medical simulator

Difficult to open for the first time to break the narrow forbidden area!

Blood vessels are the source of life, and muscles are the source of movement and the vascular bed.Contain and protect blood vessels!

Chen Tingye raised his brows slightly, and Zhou Cheng's answer was very intuitive, saying, "Let's sew up the nerves first."

The muscles and tendons on the opposite side are stitched by your director. Should I drive them off now or you and Wang Yaoxiang?It's not suitable for me to go, you two are looking for death.

"Can you suture nerves?" Chen Tingye asked again.

I want to find out Zhou Cheng's bottom line.

But one thing Chen Tingye got wrong is that men are no better than women, and there is no way to find out——

"A little bit." Zhou Cheng didn't refuse.

Because nerve anastomosis is a second-level operation, he has second-level surgical authority.

No matter how bad it is, Chen Tingye authorized it to be written by Chen Tingye as the chief surgeon. He performed level IV surgery, and he was not afraid that no one would take the blame.

"Then sew together to save time." Chen Tingye said at the same time.

"Those two nerve sutures. Weiqiao 6-0!" Then he ordered the equipment nurse.

"Okay, open it right away, antimicrobial micro Joe 6-0!" The roving nurse replied, and then hurried to find the sutures.

Chen Tingye didn't expect that Zhou Cheng would really dare to answer, but this was just right.

Although nerve suturing and tendon suturing are the same level II surgery, the difference is not small, and it is not as simple as muscle and tendon suturing.

Looking at Zhou Cheng for a while, his eyes narrowed, and the smile on his mouth was covered.

This Zhou Cheng doesn't look very old, but he seems to have solid basic skills. If he can come to the Eighth Hospital, at least he can prove that he is not a doctor. Let's see if he can get it back.

And if he can get Yang Yifeng's attention and recommendation?

Huh?Will this guy be watched by Lao Ding?

Ask later.

However, after getting the nerve suture and the attached microsurgical needle holder, Zhou Cheng didn't ask the roving nurse to ask for glasses, and started to use it directly.

Well, there is only one set of microsurgery instruments, two glasses, one is at Chen Tingye's place, and the other is on Chen Tingye's head now.

Before Zhou Cheng sewed up the muscles, they were quite big, so there was no need for them, but now?

It was not easy for Zhou Cheng to ask these two people for their needs. Moreover, the nerve branch he sutured was not small, so Zhou Cheng soon worked on the nerve, provoking the needle tip.

The suture of the epineurium was quickly completed.

Of course, Zhou Cheng did not stitch all the stitches together, because the suturing of nerves, unlike muscles, cannot be sutured all at once.

The anatomy of the nerve can be divided into the epineurium and the nerve fascicles.

Orthodox nerve anastomosis can be divided into interfascicular anastomosis and epineurium anastomosis!

The suture of the epineurium is to pull the symmetrical point of the epineurium with 5-0 silk thread, then gently turn it over to the two sides in a sleeve-like manner to expose the nerve bundles at both ends, and after correctly identifying and aligning the nerve bundles at both ends, use 9 ~ 11-0 fine silk thread or nylon thread and 2 ~ 3 needles of perimerial suture.

The anastomosis between fascicles should preferably not be on the same plane to prevent adhesion between adjacent nerve fascicles.

Finally, after aligning the axis with 5-0 silk thread, perform 6-8 interrupted sutures of the epineurium, that is, the perineurium and the epineurium are sutured at the same time.After the suture is completed, it is wrapped with polyester or chitin membrane and placed in the normal muscle space or fascia.

Chen Tingye chose to use 6-0 sutures, which actually increased the difficulty of the orthodox epineurium, but this did not bother Zhou Cheng.

Zhou Cheng didn't have too many fancy skills in nerve suture, but he was familiar with it, and he made the current suture method to the extreme.

After Chen Tingye fixed the epineurium, Zhou Cheng shouted to the itinerant nurse: "Teacher, take a 10-0 suture, it's also Weiqiao."

The nerve membrane is sutured first, then the nerve bundles, and finally packed!

One step ahead of Chen Tingye, Chen Tingye glanced at Zhou Cheng's stitching position.

Well, no problem.

Is the young man single? His hand speed is very steady and fast.

As we all know, fast is for fun, and steady is for proper strength——

After Zhou Cheng got the micro-qiao suture, he quickly found the perineurium.

The epineurium is not difficult to find, but the epineurium is really hard to imagine.It's not too thin as a cicada's wing.

Even Wang Yaoxiang didn't understand, Zhou Chengcheng had already laid the needle!

The movement was a little slower than before, but Zhou Cheng's stitching process made Yang Yifeng frown, can he do it?

Going to the epineurium without microsurgical glasses is actually not much different from closing your eyes.

