233. Repairing Techniques on Heartbeat

Rogerini's situation is indeed a blessing in disguise, and the probability is very low.

His luck is better than most heart firearm wounded people when he is able to go to the operating table alive. While the bullet rubs against the heart and shoots it into the back, it only causes tangential injuries to the heart, and does not cause damage to other important anatomical structures behind the heart, making him a truly lucky person.

When facing a firearm injury, there is no fuel-efficient lamp except the lungs. Whether it is the aorta or the esophagus, repairing it is very troublesome.

The esophagus may be better, close to the heart, expand the incision, then lift the apex of the heart, and you can see it by separating the soft tissue, and there is still room for operation. However, the position of the thoracic aorta is much deeper. Once it is hit by a bullet, it is difficult to block it with your fingers alone, and the difficulty of processing increases exponentially [1].

Of course, many wounded soldiers appear in Austria every day. Although this situation is rare, as long as the sample is large enough, several "Rogelini" can always appear. However, the surgeons who need to cure these "Rogelini" cannot produce mass production, at least in a short period of time, only Kavi is the only one.

There were many people standing around the operating table. The call for heart surgery for failure just now had already dissipated, leaving only endless curiosity.

Unfortunately, the surgical window on the left chest of Rogerini was limited. After receiving the observation of the four people in the surgery, it became very narrow and could not tolerate too much vision.

This makes it possible for those who can really see the surgery clearly only those who stand in the front. If others want to see the picture clearly, in addition to being sufficiently tall, they also need to have a good pair of eyes and a good perspective.

This includes Bill Rotter, who just said he would ban heart surgery.

He never denied the feasibility of cardiac surgery because he tried it on animals himself, and the success rate was very low, but it was not zero. He had done such experiments personally and knew that the success rate of the surgery was low, so he questioned the necessity and safety of cardiac surgery.

In the inherent cognition of most surgeons, cardiac surgery with extremely high risks is the limit of surgery. No method can overcome this difficulty, just like Masimov's original determination that abdominal surgery is the limit of surgery.

Just a few years ago at the Paris Surgery Conference, Bill Rotter and several surgeons set the tone for cardiac surgery, and these contents are still echoing in his mind [2]

"Teacher Bill Root"

Bill Rotter stared at the open surgical incision: "Don't look at me, I don't agree with heart surgery."

"Even if Rogerini was successfully treated by me, you don't agree?"

"That means that his heart trauma is not serious, and conservative treatment can still be overcome."

Kawei smiled and explained: "If there is no blood pressure and heart rate value, it is indeed difficult to judge his injury if he only looks at the symptoms. But his vital signs are not stable and there is a tendency to deteriorate further. To be honest, there may be too late for so many blood clots and continuous spillover blood in the pericardial cavity.

Bill Roth is very stubborn, and he is so stubborn that he still doesn't want to admit Kawei's Theory of Microbiology.

But surgery is different, and the surgical scene and anatomy are much more intuitive than microorganisms. In addition, the vital signs that should not have appeared in 1866, the definition of shock and the alien species of Kawei have all changed Bill Rotter's cognition.

Although he did not admit it, in the past half an hour, his belief and understanding of surgery was once again shattered. This wonderful experience of completely subverting cognition Bill Rotter is not unfamiliar with it, because he had already felt it in the operating stand in Michel Square four months ago.

As for how long it takes to get them together again, it depends on whether the operation can be really completed and the recovery after Rogerini's surgery.

In Vienna, Billot can still suppress Kavi with the title of vice president, but Kavi now doesn't care about his opinion. He has the final say in the fortress hospital. The thoracic surgery is smooth and the effect is obvious, and there is no need to stop at all.

He threw the lead warhead into the curling disc and asked, "Blood pressure and heart rate?"

“90/48,127.”

"It seems that our great imperial soldiers have recovered."

Kawei looked at the dazzling array of glass bottles on the infusion stand, slightly reducing the dripping speed of the posterior pituitary leaf extract: "The bullet slowed down significantly after piercing his left upper arm, so the injection position was not deep and there was no sign of bursting. Now the bullet has been removed, and the operation can be completed by just performing a heart suture and placing a drainage tube."

