Chapter 126 Consequences of recurrent nerve damage, thumb reconstruction
Generally speaking, if a severed limb is operated on within six hours, it will have a good survival rate. If the storage environment is good and the temperature is low, there is still hope within eight hours.
There were even cases where the patients were successfully resuscitated after more than 12 hours.
The man's four fingers were still pale and wrinkled more than 24 hours after being replanted, which was a very bad sign.
Only lifeless fingers look like this.
Dr. Shan examined the patient carefully and then asked about some post-operative symptoms.
For example, do your fingers hurt?
Did you pay attention to keeping it warm?
Did you follow the doctor's instructions after the operation, etc.
Zhou Can just stood at the end of the bed and listened.
When the doctor makes rounds, there are strict rules for entry and standing positions.
The right side of the patient is usually reserved for the director and attending physician, and the left side is reserved for the resident physician. When the director makes rounds, there are usually multiple resident physicians, and the order of seniority is determined.
Those with more seniority stand in the front, and those with less seniority stand in the back.
The head nurse usually stands in front of the bed so that she can "care for" the patient at any time.
The remaining space at the end of the bed is reserved for unimportant people to stand.
For example, trainees, interns, postgraduates, and advanced students, etc. All of them can only stand at the end of the bed.
After Dr. Shan finished examining the patient, his expression became quite solemn.
Others also felt the oppressive atmosphere.
The failure of surgery is a bad result for the patient, his family, and all the doctors and nurses.
"Can you show me the medical records?"
Zhou Can didn't want to be in the spotlight, but he remembered a situation his teacher had mentioned.
He wanted to confirm the patient's basic condition first before making further analysis.
The attending physician was a greasy young doctor, about 30 years old. Perhaps due to excessive puberty, his face was left with dark marks left by acne.
He just glanced at Zhou Can lightly without any response.
I'm afraid he's still thinking, this stupid trainee, didn't he see that this is the attending ward round? Who does he think he is?
"Bring me the medical records!"
When Dr. Shan saw that the greasy man didn't react, her tone sounded particularly cold.
Many doctors actually hate bureaucracy and red tape.
Because patients cannot afford to wait, cannot afford to delay, and their condition cannot be treated in any perfunctory manner.
It is understandable that doctors and nurses curry favor with leaders and senior doctors at all levels. They all want to get promoted and receive more support and resources.
But absolutely no doctor likes bureaucracy.
Because it means high mortality rate and high accident rate.
The greasy male doctor shuddered with fear. He didn't understand why Dr. Shan was so angry?
He handed over the medical record with both hands respectfully.
"Please check it out!"
After Dr. Shan took it, he handed it directly to Zhou Can.
"Doctor Zhou, if there is anything you want to know, if it is not recorded in the medical record, you can ask at any time."
By doing this, she was almost publicly supporting Zhou Can.
"Thanks!"
Zhou Can took the medical record and read it carefully.
The patient was operating an iron wedge with a co-worker, and his co-worker cut off four of his fingers due to improper operation.
After the accident, he was immediately sent to the local social hospital.
The doctor bandaged the wound of the injured person and provided the patient with an ice pack to keep the severed finger cool. He suggested that they go to a large hospital immediately for replantation of the severed finger.
So we drove to Tuya Hospital.
After receiving the patient, Director Shen led the team to perform a severed finger replantation surgery on the patient.
In order to shorten the operation time, Dr. Shan and Director Shen performed finger replantation on the patient at the same time. Each of them replanted two fingers. Director Shen performed all the bone replantation of the four fingers.
She mainly performed tendon anastomosis, vascular anastomosis and nerve anastomosis on the patient's two fingers, as well as cortical suture of the severed fingers.
The whole operation went very smoothly.
At that time, the blood supply of the four fingers was tested and found to be unobstructed.
After reading the medical records, Zhou Can walked to the bedside and carefully examined the patient's palms and backs of his hands.
There were many purple scars on the back of his hand near the wrist and the base of his thumb.
"When you were talking to Dr. Shan just now, you mentioned that your thumb was numb, right?"
"That's right! When I was first injured, I thought I was numb from the pain. After the operation, I thought I would be fine once I woke up from the anesthesia. But until now, my thumb still feels numb."