In the forearm, there are only three important nerves.

Ulnar nerve, radial nerve, median nerve.

Zhou Cheng sutured the ulnar nerve, while Chen Tingye sutured the radial nerve.

The ulnar nerve, where it ruptures, is where the elbow and forearm travel.

The suture in this position is difficult, not the most difficult, but certainly not the easiest.

Our ordinary nerves are made up of epineurium and nerve bundles.

The ulnar nerve originates from the medial bundle of the brachial plexus, where there are 11 inner bundles of the ulnar nerve, mainly mixed bundles.

The number of inner nerve bundles of the ulnar nerve in the upper arm increased to 16!Among them, there were 13 mixed nerve bundles mainly composed of motor nerve fibers, and 3 mixed nerve bundles mainly composed of sensory nerve fibers.

at the elbow!The ulnar nerve then descends to the ulnar nerve groove between the medial epicondyle of the humerus and the olecranon, where there are 12 internal nerve bundles of the ulnar nerve, including 4 mixed nerve bundles mainly composed of motor nerve fibers, and 2 nerve bundles mainly composed of sensory nerve fibers. There are 6 fiber-based mixed nerve bundles and [-] mixed nerve bundles.

In the forearm, there are 18 nerve bundles in the trunk of the ulnar nerve, including 3 mixed nerve bundles mainly composed of motor nerve fibers, 5 mixed nerve bundles mainly composed of sensory nerve fibers, and 10 mixed nerve bundles!

And the diameter of the ulnar nerve is just that little!A few millimeters!

Divided by eighteen, is the diameter of the nerve bundle.

And the epineurium is a small part of it...

Does Zhou Cheng have any special attachments and skills in finding films this week?

Then he quickly shook his head, carefully considering the gap between Zhou Cheng's skill level and his own, and at the same time constantly scanning the gap between Zhou Cheng's and Chen Tingye's nerve stitching.

Nerves can be divided into epineurium, nerve bundles.

The nerve bundle is wrapped by the perineurium. Therefore, the suture of the nerve is not the suture of the nerve, but the suture of the epineurium and the perineurium. The nerve itself cannot be dropped.

If the needle is dropped, the person will go numb.

And the knots need special treatment——

Because only after special treatment can the nerves be better protected, thread knots may cause nerve compression symptoms, and compression of different nerve bundles will cause different results.

The ulnar nerve is in the forearm. Although there are eighteen nerve bundles, their functions are different——

The 2 motor nerve bundles make up the muscular branch.

The ulnar nerve continues to descend between the flexor carpi ulnaris and flexor digitorum profundus, medial to the ulnar artery, and gives off the dorsal branch of the hand above the radiocarpal joint.

The trunk of the ulnar nerve here is composed of 5 mixed nerve bundles and 1 mixed nerve bundle mainly composed of motor nerve fibers.

The dorsal branch of the hand consists of 4 mixed nerve bundles mainly composed of sensory nerve fibers, distributed in the ulnar half of the dorsum of the hand and the skin on the back of the little finger, ring finger, and ulnar half of the middle finger.Its stem descends along the radial side of the pisiform bone.

Then, Yang Yifeng seemed to notice that Zhou Cheng's knots seemed to be pointing in the direction of certain nerve bundles.

A rather absurd idea unfolded in his heart.

Zhou Cheng, did he know which nerve bundle is purely motor branch, which nerve bundle is purely sensory branch, and which one is mixed nerve bundle?

Yang Yifeng's evaluation was very professional, because he was a professional himself.

Maybe Wang Yaoxiang couldn't even understand, couldn't figure it out.

That's because he didn't read the book thoroughly, didn't read it carefully, and didn't study it in more detail.

Clinical medicine is not traditional western medicine, it is modern medicine, which can explain the truth thoroughly and clearly.

Yang Yifeng knows that there are some top limb salvage masters who can discard part of the sensory nerve bundles, and then make room for the motor branches!This trick is called losing the car to protect the handsome man, and it can still be used in medicine.

It seems that this is what Zhou Cheng meant when he turned the direction of the thread knot there.Moreover, Zhou Cheng's orientation is different from that cut off.

The microjob nerve sutures are absorbable. After a few months, when the nerve bundles grow up, the sutures will fall off naturally, and the knots will also disappear. Once the outer membrane is healed, the compression will be relieved naturally.

However, a very professional question popped up and entered Yang Yifeng's mind.

"Brother Zhou Cheng, if you sew up all the perineurium alone, how can you avoid the occurrence of neuroma and epineurium adhesion?" Yang Yifeng asked the most critical question.

Neuroma is not a malignant tumor, but it grows between the epineurium and the nerve bundles, and is compressed, causing various symptoms.

