Chapter 260 256. Innovation in vascular transplantation (2)

Time went back to Mendestein just after he left the operating room.

He didn't expect that he could contribute to the operation. Although this "working" method once again exceeded his understanding like the tracheostomy just now, he was still willing to follow Kawei's request

Do.

"Captain, how is Craig?" asked a Prussian soldier anxiously when he saw Mendestein walk out of the operating room.

"The situation is not very good, they are still in surgery."

"Just let them operate?" The soldier was also doubting the identity of these people, "If so."

Mendestein shook his head slightly and winked him. The direction of the eyeball turning was the doctor who came out with him: "I believe in Dr. Kavey's professional ethics and his ability. Now Craig

The situation is not good, and the surgery needs our help."

The soldier quickly understood what he meant: "How to help?"

"It's very simple, just draw some blood." The doctor walked forward with a smile, smiling and said to them in standard German, "Everyone has to draw!

One point, and then determine who can give this patient a blood transfusion.”

Another noun that I have never heard of and seen before, Mendestein even began to worry about whether Prussian surgery has lagged far behind other European countries.

"What does blood transfusion mean?"

"Craig, is this name?" the doctor continued to explain to them. "Craig had a blood vessel broken by a bullet and the bleeding was very serious, so he needed to inject some blood."

"Don't it usually bleed? Why did it turn into a blood transfusion?"

The doctor smiled: "The treatment method is not absolute, it depends on the situation. Because there are many types of blood, the same blood can be input into his body, so I need to collect your blood for pairing."

For the soldiers of the detective company who often lick blood on the front line, blood collection itself is not painful, and what really makes them nervous is the true identity of these doctors.

"Are you a student of Dr. Chino?"

“Yes, that’s right.”

"Also Italian?"

"Yes, we are all doctors at the General Hospital of Florence, Italy."

"I almost thought you were Austrian in your pure German."

Mendestein suddenly mentioned a mouthful and looked at his reaction. Unexpectedly, the other party was not surprised, but laughed even more happily: "I taught German by my mother, she is Prussian, and my father is Florentine.

.”

"Oh, by the way, I haven't introduced myself yet." He changed back to Italian: "My name is Botini."

This is the only doctor who really comes from Italy. Compared to the Latin used by others, he speaks Italian more naturally. Of course, the other party doesn't understand Italian, as long as he can speak a few words.

, and then bring an Italian accent to German.

The entire camouflage operation was initiated by Kawei, which no longer used the combat experience of the guards, but the identity of the doctor and the advantages of mastering multiple languages. After all, French and Latin are languages ​​that doctors must learn.

The guard soldiers and nurses pretended to be locals here and stayed here on the grounds that they had no horses and were sick.

Kavi also spent time on the disease, and did not use cholera and the Black Death. Because the former requires going to the toilet at all times, while the latter is too contagious and pathogenic. More than a dozen Black Death diseases, the undead people are

It is impossible, even considering the contagiousness, these Prussian soldiers might directly choose "humane destruction".

After thinking about it, Kawei chose tuberculosis that is better disguised and just had to lie in bed and cough.

If the study of tuberculosis was not almost 0, no one knew the infection path of tuberculosis bacteria, and maybe even asked questions. Fortunately, the people in the guard team are experienced and the nurses who can be selected by Kawei are also smart people.

After several rounds of inquiries, I didn't show any of my best.

But it is not easy to deceive the other party completely, especially for such group fraud, the preparation time is extremely limited, so it is almost impossible to achieve perfection.

Considering that Mendestein has been suspicious that the blood collector will definitely become the target of public criticism, and the easiest person to pass the test is Botini.

It was just as Kavey thought. After hearing his Italian speaking, Mendestein immediately gave up asking: "Do you think the operation will be successful? Can Craig survive?"

"The surgery is difficult, but I believe Kavi." Bottini habitually said Kavi's name first and immediately added, "And Teacher Chino's skills, they are the strongest surgeons in our hospital.

”

Mendestein was still unsure because he had seen too many soldiers who died of thigh injuries: "Can he survive?"

Botini said with the syringe in his hand: "It depends on whether you have enough blood."

Blood vessels are hollow pipe nets all over the body, and vascular surgery is like plumbers.

Earlier, due to theoretical shortcomings in materials and blood flow, vascular surgery was done to check for omissions and repair duct malformations, mainly dealing with trauma, hemangioma and varicose veins in the lower limbs.

As the understanding of blood gradually increases, thrombosis has become a new topic in vascular surgery.

From early treatment of varicose veins, vascular repair in the late 19th century, hemangioma bomb disposal in the early 20th century, to thrombosis-endomembrane resection in 1946, to the creation of vascular vascular with catheter dilatation of the femoral artery in 1965

Intraluminal technology, followed by balloons, stents, and autologous blood vessel transplants and artificial blood vessels.

