Doctor's Life Simulator

Chapter 73 Isn't there a major flaw in this flap selection?

Since Li Lian'an had completed all three operations, the big screen directly cut into Qin Lang's surgical field of view.

In the operating room, Qin Lang began to dissect the blood vessels in the recipient area, and saw that pair of strong hands holding the scalpel, exploring the dorsalis pedis artery and vein at the place where the dorsalis pedis artery runs, and began to peel off the adventitia very neatly.

Under the microscope, Qin Lang quickly isolated 1 artery and 2 veins.

"Flying clouds and flowing water!"

The directors really wanted to habitually drag the pictures on the screen back and watch them carefully back and forth, just like secretly watching a small movie together in the dormitory back then. It's dragging back and forth, I can't wait to zoom in!
"Qin Lang cut it open with one hand, separation is simply art!"

Shen Jiachen sighed again, why did such a good seedling fall into Wei Guoqiang's hands, he even felt agitated in his heart, and he was immediately overthrown by zero points.

Prepare it for Li Lian'an, and I will take Qin Lang away!

On the big screen, Qin Lang began to cut the skin flap after a while, and this was what all the chief physicians were most concerned about.

"Which flap will Qin Lang choose for repair?"

After all, there are many flap options for this type of surgery, which are related to the technique, experience, and design concept of the surgeon.

For example, in the First Hospital of Zijingang Affiliated University, their departments have tried sural nerve nutrient vessel flaps, saphenous nerve nutrient vessel flaps, and peroneal artery and posterior tibial artery branch skin flaps to repair ankles and heels. And the wound near the proximal end of the dorsum of the foot.

However, these flap designs are often powerless for the repair and reconstruction of the distal dorsum of the foot, toes and even plantar wounds.

There is also a dorsal dorsal cutaneous nerve nutrient vascular flap of the perforator of the fourth metatarsal artery to repair toe wounds, but this method cannot solve large defects of the foot and plantar defects.

In the past, Director Shen tried the retrograde island flap with the medial plantar artery as the vascular pedicle. Although it can solve part of the plantar wounds, the scope is limited and it is only suitable for small wounds.

In Shen Jiachen's mind, various plans kept flashing, and then he saw Qin Lang's plan that made him somewhat unexpected!

Director Qian Mubai on the side also gasped, feeling slightly regretful:

"He is using the anterolateral femoral flap, using the descending branch of the lateral circumflex femoral artery as a flap with a vascular pedicle. How could it be this flap!"

Seeing Qin Lang's operation, all the directors were a little surprised, and a question arose in their minds.

Sure enough, Director Tian Bo at the side finally caught the opportunity and sneered:
"Director Wei, the selection of your anterolateral femoral flap is indeed a little unexpected. It is also ingenious. Indeed, using this flap has the advantages of concealing the donor site and large flap area. The vascular pedicle of the flap is constant, The vascular pedicle is longer, so it is more flexible to repair the wound, and it can be cut in the supine position, and there is no need to change the taste during the operation. But this has a huge flaw.”

As a senior expert in hand surgery, Director Tian Bo has studied heel, plantar, and dorsal wounds for so many years. He never thought of using anterolateral femoral flaps, but they all failed.

Tian Bo recalled his rich and varied failure experiences, and said with certainty:

"The subcutaneous fat in the anterolateral femoral flap donor area is thick, so this flap has always been bloated after the flap survived the operation. Later, it needs to be re-operated to remove fat, which increases the number of hospitalizations and operations of the patient. It will greatly prolong the course of the patient's disease and make the patient extremely miserable."

Tian Bo looked at Wei Guoqiang sharply: "Director Wei, based on my experience, this flap selection is not the best solution."

After Tian Bo finished speaking, Deputy Director Shen Jiachen also agreed:
"Director Wei, I also agree with Director Tian's point of view. In fact, I also tried to use the anterolateral femoral flap to repair the defect of the dorsum of the foot and the sole of the foot, but in the end result, firstly, the survival rate of the flap was not high, and secondly, , the skin flap is bloated and unsightly, and the second-stage fat removal is time-consuming and labor-intensive, and the feedback from patients is very poor.”

Wei Guoqiang didn't understand the defect of the anterolateral femur flap selection proposed by the two directors, but he didn't know why Qin Lang made such a choice.

However, Wei Guoqiang was very calm, and pretended to be relaxed and said: "Everyone continue to look down, such a choice has its own reasons."

Seeing Wei Guoqiang's gesture, Shen Jiachen stopped talking and continued to watch the screen.

Tian Bo squinted his eyes, and thought to himself, "I'd like to see what flowers you can make."

In the observation room, it fell into silence again.

In the operating room, Qin Lang continued to cut the skin flap quickly, still according to his rhythm and technique, and cut the skin flap precisely according to the shape of the wound.

After completing this step, he began to incise the subcutaneous tissue and deep fascia from the edge of the flap, and peeled off the flap under the deep fascia to ensure that the descending branch of the lateral circumflex femoral artery perforated the skin in the flap.

"It's amazing. Although I don't agree with the general direction of the flap selection, Qin Lang's operation is still at the textbook level, which makes people feel physically and mentally happy."

Shen Jiachen really never tires of watching Qin Lang's operations, but he is still slightly worried.

After all, the design concept of the operation is much more important than the specific operation, and the flaws in the thinking cannot be made up for by the operation.

Hanging heart, continue to watch, on the big screen, in the gap between the rectus femoris muscle and vastus lateralis muscle, Qin corridor dissects the descending branch of the lateral femoral circumflex artery and its accompanying vein to the required length, and runs along the carrying part The fascia lata was stripped to form an anterolateral free flap.

This hand, the perfect peeling of the skin flap, even Tian Bo had to applaud!Then the heart is powerless and furious:
"This Qin Lang is really a bald monk who is born with such a material. In front of Qin Lang, this Li Lian'an is a blacksmith's material, a beaten product! I, Tian Bo, sleep by the toilet, not far from shit!"

While Tian Bo was thinking of the witty words, Qin Lang began to ligate the lateral circumflex femoral vein at the proximal end.

Looking at Qin Lang's progress so far, Shen Jiachen held his breath, because he hadn't seen where Qin Lang broke the situation.

Wei Guoqiang was also flustered in his heart, but his face was as calm as usual, and he smiled slightly at Dean Hang and Director Qian from time to time.

On the big screen, after cutting off the skin flap, Qin Lang began to completely stop the bleeding in the donor area, divided into intermittently sutured muscles and fascia lata.

Seeing Qin Lang's stitching, several chief directors were full of admiration, even Qian Mubai was amazed: "I have to say, Qin Lang's stitching is among the top three among all the people I have seen. of."

The doctors Qian Mubai had seen were many world-class ones, and being able to get such an evaluation showed that Qin Lang's skills were profound.

After this step was completed, Qin Lang started an operation that no one expected.

"What is he doing?"

Shen Jiachen stood up from his seat, he finally got the change he was expecting.

Tian Bo's expression was also ugly, because he had never thought of, seen, or heard of this step.

Wei Guoqiang's eyes lit up: "Here he is, he is here at last!"

PS: Thanks to Darong Rongzai for the 500 coins, the bloody knife for 100 coins, and the bloody knife for another 100 coins, thank you for your support~
(End of this chapter)