Chapter 166： Retrograde method

on Monday.

Ling Ran came to Yunhua Hospital with his own thesis.

The hospital at five in the morning was slowly awake. Tens of breakfast carts occupied several walkways of Yunyi. On the way to the parking lot, the security guards started to charge. The most active are the scalpers. They sell famous expert numbers, whether they are directors or deputy directors, with fame and fairness, so that doctors occasionally joke at this price.

In front of the toll counter of the outpatient clinic, a long line has begun to be discharged. The expert clinic of 13 or 17 is their first choice. Only when the expert account is finished, will someone choose an ordinary clinic of 5 or 7.

The ox party in which it is mixed can raise the expert number of 17 yuan to 60 yuan, and want to sell 80 yuan or even 180 yuan.

The month Pan Hua returned with the "Japanese expert", the expert account sold for up to 500 yuan, which is rare in Yunhua Hospital.

Compared to scalper tickets like celebrity concerts, scalper tickets in hospitals are even more profitable. Experts will go to the clinic every week. They are not worried about selling, the supply is stable, and the transaction is mainly cash ...

The emergency department is more peaceful.

The patients were settled at night, the patients did not come during the day, and the nurses in the consultation area were a little sleepy.

"Bring you some fruit." Ling Ran placed a bag of fruit from the home on the waiting table.

The two little nurses were pleasantly surprised: "Dr. Ling is very kind."

"It should be." Ling Ran's understanding of Li Shang's exchanges was quite deep. He now often receives gifts from the nurses and doctors, the patients and the family, the elder sisters, and others. In the end, they have to give back one or two. Fortunately, Ling Ran's mother Tao Ping has been preparing gifts for Ling Ran.

"Wow, the grapes are so fresh ..."

"And apples, I like apples the most ..."

Regardless of whether the two nurses and sisters are true or not, they always expressed favor with Ling Ran's gift.

"Grapes and apples are grown by relatives and friends in the neighborhood. My family orders them in advance every year, and they can be delivered to them at any time during the picking season." Ling Ran explained specifically, "Although chemical pesticides are still used, but It's all within the standard and it's very clean. "

The two little nurses nodded excitedly and said in unison: "Dr. Ling is the best."

Ling Ran smiled in, put the written thesis on Huo Congjun's desk, changed to a white coat, and went to the operating area.

Change your hand-washing clothes in the operating area and pass through the lounge. You can smell the stewed meat without accident.

Ling Ran smiled in and found a flat plate piled up with more than a dozen pig trotters. A small sign was placed on the lower right, with a QR code hanging next to it. In order to balance the income and expenditure, each pig trotter was 19.9. Yuan, please pay for it yourself.

Looking up again, I saw Lu Wenbin standing next to the table with a smile on his face. The white coat looked more and more like a chef.

"Are you ready for surgery?" Ling Ran's focus has always been on the operating room, pig trotters or whatever ... delicious and useful.

While Ling Ran was talking, she pulled out her mobile phone and scanned a pig's hoof.

Lu Wenbin took a big one from the bottom, handed it to Ling Ran, and laughed again: "The operating room is ready. The anesthesiologist is still Su Jiafu, and the magnetic resonance films are also placed inside. The 38-year-old air conditioner, When I installed the air conditioner, my hands got stuck, and the forefinger was rent and avulsed, the skin defect was more serious, and the tendons and blood vessels were detached. "

Rotary avulsion is more severe than a cut wound.

For doctors, the survival rate of replantation will also decrease.

Ling Ran nodded slowly and asked, "What are the expectations of the patients and their families for the operation? They know that the possibility of complete recovery is almost zero."

"Family understand." Lu Wenbin said: "I informed them that skin grafting and blood vessel transplantation would be necessary. Shortening of fingers is also inevitable. Family members said that it is acceptable. However, patients hope to restore hand function as well as possible, and recover quickly Some, can work again soon. "

Lu Wenbin said a pause, and said, "The patient's family conditions are not very good, and he cares more about medical expenses."

Ling Ran nodded slightly. For the replantation of broken fingers, these were considered as normal requirements.