"It's crazy to actually do stitching!"

"It's hard to believe that the difficulty of doing stitching on such a heart is conceivable."

"Can this really be done?"

Everyone around them made various amazement. Who would have thought that the heart trauma that was originally outside of surgery would become a surgical treatment item in a blink of an eye.

Unlike Bill Rot, who works in big cities, many surgeons do not come from the civilized and elegant Vienna. The Austrians they come into contact with often choose daggers or knifes when quarreling, while the heart is the focus of attack.

"If the heart trauma can be handled successfully, many people may not die."

"This is really an indescribable day, it's amazing."

This is what Kave wants, but the stitching of the heart is not easy. At least Lucius cannot be allowed to do it now: "Doctor Lucius, let's change hands and let me block the rupture."

Lucius was highly focused, and his fingers kept feeling the rapid beating of his heart. He had previously questioned the rationality and feasibility of opening the chest and suturing the heart, but now the surgeon's pursuit has dominated all his brain nerves, and these are no longer problems.

Too exciting!

It's so exciting!

I don’t want to let go, I really don’t want to let go! If possible, he would just press the cracked mouth and keep pressing it.

After all, the heart is not an abdominal organ, and it can be stopped obediently in its original position and let the doctor handle it. The heart in the living person's body is beating all the time, especially those ruptured hearts. The number of beatings must exceed 100 times. The frequency is high and the impact on the surgical operation is very great. Needless to say, you can feel it by just looking at it with your eyes.

The cold corpse cannot reproduce the beating of the heart, and it is impossible to feel the beating of the heart on the corpse. There was no external circulation in the 19th century. If you want to learn to do suture on the heart, you can only practice repeatedly on the operating table except for using a lot of animal experiments.

For Lucius and the vast number of soldiers, it is impossible to contact animals in the future, and some of them are wounded soldiers.

In fact, even if he returned to Grants, he didn't have much spare money to continue to buy live animals for heart repair experiments.

If you want to gain experience, you need to go for a heart repair surgery directly, but they have no experience in heart repair. Only by handing the surgery to Kawei can the injured survive, so this is a dead cycle in a short period of time.

Now any operation that touches the beating heart is a valuable experience and an important process for accumulating experience. Next time I encounter heart repair surgery, I don’t know if I have to wait until the year of the monkey and horse month to go.

"Doctor Lucius, Doctor Lucius!" Cave interrupted his thoughts. "I know it's very interesting to press the heart, but for Rogerini's health, I have to sew the crack as soon as possible."

Lucius finally came back to God: "Uh, I'm sorry."

The pace of finger exchange was very fast this time, and Kavey's proficiency training from outside the emergency department for many years was not comparable to that of them: "Salson continued to stare at the incision of the xiphoid process, and Goram used Wen's normal saline to rinse the surface of the heart."

"good."

"Lucius, use your fingers to help you put the sides of the heart cleft together, just like what I did just now." Kavey waved to the nurse in the distance, "Give me a needle holder and needle thread, just use the chrome cotton thread that stitches the muscles."

The heart is very important, but the tissue composition is still mainly muscles. Apart from the need to get used to the heartbeat, there is nothing special about suture itself.

The only thing to care about is the blood vessels that provide the heart's blood supply, that is, the coronary artery.

The heart provides systemic blood supply and is also responsible for its own blood supply. The difference between the coronary artery and other blood vessels is that it moves on the surface of the heart. If the heart rupture touches or is close to the coronary artery, the difficulty of suturing will be different. [3]

This is also the main reason why Kawei needs to rinse his heart with normal saline. He needs to remove blood on the surface and expose these coronary arteries as much as possible.

The result is pretty good. The tangent wound above the apical heart rubs against the edge of the distal left anterior descending branch and does not damage the blood vessel. However, the wound is very close to the blood vessel, so you need to be very careful when suturing it.