The patient described his true feelings truthfully.
Zhou Can nodded, took a straw from the metal cabinet beside the bed, and touched the patient's index finger near the palm.
"Do you feel anything?"
"A little bit, but it seems to be separated by a layer of clothes."
The patient's education level was limited and his description was not very specific.
The metaphor is quite vivid.
Zhou Can tried his other three fingers in turn, and they were almost the same.
It feels very dull and the touch is extremely insensitive.
At this point, Zhou Can basically had an idea in his mind.
He picked up the film taken by the patient and looked at it carefully.
Doctor Shan waited patiently, and even though the other doctors were somewhat dissatisfied with Zhou Can, they had no choice but to be patient.
"Doctor Shan, is the injured area on the back of the patient's hand the recurrent branch of the median nerve?"
"Yes! The reverse branch of the median nerve is approximately at this location."
She nodded.
Then, his eyes gradually brightened.
There was also a look of sudden enlightenment on his face.
"You mean, the median nerve is damaged, so the blood flow is affected?"
Doctor Shan's expression at this moment no longer showed the cold and serious demeanor of a chief physician.
He is clearly a happy child who has found the answer.
The solemn expression from before had long since disappeared.
"I didn't say that, you said that." Zhou Can blinked.
"Haha, you have at least made a great contribution by finding out the reason why the blood circulation in the severed finger is poor."
Dr. Shan rarely smiles.
At this moment, Zhou Can was sensible, giving her enough face and giving her all the credit, which made her very happy and benefited.
"Mr. Gao, we suspect that you have injured this part of your body, and it is very likely that you have injured your nerves. Nerve cells are the only cells that cannot regenerate. Therefore, if the nerve damage is serious, I am afraid we will be unable to do anything. Now I will prescribe two tests for you, focusing on whether the nerve pathway is interrupted and the condition of the hematoma in this area."
"After we find out the cause, we will develop a new treatment plan for you and do our best to preserve the fingers and hand function of your hand."
She always leaves room for maneuver when communicating with patients.
And let the patient make their own choices.
Zhou Can secretly learned and absorbed the communication skills.
In addition to working hard to improve their diagnosis and treatment skills, communication with patients is also a compulsory course for doctors.
"Doctor Shan, can you tell me what the connection is between nerve damage and poor blood flow to the replanted severed finger?"
The greasy male doctor's medical level should not be very high.
I don't even know the relationship between the two.
The relationship between the two is rarely recorded in books. They are all valuable experiences summed up by doctors in practice.
Zhou Can just pointed it out and Dr. Shan knew the reason.
She obviously understood the connection between nerves and blood circulation.
This also shows how important it is to have a director-level teacher.
You can avoid taking many detours.
"You can ask Dr. Zhou for advice!"
She should be taking this opportunity to teach the greasy male doctor a lesson for his arrogance and bureaucratic behavior towards Zhou Can.
The greasy male doctor looked at Zhou Can with embarrassment.
It is somewhat embarrassing for him, a senior resident, to ask a resident for advice.
What's more, not long ago he acted like a big shot in front of Zhou Can.
It’s so embarrassing to ask others for advice now!
If you don't ask, it will only be more embarrassing.
Everyone knew what was going on and would definitely laugh at him in secret.
"Doctor Zhou...can you give me some advice?"
The greasy man had no choice but to shamelessly ask Zhou Can.
"Nerve damage may affect blood circulation. Didn't your teacher teach you that?" Zhou Can asked back.
"Ahem... maybe I've taught you that, or maybe I just forgot."
The greasy male doctor's teacher is, at best, an attending physician.
If the teacher doesn't like his personality, it is likely that he will just go through the motions.
Therefore, we should look for the reasons for our poor performance within ourselves.
Arrogance, bad manners, and bureaucracy are personality defects that may make you unpopular with senior doctors.
"Doctor He, remember to follow up on the patient in this bed. After he finishes the examination, you can show me the results, or ask Director Shen to come. His severed finger has been replanted for more than a day, so we must not delay."
Dr. Shan asked Dr. He to follow up on the matter.
She continued to make rounds with a few others.
There are more than a hundred beds to check, and even if it takes an average of one minute to check each bed, it will take nearly two hours.
