The circulating nurse took the inflated balloon and squeezed it hard.
When the pressure reached 35 kPa, the circulating nurse picked up the alarm and set it for 1 hour.
The tourniquet time for the upper limb is generally one hour, and no more than one and a half hours at most. You should relax for at least 15 minutes every hour. Nowadays, you can only use an alarm clock to set the time. Later generations have special tourniquet machines with a timer alarm function.
"Small round knife No. 15." Li Zheng stretched out his hand.
Lin Xiaomei immediately slapped the knife handle on his hand.
Chen Dayong helped Li Zheng to adjust the patient's right hand position.
Li Zheng made a Z-shaped incision at the transverse line of the metacarpophalangeal joint. After cutting the skin, he found that the subcutaneous tissue was completely covered by hyperplastic tissue.
Chen Dayong was dumbfounded and said, "The endometrial tissue is so proliferative, this whole area needs to be cleared out!"
Everyone's heart tightened.
If all of it needs to be cleared out, today's surgery will be very troublesome.
"Li Zheng, why don't you separate them first? Maybe the deep tissues won't be invaded?" Xiang Yuanzhong said.
After all, they are patients from our own department. The more complicated the operation, the higher the risk.
The others nodded as well.
Zhu Qidong frowned even more.
It's just been cut open, and you already know it has to be removed entirely. Do you have X-ray vision?
When Zhu Qidong thought of X-ray vision, he thought of the Kirschner wire surgery. Could it be that he really had X-ray vision?
Li Zheng nodded and said, "I will separate it, but judging by the current situation, not only the subcutaneous tissue needs to be removed, but also this piece of skin needs to be cut off."
Now everyone was even more dumbfounded.
"The skin also needs to be removed, so how to repair it? Do we need skin transplantation?" Bao Youshan asked.
Li Zheng shook his head. "Let's clean the subcutaneous tissue first, and then choose the surgical method based on the situation."
After saying that, Li Zheng stretched out his hand.
"Ophthalmic forceps and ophthalmic scissors."
Lin Xiaomei handed him a pair of tweezers and a pair of scissors.
Li Zheng carefully cut the proliferative tissue in the middle, and then separated it from the subcutaneous tissue on both sides.
It was found that the hyperplastic tissue was tightly adhered to the skin and could not be completely separated, so a complete resection of the skin and subcutaneous tissue was the only option.
Bao Youshan was horrified when he saw the skin tissue being removed.
This is the finger joint area. If the skin is missing, even with skin grafting, the subsequent scar formation will be very obvious and will seriously affect the function.
The others looked on with frowns on their faces.
This operation still needs to proceed in the most complicated direction!
"Is it not possible to do it without cutting the skin?" Zhu Qidong asked Duan Jianhui in a low voice.
Duan Jianhui shook his head and said, "No, the endometrial cells have a very strong ability to proliferate. If there is even a little bit of residue, it will grow again, causing the operation to fail. The next operation will be even more difficult."
Zhu Qidong nodded. This operation was completely beyond his capabilities, so he couldn't imagine how Li Zheng would complete it.
There are two flexor tendons and two sets of neurovascular bundles in this area. If all of these need to be transplanted, three hours will definitely not be enough. If skin grafting is also required, the operation will take even longer.
The most crucial thing is that the difficulty of this operation has reached the sky, because without a microscope, the most important blood vessel transplantation cannot be guaranteed.
Li Zheng continued the operation without showing any nervousness or panic, as if everything was under control.
After Li Zheng cut off the local skin, he cleaned the subcutaneous hyperplasia tissue bit by bit.
When cleaning near the vascular nerve bundle, stop.
"Microtweezers, microscissors, and microglasses." Li Zheng looked up.
Lin Xiaomei handed him a smaller instrument, and the circulating nurse put a pair of special glasses on him, just like the adjustable frame glasses you wear when you get glasses at an optician's shop.
After Li Zheng put it on, the surgical field of view was indeed magnified several times, but only a few times. A real surgical microscope, with its eyepiece and objective lens together, can magnify 50 times or even higher.
The middle of the finger is the flexor tendon, and on both sides are the proper nerve and proper artery.
Li Zheng continued to carefully separate the inner blood vessels and found that they were severely affected and the nerves were completely adhered, making them impossible to separate.
"The inner neurovascular bundle cannot be saved." Li Zheng said, and cut it off without any hesitation.
Continue to separate the outside.
"How's the outside?" Xiang Yuanzhong asked nervously. The surgical site was too small to be seen.
Li Zheng nodded and said, "The outside is better, it may be possible to separate it."
Everyone breathed a sigh of relief.
If the nerves and blood vessels on one side can be preserved, the impact on the finger will be relatively small. There will be no problem with the blood supply from one blood vessel, but one side of the finger will feel slightly numb.
The digital nerves and digital arteries are closely attached to each other, so they are called neurovascular bundles.
After Li Zheng cleaned up the proliferative tissue, he carefully separated the nerves and blood vessels.
Then the epineurium was cleaned off and a careful examination revealed that the nerve was intact and not affected.
Check the blood vessels again.
"The nerves on this side can be preserved, but the blood vessels must be removed." Li Zheng said in a deep voice.
Everyone's heart tightened again.
Vascular transplantation is inevitable!
"Li Zheng, how confident are you that the transplant will be successful?" Xiang Yuanzhong asked.
"One hundred percent." Li Zheng said calmly without looking up.
"hiss!"
There was a sound of gasps in the operating room.
hundred percent.
This is a taboo for doctors, how could it come out of Li Zheng's mouth so easily!
No matter how small the operation is, no one dares to say that it will be 100% successful!
What's more, this is a very difficult operation, especially without a microscope. Where does he get the confidence from?
My dear, there is more to this chapter. Please click on the next page to continue reading. It will be even more exciting later!
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