The most common patients with severe finger replantation are industrial workers. Industrial workers are less concerned about appearance, and more concerned about survivability and medical burden.

"Let's go inside." Ling Ran dropped the trotter bones, wiped his mouth, washed his hands, and entered the operating room. With the help of the nurse, he put on a surgical suit covering the whole body.

At this time, the operating room was almost sterile.

However, in the operating room of the emergency department, the standard of sterility is not high, as is the case with hand surgery. After all, every time a patient enters, it is impossible to clean it thoroughly.

Neurosurgery can do craniocerebral operation room, cardiothoracic surgery room can also better prevent foreign pollutants, there is no such condition in emergency department, and hand surgery also does not.

Similarly, there will not be a high-cleanness operating room including general surgery. When a pack of **** is sprayed on the roof, any high-cleanness operating room must be blind.

Ling Ran reads the MRI film as usual. Lu Wenbin and Ma Yilin unbuttoned the towel wrapped on the patient's hand and tried to clean the patient's non-operative oil.

After Ling Ran read the film and returned, he proceeded to debride.

I saw that his waist and neck remained straight, his legs were apart, his elbows and wrists were firmly supported, and his spirit was highly concentrated ...

Lu Wenbin and Ma Yilin both watched and learned.

Among surgeons, microsurgery is the most important aspect of surgery. Because microsurgery is a typical physical surgery, it takes a long time to focus, and the burden on the body is extremely serious.

Without a good posture, the microsurgeon's doctor doesn't have to wait for his fame to become a family.

"The light is lower." Ling Ran ordered, the itinerant nurse came over immediately, and pressed down the light of the affected hand.

The main function of the light is to maintain the temperature.

A key point of replanting a broken finger is the temperature of the hand. Once the blood temperature drops too much, it is very difficult to survive the replanted finger.

At the same time, the anesthesiologist Su Jiafu also mobilized his mind, watching the monitor at any time, and always ready to deal with the problems of vasospasm and blood clotting.

In the operating room, in addition to heparin, doctors can also use several papaver @ sulin, the latter has a more prominent anticoagulant effect, which is a super effective special drug, which may not be eliminated for a long time.

"The retrograde method is used today." Ling Ran finished the debridement and made a decision.

The antegrade and retrograde are relative to the order of stitching.

The so-called antegrade is to fix the bones and joints first, then sew the extensor tendons, then refer to the dorsal tendons, the dorsal skin, then the flexor tendons, arteries and nerves, and finally the palm skin suture. It can be seen as easy first and then difficult.

Retrograde is basically the other way around, sewing the most difficult arteries, nerves and flexor tendons, and then making joints and extensor tendons.

Newcomers usually go forward in surgery, can complete more steps step by step, and build confidence step by step. Retrograde is a relatively high-end operation, and only a few doctors will use it.

If Ling Ran had just replanted the broken finger at the master level, he might only have mastered the forward method, which is now the perfect level, so that he could use the retrograde method proficiently.

There is not much difference in the results of antegrade and retrograde. The differences are mainly the habits of the doctor, the state of the patient, and the ability to control risks.

In the case of avulsive wounds, the fixation of bones and joints is relatively easy, and replantation of arteries and tendons is the most important.

Ling Ran and Ma Yanlin are on one side of the double binocular microscope, while Lu Wenbin uses a high-power microscope ~ www.novelhall.com ~ upstream of the right arm to intercept the patient's own blood vessels for transplantation.

Arteries must be transplanted, veins must be transplanted, and **** must be transplanted over a large area.

It took three fingers for two hours to complete the hardest part.

"Another 10-0." Ling Ran was slightly tired, but her eyes did not leave the microscope, for fear of losing her vision.

laugh.

The operating room door was opened, and nurse Liu Yingying came in with a smile: "You come out and remember to pick up the eggs. One person has a box of soil eggs, a box of salted duck eggs, and there is an extra box of 4 potatoes above the deputy director."

After a pause, Nurse Liu said, "Dr. Ling, Director Huo asked you to take his share."

"Oh." Ling Ran still didn't look up.

The same is true for Lu Wenbin and Ma Yilin.

Nurse Liu has long been used to it, and smiled and went to the operating room next door to inform.