eighty or ninety dollars a session. The rest is basically free."

"Don't think this money is easy to earn..."

"If no one can earn this money, you will lose this finger."

Hearing this, the young man shook his head and said nothing.

He just followed Liu Wanqing out. When he reached the door of the operating room, he looked back at Zhou Yanqing and then at Liu Wanqing.

He lowered his voice and said, "I just heard Doctor Zhou call you Senior Brother. Is it possible that you are older than him? But his skills are better than yours?"

Liu Wanqing's tone suddenly became serious.

"Brother, your surgery is complete."

"This is the emergency operating room. Patients and their families are not allowed to stay here. What you need to do next is to go out, turn left, and go to the emergency department's observation ward to get a few anti-inflammatory injections."

"It's better to get another injection of tetanus antitoxin, then go home and rest..."

The young man immediately said, "Doctor Liu, why are you still so angry?"

"I was just kidding."

"You are the senior brother, you take the money and the junior brother does the work, how great is that..."

After hearing this, Liu Wanqing was so angry that he almost vomited blood!

I thought the young man would change his words, but I didn't expect his words to be even more offensive!

In the operating room, Tian Chao shook his head in his heart after hearing this.

But he flattered her and gave her a thumbs up: "Brother Zhou, you are really amazing. You performed a tendon and vascular repair operation on a patient with hand injury all by yourself."

"This is awesome!"

Zhou Yanqing asked back: "Tian Chao, so the difficulty of our clinical operation is actually higher than that in the training room."

"In the gym, at least there are blood vessel permeability test instruments to assist, but on the operating table, it's really a one-time deal, and it all depends on whether the blood vessels can be open."

“There is no way to get timely testing.”

Tian Chao thought about it and nodded: "I don't usually think about testing. If the blood vessels are not sutured properly and blood leaks, I will just add more needles. Unless there are special circumstances, I will not consider blood vessel transplantation."

"So Master said that the practitioner's basic skills need to be solid enough..."

As the two were talking, they left the operating room and walked towards the locker room.

The dressing room of the emergency operating room is not as formal as that of the surgical operating room. They are all on the same floor and there is only one passage.

So, when Zhou Yanqing and Tian Chao came out of the emergency operating room, the young man who had just been sutured was still gesturing to his family at the door.

When he turned around and saw Zhou Yanqing, he immediately recognized him and said to his wife, "Look, he's the doctor I told you about!"

"His skills are very impressive. He can do all the techniques that my senior brother can't do."

The young man said, smiling and extending his hand: "Dr. Zhou, thank you! You have worked so hard."

The young man's wave instantly attracted the attention of many other patients and their families.

Zhou Yanqing was looked around by the gazes, without any nervousness. He did not say much. He smiled and nodded at the young man, then turned around and left with Tian Chao. The topic they were discussing was temporarily suspended.

Tian Chao asked: "Brother Zhou, why don't you go over and talk to him?"

Zhou Yanqing tilted his head slightly and said with a smile: "Why, Tian Chao, you will be very happy to see your brothers get humiliated, right?"

"This patient's behavior is obviously a bit problematic. I went over to chat with him, and when Senior Brother Liu came out later, he thought I had some special hobby and liked to listen to other people's gossip. Why bother?"

"There's really no need for such verbal greetings!"

"He needed medical treatment, and I happened to be able to provide medical skills. It was just a coincidence." Zhou Yanqing smiled nonchalantly, enjoying the joy of completing an operation alone.

As he was talking, Zhou Yanqing's phone rang again -

It was Ning Zhu.

After Zhou Yanqing answered the call with a smile, the smile on his face froze, and then he quickly turned and rushed towards the emergency operating room.

Tian Chao was stunned on the spot, still in shock as he watched Zhou Yanqing run away.

After seeing Zhou Yanqing running into the emergency operating room, he belatedly realized and ran after him!

(End of this chapter)