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Limb salvage surgery is an extremely complex operation involving many disciplines.

Strictly speaking, it is not a surgery similar to fracture internal fixation.

For limb salvage, there are also indications, not to mention others, the first thing to ensure is the blood supply.

It's like our plumber goes to check the water pipe, what is blocked in the end, and then just take it out.

But in humans, you don't know where the blockage is because the patient doesn't have time to check up before surgery.

So even directors like Huang Shinan can't guarantee that they can perform limb salvage surgery to remove the thrombus...

Zhou Cheng also does not know limb salvage surgery.

This is a fact.However, Zhou Cheng knows the amputation and arteriotomy and thrombectomy in Level II surgery.

After mastering amputation, it is natural to understand the indications and precautions of amputation.

Originally, the scope of amputation was to transect the middle part of the thigh, but in order to preserve the function of the patient as much as possible, Zhou Chengcheng extended the blood vessels as far as possible.Retaining an extra limb can allow the patient to preserve more functions.

And Zhou Cheng does not know the thrombus removal in the strict sense of vascular surgery, and there is no preoperative examination, so he can only use the touch of his hands and perfect anatomical knowledge.

After releasing the proximal ligated femoral artery, feel where it is blocked.

This is a technical task that requires very solid anatomical knowledge to support you to find the shape of blood vessels on the surface of the body and feel the touch of blood vessels.

Zhou Cheng performed arterial thrombectomy twice in total. He first came to the middle and lower part of the thigh, and then got a little greedy. After removing the thrombus from the posterior tibial artery of the calf, he discovered it by accident!

The dorsalis pedis artery is open!

This left him wondering what to do.

Because Zhou Cheng's original purpose was to amputate his limbs, and he just wanted to keep them longer.

Men, like thick and long...

Luo Yun wanted to strangle Zhou Cheng to death.

Slanted eyes glanced at Yan Hanhan's expression at the moment was stiff, the corners of his eyes twitched, his eyelids twitched, and his eyes glanced at the sharp knife in his hand, as if he wanted to give Zhou Cheng a shot, and immediately scolded Zhou Cheng after reading it: "Fuck off."

"I'll see the situation first."

Luo Yun then probed for the dorsalis pedis artery with his hands.

Whether the blood vessels are unobstructed, the most direct and official insistence is CTA to check whether the blood vessels are unobstructed.

But the patient couldn't have the operation before the operation, and his life is still hanging by a thread. Naturally, it is impossible to use this most standard inspection to review.

There are also simple checks.

Palpation, that is, to feel for the pulse of the distal artery.

The arterial pulsation of the human body strictly follows a rule, that is, if the arterial pulsation is touched at the far end, it definitely proves that the blood vessel is unobstructed.

Otherwise, you can't go to the far end.

Luo Yun quickly touched the dorsalis pedis artery, and then felt the weak beating of the artery with his fingertips.

Not strong.

It can't be strong, the patient is about to go into shock, how strong can he be?

However, besides simple palpation, Luo Yun also planned to use another more direct way to prove it!

"Itinerant, prescribe a [-]ml syringe." Luo Yun immediately asked the itinerant nurse for equipment.

Whether the blood vessels are unobstructed is a key factor in whether the amputation should be stopped. Therefore, such a guess cannot be completed based on palpation alone.

When Luo Yun called out, Yan Haihan, Li Changhong, and Wang Yaoxiang all stopped their movements.

Then he looked towards Zhou Cheng, his expression was uncertain for a while.

Luo Yun also looked at Li Changhong and Wang Yaoxiang, and met their eyes, watching their tangled expressions.

At this moment, Wang Yaoxiang felt that his gluteal muscles were numb.

He has also been working non-stop on preparations for amputation, has cut a brachialis, and is cutting the biceps.

I planned to finish the amputation of the upper limbs, and I left it to Yan Haihan and the others with my director Li Changhong.

Can?

Here comes the problem!

Isn't this like half of the diarrhea, and you have to force it back by yourself...

But not bad!

It's just that a half of the muscle has been cut, and it can be made up, otherwise.

This joke can become a big one.

His face and ears were a little red, and he panicked with embarrassment.

Zhou Cheng, a subordinate, can operate faster than them?

This actually made him feel quite humiliated.

But fortunately, Zhou Cheng is very fast.

The second is to feel lucky.

If Zhou Cheng, a junior doctor, would naturally progress slower than their surgery!

In the end, the three of us did the amputation, and finally Zhou Cheng's leg was still there!

Four Guarantees One!

Absolutely!

Isn't that where you live in Bengbu?

What should I do then?

Li Changhong didn't know, but fortunately, such a thing hadn't happened yet. Before that, the accident happened.

Li Changhong, Wang Yaoxiang, and Yan Haihan kept looking at Luo Yun and Zhou Cheng, but Yan Haihan didn't believe that Zhou Cheng really opened up the blood vessel, so he reached out and touched it himself.

Chi Chi.

Chi Chi.

The pulsation of the blood vessels in the distal extremities is definitely not as violent as the pulsation of the heart and the aorta, and only a slight pulsation can be felt.

But the existence of the pulsation is real.

Soon, the syringe was on the stage.

