Chapter 251 247. Creativity is the upper limit for surgeons [1]

【Yang La, muscle pain below 38.8, L4 is not good. However, after I got home, I found that typing is much easier than going to work, and I can still update it after taking medicine. Anyway, I can't sleep, so I just coded a little slower, so I waited for me

Please finish it slowly, forgive me]

In the early years, the surgical method of emergency surgery was similar to opening a blind box, and there were very few tasks that could be assisted by imaging. The surgery was intense and stimulating, but it was full of various risks and choices for both doctors and patients.

However, with the development of modern medical devices, imaging accounts for a higher and higher proportion in diagnosis, and evidence-based medicine also relies on a large number of sample data to formalize medical methods. Under what circumstances are there to be clear

Regulation.

This undoubtedly increased the survival rate of patients, but it gradually lost the fun of opening blind boxes.

Of course, Kawei is not a surgeon for this kind of fun. For him, the blind box is a small surprise in life and work, and its positioning is similar to the spicy and exciting seasonings in dishes.

It will definitely not be able to adapt at the beginning if it is missing, but as long as the time span is lengthened, it will slowly get used to it. On the contrary, if it suddenly appears after disappearing for a long time, it is used to being ordinary.

The taste buds of the taste will cheer for this taste.

Kavi is probably in this wonderful state now, which is even more exciting than the previous abdominal surgery on Fernan.

After completing blood distribution and stabilizing vital signs, he held tweezers in his left hand and held his right hand, and began to carefully cut open the membrane structure on the surface of the blood vessels and investigate the blood vessels that were just sutured.

"The lights get closer."

Because the surgery field is opened large enough for ordinary abdominal surgery, the surgical area is within the peritoneum, and more than a dozen candlestick chandeliers placed in the operating room can barely maintain the supply of the light source.

Now the surgical area is deeper behind the peritoneum under the intestine, and the common iliac artery is in the pelvic cavity, and the incisions that can be opened are limited, so this candlestick light source that can move up and down is a bit insufficient.

Kawei is unable to invent electric lights. Even if there are electric lights, it is difficult to safely erect generators and wires in such field hospitals, and electric shock accidents are likely to occur.

All he could think of was this method: "Go and find a hand-held oil lamp, and then come over with a mirror."

The light of the oil lamp reflected into the field of art, and Kawei's heart was half cold.

After the abdominal aorta is divided into the right common iliac artery, the right internal iliac artery and the right external iliac artery are separated. At the intersection of the right internal iliac artery, the posterior wall of the blood vessel is broken. The outer endometrium of the blood vessel is exposed and broken.

The originally conceived simple repair and suture is no longer possible. The only correct way to deal with it is to perform local vascular resection and then make the two sides of the broken ends intersected.

For Kawei, it is not difficult to deal with ordinary blood vessel breakage as long as vital signs are guaranteed. The real difficulty is to control the distance damage, because the continuity of the blood vessels must be ensured after suture. The useless ones need to be cut off before suture docking.

organize.

Kavi had a headache and decided to appear before him again, whether to give up suture and amputation, or choose to put difficulties on himself and try to keep his right leg.

"The breaking distance is more than 1cm, which is consistent with my previous judgment." Few people can hear the overtone of this sentence, so Kawei needs to make further explanation, "This blood vessel is seriously damaged and must be removed,

Then it matches again”

The words suddenly stopped here, and asked a silent question and followed his gaze to the three doctors on the stage.

Bergert was not experienced enough and said a very ambiguous thing: "It is very difficult to match. Will the suture inwardly develop vascular stenosis?"

"This is something you need to consider when stitching." Kavey looked at Damirgaon, "What do you think?"

"The rupture of blood vessels is too big, and a large section of ruptured blood vessels needs to be intercepted, and the final coincidence." Damirgaon seemed to have thought of this layer, but he could not express it in words.

Seeing that he was like this, Herman added: "The blood vessels are not long enough?"

"Finally, I'm right." Kawei measured the length of the rupture again and said, "The distance is too long, and after cutting it, the suture tension is too high. However, the blood vessels are elastic, and there is no big problem with a little lengthening. Everything is

I will only know after doing it.”

Kawei hesitated for a moment and immediately gave the answer: "Try sewing first."

If it is a modern surgery department, you can do allogeneic blood vessels and artificial blood vessels to replace them. Of course, this choice is also troublesome and risky. First of all, there may not be any in the emergency department. Even if it is true, if it is done, if it is grafted with allogeneic or artificial blood vessels, the patient will eventually be able to last for a lifetime.

Take immunosuppressants.

In such a large environment, immunosuppressants may not be the first choice. So no matter what era, Kavi seems to have two ways to go, but he has to choose to stitch it directly.

Fortunately, the length of the ruptured blood vessel does not exceed the limit that cannot be sutured. The length of 1cm and the physical fitness of the injured is OK, so there should be no big problem with suturing with the elasticity of the blood vessels.

"Two blood vessel forceps, the blood vessels suture the wire, ready to be anastomotic."

"It's ready, Dr. Kavey."