Therefore, ward rounds are basically for key patients.
Patients who have just finished surgery, patients whose lives may be in danger, and patients who have been given special instructions by the director all need to be carefully examined to understand their conditions. The rest of the ordinary patients can only be left to the residents, trainees, and interns to examine slowly.
About half an hour later, they had checked all the open beds in their group.
Doctor Shan took them into the two wards of the group to continue their rounds.
Patients who need to be admitted to a ward generally require special care or have high requirements for the environment.
Nurses and doctors also pay special attention to the patients in the ward.
Everyone is afraid of something happening.
Zhou Can saw the male patient who was transferred from bed 120 at a glance.
"Hello, Doctor Zhou!"
When the male patient saw Zhou Can, he immediately greeted him enthusiastically.
If Zhou Can hadn't been scolded by his superior doctor a few days ago, he would have reported his problem.
It is hard to say whether he can save his leg.
The male patient didn't say it, but he always kept the gratitude in his heart.
He was very excited and happy to see Zhou Can at this moment.
"Hello! Are you here?"
Zhou Can walked up and talked with a smile.
The male patient's wife also knew what was good for her and knew that the young doctor was her benefactor. She handed Zhou Can a bottle of eight-treasure porridge that she was going to give to the patient as breakfast.
"I have to thank you for last time. We are country folk and don't have much good stuff. Please have a bottle of porridge. Don't be disgusted."
"Thank you, but our hospital has a rule that we cannot accept any gifts from patients and their families. This bottle of porridge should be kept for uncle!"
Zhou Can felt particularly relieved and happy.
Every time they cure a patient's illness or save a patient's life, they are grateful from the bottom of their hearts.
For example, Mr. Cui, Mr. Wu's child, or the simple middle-aged couple in front of him. Zhou Can was very happy with these people's acts of gratitude.
"Is your leg better now?"
"After another surgery, I feel much better. My legs are no longer swollen and painful."
The middle-aged man said with a smile.
It seems that the middle-aged man is in much better spirits than that day.
Zhou Can took the opportunity to lift the quilt and check the middle-aged man's feet.
The swelling has gone, and the subcutaneous purpura has also disappeared. The skin color of the foot looks good. However, the skin of the foot is still a little wrinkled. This is normal.
It is necessary to wait until the patient is able to walk before doing some rehabilitation exercises on the foot.
Everything will return to normal by then.
"After his first surgery, blood clots formed in his blood vessels, which may be related to the damage to that section of blood vessels. Later, Director Shen cut off a section of his veins and replaced them with his own, which completely solved the problem."
Doctor Shan explained from behind.
Maybe she also wanted to tell Zhou Can that the thrombosis was not caused by her failure to sew properly, but by the patient's damaged blood vessels.
In fact, it all comes down to lack of experience and poor skills.
If Dr. Xu had performed the vascular anastomosis in this operation, this would definitely not have happened.
Soon, they checked all the beds in the two wards.
The patients who live here all have problems of one kind or another and need careful care or intensive monitoring. Many of them have undergone major surgeries.
For example, Zhou Can had the honor of seeing the patient who underwent sternotomy performed by Director Shen yesterday in the inpatient ward.
The ultimate goal of this operation is generally to remove the scapular gland tumor.
It is a major open-chest surgery.
The level is at least level three, and the risk factor is extremely high.
Sometimes, orthopedics cannot complete such an operation alone and needs to work together with cardiothoracic surgeons.
If our hospital has a specialized scapular gland surgery department, it is also possible to directly invite doctors from this department to perform a joint surgery.
As medicine becomes increasingly specialized, it would be truly amazing to achieve perfection in one particular branch.
Speaking of this, we have to mention the Japanese spirit of craftsmanship.
Their craftsman spirit of pursuing only one thing throughout their life is actually worth learning from.
Even when making a plate of sushi, some people take it to perfection.
Who would have thought that making sushi is such a simple thing, someone could become a master with it. And after continuous improvement, sushi making has been divided into several schools.
It is further subdivided.
To know the big from the small.
It is conceivable that there is a reason why Japan has been able to achieve success in many fields.