The more knots you suture, the higher the pressure in the nerve bundle, and the easier it is to entrap!

Under stimulation, the neuroma will pop out.

A question actually involves many aspects of knowledge, which is Yang Yifeng's knowledge background.

Zhou Cheng frowned slightly, not to say that Yang Yifeng's question was so difficult to answer, but because the suture of the epineurium is not very likely to cause neuroma, compared to long-term chronic stimulation, the probability is much lower. much smaller.

Therefore, Zhou Cheng had never considered this problem even in the simulated copy before, but he had thought about the problem of adhesion a long time ago: "The firm suture of the perineurium is conducive to early recovery, because sutures on different planes , so the chances of sticking are not great."

"It can be as early as five days after the start of small passive movements."

Exercise is divided into active and passive. Active means moving by oneself, and passive means moving by others.

"As for the issue of neuroma, this can be discussed."

"I can't control so much now, the most is to grow and then cut." This question is beyond Zhou Cheng's knowledge blind spot. This may be a question that should be considered when redefining perfection above the perfection level of nerve suture.

At the level of perfection, this need not be the case.

But Zhou Cheng's weak words made Chen Tingye, who was standing opposite, frowned fiercely, frowned and said, "Can I start passive activities five days after the operation?"

"When we usually encounter patients, the most courageous ones will wait ten to twelve days."

"Director Zeng, do you do five days regularly or five days occasionally?"

The speaker had no intention, but the listener had intention, Chen Tingye looked at Zeng Yi!

That look seemed to be saying, Director Zeng, the replantation of amputated limbs on your side is more courageous than us, and you can move in five days?

Hearing this, Zeng Yi immediately rolled his eyes, was taken aback, and hurriedly apologized and said with a smile: "Professor Chen, Xiao Zhou may have made a mistake. We usually start activities in three to five weeks. It's safer. Every month."

At the same time, he also took a look at Zhou Cheng, and didn't dare to stare at him, because Zhou Cheng's operation of suturing the epineurium with the naked eye just now was too coquettish, so he noticed that Chen Tingye had interrupted the operation, and kept looking at Zhou Cheng.

So I asked the roving nurse to pass the microsurgery glasses to Zhou Chengyong first. He was still stitching up the muscles anyway, and he was not so old and dizzy yet.

When Yang Yifeng heard Zhou Cheng's words, he suddenly realized something in his heart, and then he heard Zeng Yi's words, and at the same time cast a complicated look at Zeng Yi——

In fact, Director Zeng, we know that you can speak, but if you don't understand, can you not speak?

We are seriously discussing academic issues, not playing with you in the system of giving favors, steps, etc...

Chapter 157 Unbelievable show!

Zeng Yi's words brought Zhou Cheng back to reality, so he kept silent.

Ability can determine how much you do, but in fact, identity is the root of what you do.

I came to the operating room by myself because I was invited by Yang Yifeng to perform angiotomy and thrombectomy, that is, limb salvage.I should have left after this matter was completed. This is my duty, and it is also the business scope of asking for help.

It's just that I stayed for a while wishful thinking, and now I can do more tendon sutures and nerve sutures, but this part is Chen Tingye's humility. To put it more bluntly, it is a reward.

Zhou Cheng is only a resident doctor now, and it is unusual for Cai Dongfan to get Cai Dongfan's attention, and he can mischievously take on extra things to do.

But in fact, in the eyes of Yan Haihan and others, Zhou Cheng is just an outsider, if he is still mischievous around them, it is not called escape, but troublesome.

It is true that Zhou Cheng can replant severed limbs himself, and he does it extremely well.

But now Zhou Cheng not only represents Zhou Cheng himself, he represents Cai Dongfan in front of Yan Hanhan and Zeng Yi.

Now in front of him is Professor Chen Tingye from the Affiliated Hospital of Shonan University, a top professor of hand surgery in the province, so besides representing himself, Zhou Cheng is also called the junior doctor of Zeng Yi and Li Changhong by the way.

This is Zhou Cheng's current identity.

An adult's self-knowledge and maturity, to a large extent, depends on whether he does things recklessly, and reckless actions, in addition to beating and hurting people in a hurry, more depends on whether the things he does correspond to his own identity .

Instead of a mature and stable appearance on the surface, which can be pretended.

Therefore, Zhou Cheng knew very well that what he said actually represented Zeng Yi and the others to a certain extent.

At least Chen Tingye thinks so. If he puts his own strength on Zeng Yi and the others, some misunderstandings will inevitably occur, just like the previous Professor Ding Changle misunderstood Cai Dongfan.

Later, Cai Dongfan explained to him in detail the misunderstanding between him and Ding Changle, and the misunderstanding that Ding Changle had with Zhou Cheng before.