Vascular surgery is like blood to the body to modern medicine. Although it cannot be seen on the hospital department table, and there will be no wards, it has long been integrated into various surgical departments.

Science continues to move forward, allowing vascular surgery to extend its branches, and the surgeon's innovative thinking and means can make these branches play an unexpectedly brilliant color.

At this time, blood collection is actively being collected in the church to match blood types, while in the confessional room, something very new is trying.

"The femoral vein defect exceeds 8cm." Kawei measured the distance with a ruler again, "Lengthen the incision to 20cm, I want to take more large saphenous veins and double the amount!"

“Double?”

Bergert lacks experience. Herman has experience but knows very little about blood vessels, and the others next to the operating table are even more unable to keep up with Kawei's ideas. The only person who saw his intentions at the scene was standing in the Ichishu position.

Ignaz.

In fact, he was not sure, because the operation that came to his mind was too difficult.

"Are you going to put the two blood vessels together?"

"Teacher Ignaz is still amazing." Kavi's approach is extremely rare even in modern surgery. Ignaz can guess enough to prove that he also has talent in this area. "The blood vessel diameter is not enough, then

Expand its pipe diameter. One is not enough, then two."

"Expand the diameter of the pipe? Two?"

Herman also seemed to react, lifting his hands with empty fists as cross-sections of two blood vessels, slowly separating his five fingers to form two semicircles, and then his fingertips were connected together. The original two semicircles merged into one more

Large circle: "Are you going to cut the blood vessels and then stitch their sides together?"

"right."

Kawei cuts the skin and muscles downwards, and makes an irregular and slightly oblique incision, exposing the large saphenous vein walking on the knee with a hook: "Stop talking about this, separate the large saphenous vein as soon as possible

It's time to be chaeze." [1]

The great saphenous vein has many advantages, its shape is straight enough, and its distance is long enough, so it can be used as it is taken and used, which has become the first choice for autologous transplantation in vascular surgery [2]. However, there are also many disadvantages, the tube diameter is small and has the unique vein.

There are many valves and branches.

In addition, the length required for this autologous transplant is nearly 20cm. In addition to breaking branches, it also requires separation of surrounding tissues. Removing valves in the lumen is not very difficult to retrieve blood vessels, and it is time-consuming.

The four-person group began to carefully separate the saphenous vein from the distal end of the lower limb to the proximal end. Unlike the coronary artery bypass, because Kawei wanted to merge the vascular official cavity, the surrounding tissues must be separated and there must be no residue [3].

Otherwise, there will definitely be inconsistent when doing merging sutures, and blood leakage occurs when sutures, which will be more than worth the loss.

While separating the surrounding tissue, they need to cut off and ligate all small branches. Freeze the entire large saphenous vein, and then use hemostatic forceps to control the upper and lower ends to cut a spare blood vessel about 20 cm long.

Kawei has tried his best to speed up, but the equipment is not of sufficient quality and the number of branches is large. In addition, the assistants are not proficient in operating skills, so the free process, which only takes 20 minutes, was extended to 45 minutes.

Amor's second anesthesia has gone down, and time is passing by quickly.

"Berger, like just now, put the blood vessels into normal saline, add a little sodium citrate, and clean it." Kawei gave him the blood vessels and changed to the femoral artery and vein anastomosis, "Teacher and I

Connect the femoral artery first, even if the return is not smooth, it will be temporary. At least now, it can get enough blood in its lower limbs."

At this moment, Botini walked into the operating room with two bottles of full blood: "The blood has been obtained, and there are five people with blood types that match. I got 1,000ml first."

"Hang it up."

"How are you?"

"Young people are strong and can hold on."

"Where is the blood supply to the lower limbs?"

"It's still under preparation." After checking the femoral vein without a valve, Kawei put it in the femoral artery defect and gave the seat to Botini. "The length and diameter are very good, you guys are just right

Stitch it."

It is not difficult to match such a large blood vessel. As long as you master the suture method, a doctor like Ignaz with a deep surgical foundation can complete the operation well. Botini's skills are not bad either, and the first four wars are

He had proved himself in the month, otherwise Kavi would not have put him beside him.

During the period when he was giving up the position of the main surgery, Kavi was not idle. He needed help from Bergt to deal with the great saphenous vein.

Compared with the femoral vein that was less than 5cm just now, the difficulty of handling this large saphenous vein has suddenly increased, and it cannot be solved by rinsing it with normal saline alone.

The first thing to do is to use scissors to further clean the tissue around the lumen, then place the blood vessels on clean gauze, pour salt water into it with a syringe, and check whether there is any leakage in the surrounding branches.

"Pinch that end with your hands." Kawei sucked the salt water of sodium citrate, filling the blood vessels with completely bulging. "Very good, there was no leakage in the sewing."

"What should I do next?"
To be continued...