"Sewing the heart is not that simple." Bill Rotter suddenly asked, "How do you deal with suture? Do you just use needles and threads? If you really want to do this, I advise you to give up as soon as possible."

Kawei understood what he meant: "Of course, not."

"Oh? Do you have any good solutions?"

The reason why Bill Rotter's heart suture experiment has not been successful is because the heart beats cause great difficulties to suture, and the other is because the suture itself will cause damage.

The operation time in the 19th century was short and it was difficult to deal with major bleeding from heart trauma, so the operation was very rough, but the surgery in the 21st century had already solved this problem. Kawei called Salson, who had been helping to look at the incision under the xiphoid process: "With Golam, take surgical scissors, turn on the incision under the xiphoid process, and take some pericardium down."

The two were confused and didn't know the reason for doing so.

"You have to cover the wound with a pericardium?" Lucius was more experienced than them and seemed to see the effect of the pericardium. "This may be easier to block blood overflow and more conducive to repair."

"No, the suture repair of the myocardium can completely block blood."

Bill Rotter realized Kavi’s real purpose: “Do you want to use the pericardium to block the suture and cut the heart?” [4]

Kawei smiled: "The teacher is right. The heart is beating constantly. The suture needs to bear a certain amount of tension, which can easily damage the tissue at the suture. After all, it is the heart. If there is a problem with the suture itself, it is very likely that it will win a second rupture after the operation."

"Use pericarp to make gaskets" Bill Rotter never thought of this method, "It's really feasible?"

"It works, I've tried it on animals (actually not)." Kawei fooled it with a sentence "experimental" and "you cut off the pericardium and cut it into small squares of 0.3*0.3. I need to put them on the stitching."

The texture of the pericardium itself is not soft. It needs to be flattened and then sandwiched in the middle of the gauze and soaked in carbolic acid for five minutes, and then rinsed with normal saline three times before use.

Then it was a fine job to penetrate them into the suture piece by piece, and it took a lot of time for several assistants.

"We do intermittent mattress-style sutures for the full-layer myocardium." Kavey carefully held the needle holder in his hand. With the help of Lucius closing the rupture, he slowly moved his finger down, revealing one end of the rupture. "The distance from the rupture should not be too close or too far, and he should also take into account the surrounding coronary artery."

The needle tip of the suture needle pierced into the surface of the heart with the beating of the heart, crossing the myocardium below, and piercing into the muscles on the other side of the rift. Lucius's technique is very good. Knowing that Carvey has no auxiliary left hand now, he immediately used a forceps to push the heart to help the needle tip penetrate the muscles.

Kawei's index finger on his left hand needs to stabilize the crack while doing a suture with his right hand, so he can only leave the sewing to Ichisuke: "You can do a sewing."

Lucius knew very well that this was his own opportunity to practice.

He gently leaned the disinfected gasket on the wall of the heart, relaxed his hands, followed the rhythmic beating of the heart, and wrapped the sutures at both ends together, tightened, and then tangled them together, tightened again: "One knot, two knots, three knots, finished."

Kawei carefully observed the surgical knot and did a very beautiful job.

He quickly moved his fingers down again, revealing the middle part of the rupture: "Step while the iron is hot, continue"

The operation starts with an incision, and it takes only one hour to complete it. Compared with the abdominal surgery that starts with three hours, the intensity and difficulty of heart repair are not low, and this time seems very unreal.

On the day of his admission, Rogerini got rid of the crisis caused by pericardial pressure.

"It's well-stitched." Kawei looked at the three surgical knots on the surface of the heart, praised it, and continued, "Get some saline and rinse it and see if there are any other rupture wounds."

The next step was to finish the work. Kavey listened to the vital signs three times and checked the amount of drugs used. After he made it clear that Rogerini's body was fine, he got off the operating table.

"The heart repair is completed and the operation is over."

He took off the leather skirt and gloves in front of him and walked towards the door of the operating room: "Don't look, the rest is just suturing the muscles and skin. You are fine and you can follow me now. While there is still time in the morning, we can just review the operation."
Chapter completed!