Li Zheng shook his head and said, "The thumb is very important, accounting for half of the entire finger's function. Skin grafting will cause local scar contracture, affecting joint function. Besides, the subcutaneous tissue here is gone, so it will be difficult for the skin graft to survive on the tendon."
"Qidong, apart from Li Zheng, you are the most professional here. What do you think is the best way to repair it?" Duan Jianhui asked. He wanted to know whether Zhu Qidong's plan was the same as Li Zheng's. If not, then it would show how big the gap between him and Li Zheng was.
Zhu Qidong thought for a second and nodded. "It's best to use a local skin flap to cover the wound. The blood vessels in the thenar eminence all run in an antegrade direction, making it very suitable for local skin flap transposition. The tissue here is also thick, and the vacant skin tissue after transposition can be repaired with skin grafts."
Duan Jianhui nodded and said, "Your idea is very good. It can not only solve the problem of wound coverage, but also solve the problem of skin graft survival."
The others nodded as well.
"You're truly a professional. You came up with such a great surgical plan so quickly. You're quite talented!" Xiang Yuanzhong exclaimed. He glanced at Li Zheng, looking forward to his surgical plan.
Everyone was waiting for Li Zheng's evaluation of the plan.
Zhu Qidong looked at Li Zheng confidently. There was no more perfect plan than this. Now it depends on how well Li Zheng performs the flap surgery. If he is not confident, he can do it himself. After all, flap technology is another branch. Good microsurgery technology does not mean that the flap will be done well.
Li Zheng shook his head, reached for a No. 15 scalpel, and said, "Local flap transposition can easily cause swelling after surgery, and the pedicle can twist, which can easily pull on the thumb during movement, affecting its function... Your idea is quite conventional, lacking any innovation. Your thinking is still too limited."
Hearing this, Zhu Qidong's heart seemed to be pulled hard.
Li Zheng thought that the idea he thought was perfect was actually full of flaws and outdated.
Everyone was a little dumbfounded. If this plan is not good enough, then how good is your plan? Everyone was intrigued by Li Zheng.
"Haha, Li Zheng, what are you going to do?" Dean Zhang just likes Li Zheng's ability to constantly surprise him.
Li Zheng nodded and said, "The skin on the palm side of the thumb is less elastic than other parts of the body, but it is more wear-resistant. Therefore, to repair this area, we must use skin with the same characteristics."
Everyone nodded. This was easy to understand. After all, the thumb is often used to grab things. If the skin is not wear-resistant, it will easily be damaged.
Li Zheng continued, "The skin characteristics of the thenar eminence are similar, making it an ideal location. However, a transposition flap is not the optimal solution."
Everyone stared at Li Zheng.
"Hurry up and tell us, don't keep us in suspense!" Dean Zhang urged.
"For this area, we can take a small free skin flap with a vascular pedicle and perform a skin flap transplant!" Li Zheng nodded.
"What? Skin flap transplant?" Zhu Qidong exclaimed, "When can a free flap be harvested from the thenar eminence?"
Others were even more confused.
Removing skin flaps and performing transplants are technologies that the county hospital would never even dare to think of.
It is very difficult to just obtain a qualified skin flap, because the skin flap needs to be connected to a group of arteries and veins so that it can be transplanted. The size of the skin flap determines whether the blood vessels can effectively supply blood. If it is too small, it cannot cover the wound. If it is too large, the blood supply is insufficient and the edge of the skin flap is prone to necrosis.
Therefore, the first step is crucial and sometimes it determines the success or failure of the entire operation. After all, as long as it is removed, the remaining transplants will be done according to procedure as long as the blood vessels are anastomosed.
Li Zheng shook his head and said as he operated, "Who says you can't use the thenar eminence for skin flaps? Theoretically, any part of the body can be used. The key is whether you can accurately locate the perforating artery."
Dean Zhang and others nodded repeatedly after hearing this.
This is still because ability limits imagination!
"How do you locate the perforating artery? The blood vessels in the thenar eminence are so small that even Doppler may not be able to detect them, not to mention that you haven't even marked them!" Zhu Qidong didn't believe that Li Zheng could successfully remove the flap.
"I have a lot of experience and don't need Doppler positioning." Li Zheng said with a smile.
His words made everyone laugh.
"You are a general surgeon, and I have never seen you perform this kind of operation before. You say you are experienced, but that is just an insult!" Duan Jianhui said with a smile.
The others nodded as well, feeling that Li Zheng was being dishonest.
Amidst everyone's contemptuous gazes, Li Zheng had already completed the outline cutting of the flap.
Everyone also focused their attention on his operations.
This is an unprecedented operation and may very well be the highest level operation in the province. After all, Zhu Qidong has never seen it before.
"Ophthalmic scissors."
Li Zheng stretched out his hand. Lin Xiaomei immediately patted his palm.
Li Zheng quickly separated the subcutaneous tissue and soon freed a skin flap the size of a thumb nail. He pulled it up and found two small blood vessels connected to it.
"I really... really found it!" Zhu Qidong's eyes widened, staring at the small skin flap, trying to see it clearly.
Duan Jianhui and Xiang Yuanzhong were also completely dumbfounded.
They have been working in trauma orthopedics for most of their lives, but they didn't know there were perforating arteries here.
"Li Zheng, your dissection has reached a level of meticulousness!" Duan Jianhui sighed. Even a master of hand surgery may not be able to find the perforating artery successfully under the existing medical conditions.
What's more, Li Zheng didn't even use Doppler ultrasound. He found it successfully based on his own experience and feel.
Chen Dayong laughed and said, "You don't know, when Brother Zheng was studying anatomy, he would always stay with the cadaver teacher until midnight. At that time, we all thought he was dating his girlfriend, but later we found out that he was staying with the cadaver teacher!"
"hehe……"
Everyone smiled when they thought of that scene.
A person's ability is not innate. In addition to talent, hard work is more important.
Li Zheng nodded and smiled. "During that time, I dissected every cadaver in the department. I could almost count the hairs on each one! But during that time, I always had a smell of formalin on me that I couldn't wash off. My classmates all thought I had some kind of illness!"
"hehe……"
Everyone smiled, but felt deeply moved in their hearts.
"There is no such thing as a genius. Those people you think are geniuses are just those you haven't seen the 99% of sweat they silently put in!" Bao Youshan, who had been concentrating on the operation and not saying a word, suddenly blurted out a very profound statement.
Everyone nodded, and looked at Li Zheng with more admiration.
Li Zheng's operation was very familiar and he looked like a really experienced veteran.
I saw that he had already ligated and cut off the vascular pedicle, and began to deal with the severed blood vessel end on the other side of the thumb, preparing to anastomose it with the blood vessels of the skin flap.
"Haha, your plan is great. It makes perfect use of the blood vessels in the fingers." Dean Zhang was a little excited. Li Zheng never let him down.
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