Luo Yun pulled out the needle, and directly pricked Zhou Cheng's left toe, which had undergone surgery, and then waited and watched for it to change.

Bloodletting by pricking the far end of the body with a syringe is one of the strongest evidences to verify the existence of blood supply...

Moreover, it is the simplest, most economical and effective method, but this method is not very applicable in clinical outpatient clinics.

Otherwise, it is simple and straightforward to prick a patient a few times, but if the prick is wrong, the patient will feel pain and be easily beaten.

So it is only suitable for use on the operating table.

A group of orthopedic surgeons are staring at the toes.

The blood did not ooze out as fast as a normal person, after a full half a minute, a small drop came out, like a new daughter-in-law, she was a little shy if she couldn't hide her face.

Seeing this, everyone breathed a sigh of relief.

It's fine when you come out, it's fine when you come out.

Nowadays, the blood pressure of patients is very low, and the body will give priority to supplying important organs such as the brain and heart in order to protect itself. It is already quite good if it can be distributed to the remote end.

As long as it is still unobstructed, with a little nutrition, and the lower limbs are not starved to death, they can be replenished after the operation.

There is no need to look at the veins.

It is definitely blocked, but the venous network of the lower limbs is intricate, and it should not be completely blocked.Moreover, there are two sets of large return venous systems. Therefore, the thrombus in the vein can be completely melted away by heparinization after surgery!

Thrombus treatment in arteries is the most important thing in limb salvage surgery!

After Yan Haihan took a deep breath, he immediately gave up the position of the chief surgeon. Although he was very embarrassed, he still held up his face and said: "Zhou Cheng, let's change positions, you will be my doctor." Here."

What it actually means is, Zhou Cheng, you do the limb salvage operation on this leg, and I will help you finish the rest of the work on the leg you just operated on.

The rest is just suturing and placing the drainage tube.

Yes, after vascular suture, drainage must be done, otherwise, the thrombus may be healed, and then the hematoma will arise. The drainage tube can drain the blood in time, and at the same time, it can be found whether the suture effect is good.

With Yan Haihan's mouth like this, Zhou Cheng stopped being obedient.

The reason why he asked Luo Yun so much before was that Zhou Cheng didn't participate in the conversation with the patient, and he was afraid that he would make a mistake and embarrass them in the middle.

After all, Zhou Cheng didn't know whether Yan Haihan talked about limb salvage with the patient's family.

However, when I think about it, it should be that the family members of such accident patients are willing to accept that they can get off the operating table without amputation.Moreover, it happened to be in line with the principle of non-injury in medical regulations.

Amputation is not injury, it is treatment. However, it is possible to temporarily communicate with the patient's family without amputation under the condition of limb salvage.

Zhou Cheng nodded and said, "Okay, Director Yan."

Then walk across to Luo Yun.

Luo Yun looked at Zhou Cheng seriously, and suddenly felt that Zhou Cheng was strange again.

Wang Yaoxiang immediately turned around and said to the itinerant nurse, "Bring some No. [-] wires."

It must be to perform unique skills - biceps, brachialis suture.

Li Changhong faltered in front of him, and whispered: "Give me those too!"

……

"Do you know the limb salvage technique?" Luo Yun, who digested some of his emotions, asked Zhou Cheng after Zhou Cheng took his position.

He actually heard what Li Changhong and Wang Yaoxiang said, but he didn't want to slap people in the face, just watch the excitement and have a bottom line.

This question made Yan Haihan poke his ears for an instant.

And this question made Huang Shinan extremely embarrassed.

Thrombosis, where it is said, is a problem of vascular surgery. Now their department with the brand of vascular surgery can't deal with it, and it is dealt with by the orthopedics department, although no one is angry with him.

But even Chen Liwei cast a strange look at him, which made Huang Shinan feel an indescribable sense of shame.

What's wrong?

If you don't know how to perform limb salvage surgery, you don't even deserve to live?

That's certainly not so serious.

The Eighth Hospital does not have a specialized vascular surgery department. If it had such strength, it would have separated out a long time ago...

……

Zhou Cheng shook his head subconsciously.

The threshold of limb salvage surgery is a bit high, he has never experienced it before, if it is replantation of severed limbs, then he will do it.

Luo Yun immediately saw the strange eyes of Li Changhong and others, and immediately lowered his voice and said: "To be honest, young and young, don't learn the tricks of yin and yang and hiding one's hand."

"Really not." The limb salvage technique that Zhou Cheng understood was only after systematic study and research on it.

"Just now, I just thought about being able to save less amputations, and save more if I can."

Zhou Cheng is full of sincerity.

Luo Yun could only smile helplessly, and said, "Let's take another look and see if the thrombus here can be removed."

Yes, Luo Yun didn't know what to say.

What Zhou Cheng said and did was completely fine.

Is vascular ligation a limb salvage surgery?no.

Is arteriotomy and thrombectomy a limb salvage surgery?Not all.

They are just Zhou Chenghui's level II surgery!

Zhou Cheng said so, but Luo Yun wanted to scold IIGMB right now!

This is limb salvage, okay?

Limb salvage surgery is not a rigorous operation, it is a set of knowledge, as long as it can achieve the purpose of limb salvage, it can be called limb salvage surgery.