Kawei slowly separated the blood vessels in the normal areas on both sides, and put blood vessels on them to lock the blood flow. Only then did he see the whole picture of the blood vessels: the bullets smashed the spine, the bone fragments and the bullets injured the bones before the bones were damaged.

The lateral iliac blood vessel wall is very fragile, the posterior wall is completely damaged, and there is no possibility of repair.

As for the bullet that should have been shot into the abdominal cavity, no one knows where it is. Now the priority of blood vessel damage is higher. After analyzing the damaged area, Kawei knew that his choice was not wrong.

This is not the first time he has undergone pelvic vascular resection and anastomosis surgery without preparation. Surgical emergency department often encounters such wounded people. The emergency department is more direct than elective, and can stop bleeding and restore blood supply as soon as possible with interventional cooperation to achieve limb protection

Effect.

There is no problem with experience, but he still feels stressed.

Unlike the emergency surgery team that cooperated with the tacit understanding, Kawei now has ordinary cards, even uncrafted young people. He does this more like a vanguard army alone and without supplies. If the match fails, he will be a vanguard.

Prestige is also a blow.

"Amor, I blocked my blood vessels, give me time, and then guarantee his vital signs."

"kindness."

"Herman helped me to help these two damage-free forceps. Damilgaon kept dropping sodium citrate into the blood vessel break to ensure that there was no blood coagulation on the wound surface was clear enough." Kawei gave the two tasks and immediately

Get their response.

"OK."

"OK."

Vascular anastomosis itself is a skillful job, and many details need to be paid attention to, but in the eyes of outsiders, it seems that there is not much difference between suturing other tissues. Kawei is a silent battlefield in front of him. Without a surgical magnifying glass, Kawei can only cat

Put your waist and try to get close to the wound to distinguish the levels of the endometrium of the blood vessels.

With silent operation, one stitch after another, the blood vessel breaking finally coincided successfully.

"The vascular suture ended." Kawei looked at the tight blood vessels and suture tension, and was quite satisfied. "Next, Herman, slowly, gently connect these two hemostatic forceps to the middle, don't let it

Pull the blood vessel wall of the pincer teeth to the suture to minimize tension.”

"Okay." Herman agreed, pinching the buckle of the hemostatic forceps with both hands

"Let's get started."

This was originally a final operation. Although it was fine, it was not difficult. In Kawei's perception, Richman should be competent. But he didn't know that he did not spend a lot of space to emphasize the meaning of "lightly close"

, Herman's hand strength is already strong, and his "lightness" and Kawei's "lightness" are two different concepts in terms of force.

Just as Herman released the hemostatic forceps, a scene that had not appeared in various preview plans in Kawei's mind happened.

The teeth of the hemostatic forceps in his right hand were adhered to the blood vessel wall, but they were not valued by him. Before Kawei could stop him, the blood vessels that had just been sutured suddenly broke the whole process. In an instant, hundreds of ml of blood came from the belly.

The artery broke out, which scared everyone, including Kawei.

At this time, in everyone's shock, only Kawei reacted the fastest. He pinched the blood vessel break with his fingers and quickly clamped a pair of hemostatic forceps. The second was Damiergaon, and Kawei started to pull it up immediately.

The work of sucking blood in the abdominal cavity.

Even Bergt prepared a blood transfusion flask and hemostatic gauze, which helped him as soon as possible.

"What's wrong with you?" Kawei was a little angry, "I have been following me for half a year, but this operation is not done well? I don't know that you must be gentle when you release the hemostatic forceps?"

"I know, but I just relaxed."

"Substitution, Damilgaon is the first assist, and Bergate is the second assist, you go and prepare for a blood transfusion." Kavey looked back at Amor, "How is it?"

With the heavy bleeding, my blood pressure fell again: "86/49, heart rate 117, I'm already working, give me some time."

"kindness."

It is good news for Kawei to stop bleeding as soon as possible and stabilize blood pressure at the same time. But this does not mean there is no bad news. The most deadly redemption just now, there was a tear at the anastomosis of the blood vessels, and the original defect of about 1cm

, now expand to 3.8cm.

The defect distance has quadrupled. No matter how strong Kawei is, it is impossible to connect the blood vessels on both sides.

It’s useless to scold Herman now. It’s already a great punishment to be demoted to Misuke. The key now is still how to protect your limbs.

Kawei's brain is running at high speed, and several possibilities and solutions come to mind.

The first thing I can do is to stop the loss as soon as possible, cut off the right lower limb, and save the life of the injured. But this is contrary to Kawei's original intention, and giving up at this time does not conform to his surgical style.

Allogeneic and artificial blood vessel transplants that can be done now are impossible to achieve. Can autologous blood vessels be used?

But this is the right common iliac artery, with thick blood vessels and the radius of the vein that can be taken is not suitable for transplantation here.

what to do?

Kawei suddenly thought of something as he looked at the gradually clear surgical field. Apart from these conventional methods of handling, there might be other ways.

"Come on, give me a scalpel."

"Scalpel?"

The strange order made the instrument nurse a little overwhelmed, but instinct still asked her to hand Kawei the knife.

"To fit this blood vessel, we now expand the incision."

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Chapter completed!