medical road high rise

Chapter 242 Lecture Tit for Tat
Chapter 242 The tit-for-tat lecture
Everyone looked up at Qin Feng on the stage, waiting for his next words.

"However, after debridement, we should be clear about the skin tissue that cannot be judged to be alive, and we must bite the fracture surface and clean up the bone fragments in the wound, so as to facilitate the later toe transplantation."

"During the cleaning process, the flexor and extensor tendons were found, marked and fixed, and the wound was cleaned with dilute povidone iodine and normal saline under micromanipulation."

Everyone below was taken aback, why did they have to do two debridements?Still need a microscope?

Someone raised their hand and asked, "Dr. Qin, I remember the most important time in the reconstruction surgery of severed fingers. Would it be a waste of time to debride twice? The longer it takes, the higher the success rate of limb replantation." Low."

"This question is very simple. Everyone should pay attention to this. This is a toe transplant surgery to reconstruct fingers. That is to say, if there is no severed finger waiting for transplantation, it will naturally not become an active problem." Qin Feng explained, "and Toe transplantation is more demanding than replantation of severed fingers. It is necessary to use a microscope to remove foreign objects and contaminated toes that are invisible to the naked eye, and to separate blood vessels and nerves..."

Qin Feng explained a lot at once, and made the experts in the audience understand.

George and the others were lost in thought, and Qin Feng turned the ppt to the next page.

“Here is the preparation for the transplantation of the palm. We need to cut the skin about one centimeter between the first and second metacarpal bones on the back of the hand. About centimeters, free the common artery of the first finger again for backup..."

Just after Qin Feng finished this page, Professor Kihara of Sang Country raised his hand and stood up with bright eyes.

"How were your toes cut off?"

Qin Feng's previous transplantation has been explained in detail and perfectly. Everyone present basically understands it, so what Professor Kihara wants to know most now is how to remove it.

This also involves reconstructing the difficult part of the fingers, cutting off the toes and classifying the blood vessels and nerves. Qin Feng only gave a general direction, but as the surgeon in charge.

How did Qin Feng achieve perfect resection before selecting blood vessels and nerves for anastomosis?
Not only Professor Kihara, but others also looked at Qin Feng, wanting to see how Qin Feng would answer this question.

Qin Feng also smiled at being interrupted again.

Because these foreigners will not tell you about etiquette and politeness, they just want to understand what they want.

Before the start, Mr. He told Qin Feng to prepare for being interrupted at any time.

"Please don't worry, the next thing I want to talk about is the cutting of the toes."

Turn the page again.

The bloody anatomical picture appeared on the screen, it was the anatomical picture of the patient in Taoshi.

"Everyone can look here. Design a small V and a small S line on the dorsal side of the second toe, which will facilitate subsequent resection operations. Cut the dorsal skin of the foot according to the two designed lines, from the dorsal side of the extended finger joint to the Make an incision of about two centimeters at the proximal end, and then free two dorsal veins at the incision, and after freeing the veins, gently pull them to one side for protection.”

"At the same time, find the dorsal toe artery in the incision of the second toe diameter in the incision. This artery is one of the important blood vessels for connection. We must ensure the separation effect and follow the artery to the proximal end. Free, ligate the branches along the way, block the blood supply, prevent too much blood from affecting the surgical field, and hindering the operation..."

According to the pictures and texts, Qin Feng explained to the people below like memorizing a text.

A big man once said that if you treat the audience in front of you as a noob, they can better understand what you are talking about.

Although the people below are big bosses, what Qin Feng said was too profound, and they still need to go back and rethink it. Qin Feng's status in their hearts is not high.

Instead, they will feel that they came up with it themselves, and Qin Feng can only be regarded as a guide at best.

But after treating them as Xiaobai, they will feel that Qin Feng is too thin, simply too thin.

"What if the toes are not full and the blood supply is poor?" asked an expert from a German country.

"It's very simple, then cut another one." Qin Feng said.

"..."

Qin Feng didn't want to say too much. The doctors in this German country were simply embarrassed. No one here had hundreds of surgical experiences. If they couldn't even remove the toes, then don't even think about transplanting and reconstructing fingers. .

"The next step is transplantation and reconstruction." Qin Feng continued, "Due to the difference between the missing degree of the reconstructed finger and the difference between the fingers, we need to make appropriate repairs for the phalanges, and fix the phalanges with Kirschner wires, or Use steel wires to cross and fix, and at the same time directly adjust the tension of the flexor and extensor tendons at this stage, so as to facilitate the division between the tendons in the later stage..."

In the last stage, Qin Feng spoke very fast, and everyone listened very carefully.

This part involves the elasticity, thickness and lumen size between the blood vessels, and the anastomosis will be very difficult.

"So we anastomosed the first common palmar artery with the first dorsal extension artery."

Everyone was shocked. As soon as these words came out, they hit everyone's heart.

This matching method is a difficult point, and normal people would not think of it.

There have been in-depth researches on the arteries of the hand at home and abroad, but most of them have studied the blood supply sources and types of the superficial and deep palmar arches.

There are no detailed reports on the length of the first common palmar artery and its relationship to the thumb.

Therefore, the first common palmar artery is one of the most neglected arteries, but it does not mean that it is not important.

On the contrary, this place is not only important, but also particularly complex.

There are digital palmar arteries and nerves accompanying the common artery, and there are more than 100 to nearly two hundred branches from the first finger palmar common artery alone.

Although what Qin Feng said is very simple, and many details are mentioned in one stroke, only those who have tried it know the difficulty and tediousness.

"Why choose the first common palmar artery?" Someone asked again.

"Because the common palmar artery and the common finger palmar artery have the same characteristics of regular distribution in a certain area of ​​the palm, it is helpful for the repair process of palm injury and disconnection surgery, the search for the middle finger palmar common nerve and the finger palmar common artery. Anastomosis can effectively reduce the difficulty of surgery.”

"At the same time, regardless of its diameter or function, it is suitable for connecting with the first dorsal bone artery." Qin Feng answered.

"Then how to find it effectively? There are so many arteries in the palm, it is inconvenient to find something, even if there is no fear of the activity of severed fingers, but too long time will have a great impact on the postoperative wound recovery of patients. "

Qin Feng looked at the person who asked the question, nodded, and continued to speak.

(End of this chapter)