"Let's go to the operating room! You three newcomers, after work every day, need to be fully aware of all the surgical patients in this group. The patient information and surgical schedule can be viewed through the intranet. In addition, you are also required to keep track of the new surgical patients admitted to this group and the patients who have not been discharged after surgery."
Dr. Shan taught the three people how to log into the intranet.
First, you need to verify your login identity. After receiving the verification request, the hospital information center will contact the department where the resident trainee is located. After obtaining permission from the department director, the corresponding viewing permissions will be released.
This is actually quite convenient.
Zhou Can went up to take a look and found that the surgical patients in this group were divided into three categories: those who had not undergone surgery, those who were about to undergo surgery, and those who had undergone surgery.
The patients who are about to undergo surgery, the time, which operating room, and who will be performing the surgery are all clearly written.
The emergency department does not have such conditions.
Basically, we treat whatever patients come in. If surgery cannot be performed on the same day, the emergency case must be transferred to a specialist.
It is already past eight in the morning, and there will definitely be no more time for them to review the data of this group of patients.
Dr. Shan took them directly into the operating room.
Today I entered a Class 100 operating room. It seemed like I was preparing for a major operation.
After entering, a strange male doctor had already arrived with two residents.
The male doctor was probably about 37 or 38 years old, tall and strong, with a strong aura. He was studying the dozen or so films displayed on the screen.
"Good morning, Doctor Chi! You are indeed the best attending physician in our group. You came here so early to study the patient's films."
Dr. Shan greeted the other party with a smile.
"Don't flatter me! If you hadn't been in charge of the ward rounds, would I have been able to go into the operating room early to read the materials so leisurely?"
After Dr. Chi responded, he continued to concentrate on examining the patient's films.
He has his strengths to be the strongest attending physician in this group.
Apart from anything else, this kind of concentration alone is not something that ordinary people can possess.
Doctor Shan also walked over and looked at the film.
The film was not complicated, showing an X-ray of a patient's right hand.
It can be clearly seen that the patient's thumb bone is missing.
The entire thumb is missing right down to the base.
It is not known whether it is a congenital deformity or an accident that caused the disability.
What surgery is this for?
Zhou Can was secretly curious.
His status was extremely low, so he could only stand behind Dr. Tang and Dr. He and watch the films from a distance.
Not long after, Director Shen walked quickly into the operating room.
There is a director, two excellent attending physicians, several residents and trainees, and three surgical nurses.
Just by looking at the scene, you can tell that this is a major operation.
Replantation of a severed finger is only a secondary surgery.
There is no need to mobilize so many doctors at the same time.
"You're all here! Not bad, you all have a positive attitude towards work."
When Director Shen looked at Doctor Shan and Doctor Chi, it was as if he was looking at the two most trusted generals under his command.
Zhou Can has just worked in the orthopedic surgery department for a few days. He wonders how many groups there are in the department?
I don’t know who the doctors in this group are.
Director Shen is the team leader, with two attending doctors, Dr. Shan and Dr. Chi, and four other residents, including Dr. Tang and Dr. He.
These are the people he knows about so far.
"The screen shows the patient's mutilated right hand. It is a congenital deformity. The thumb controls more than 50% of the hand's functions. It is very important! The patient is now a 21-year-old young man who earns a little money by working. When I was seeing him, he happened to make an appointment with me. He said that the missing thumb on his right hand had caused him a lot of trouble over the years."
"It's inconvenient for him to write, hold things, and even wipe his butt with his left hand. When he looks for a date, girls run away as soon as they see his hand is disabled. He wants us doctors to think of a way to help him grow a thumb."
Director Shen gave a brief introduction to the patient's condition.
When encountering such self-reliant disabled patients, doctors feel sympathy and are deeply moved.
Willing to help them in every possible way.
Rebuilding a thumb?
How is this made?
Today's medical technology is becoming more and more advanced. We have heard of artificial hip joints and artificial blood vessels, but we have never heard of an artificial thumb.
Low leg amputations can be treated with prosthetic limbs that restore most of the patient's leg movement function.
But what about the thumb?
Director Shen smiled and swiped the screen of the light curtain.
"Look, this is an X-ray of the patient's foot."
Zhou Can looked carefully and found that the patient's right foot bones were clear and complete.
