Chapter 213： Follow the feeling (1/2)

”Wear a 10-gauge silk thread!” Ling Ran said without raising her head during the stitching process.

The equipment nurse agreed without hesitation, quickly opened a 10-gauge silk thread, and attached it to a needle holder. Then, she patted Ling Ran with a slightly heavy but not too heavy force, and just issued a light ”pop ”Sound, blushing white cheeks.

But Ji Tianlu looked up instantly, realized what, and asked, ”What's wrong?”

In the Achilles tendon suture, the 10th thread is considered to be a thicker thread, which is more than three times thinner than the 4-0 suture previously used by Ling Ran. There must be a reason for the sudden change of the main knife.

When discussing technology, Ling Ran was still willing to say a few more words.

Sitting at the end of the double microscope, Ling Ran pointed directly under the microscope with tweezers and said, ”The broken end is not uniform. If you continue to pull with a 4-0 wire, there will be defects after trimming.”

The pulling force of the thin line is not strong. If it is added finely and closely to a cross section, the total pulling force will increase, but if it is separated, the pulling force of each two, two or three is not as good as the single 10 line .

On the other hand, the tendon is elastic, and the Achilles tendon is particularly elastic, which causes a problem. When the doctor forcibly pulls the broken Achilles tendon together, it will yield. However, after the operation is over, the elasticity of the Achilles tendon is still very large, so it will retract more powerfully.

If the broken Achilles tendons are the same length, they will rebound similarly, and the Achilles tendon function will be maintained. However, if the disconnected Achilles tends to be uneven, the strong Achilles tendons will have different lengths and shorts ... So the long stress is small and the short stress is large, and the Achilles tendon will break more easily.

This is like sewing five rubber bands of the same length. Compared to sewing five rubber bands of different lengths, the former has better suture effect and higher strength.

The solution is also very simple, that is, the use of different strength of sutures, the strength of the sutures to make up for the lack of strength of the tendons, as much as possible to ensure that the postoperative tension.

However, the solution that Ling Ran took for granted was shocked Ji Tianlu, and even scared Qu Doctor and others who looked at the screen in the classroom.

”Did you see that the broken ends are not neat?” A resident doctor couldn't help asking.

Another resident sneered sneer: ”There is so much blood, the surgical field is not clear at all, and you can see some hair tips at most.”

”It should be possible to use other conditions to make judgments. The field of view under the microscope will not be clearer than our field of view. Our screen is so large and there is no need to operate ...” As he said, he was close to the screen, almost It was scanning the screen, looking for signs a little bit.

”It may be judged based on magnetic resonance imaging.” Zhu Tongyi said, thinking and explaining: ”It is also possible to consider the distribution of blood vessels, but it is more complicated.”

”This has become metaphysics.” As soon as Dr. Qu's words fell, a group of doctors turned back to look at him.

Dr. Qu regretted it and said, ”I mean, he just stitched it so fast, how could it be more detailed than what we saw, and even if he saw unevenness, how did he know what to use? How many lines to make up for? This is a complete bet, or is his intuition or something. ”

Dr. Qu forcibly swallowed the evaluation of ”reliably unreliable”, a little hesitant.

He was not prepared to speak, so he had been standing at the end of the classroom, and wanted to see the situation before slipping away. However, Dr. Qu didn't expect that Ling Ran's operation was performed very quickly, and he quickly entered the state. A group of doctors who saw him could not stop.

Dr. Qu himself was the doctor of Achilles tendon repair. How could she leave without watching Ling Ran doing this operation?

To some extent, Dr. Qu was even somewhat conquered by Ling Ran's surgical operation.

However, the thread changing operation was neither understood by Dr. Qu nor recognized by him.

It was like the sentence Dr. Qu swallowed forcibly: He felt that Ling Ran's judgment on the spot was not reliable at all, and Zhu Tongyi's explanation was equally unreliable.

He himself is a surgeon doing the kessler method, and he does not believe that anyone can see the integrity of the Achilles tendon from the perspective of blood vessel distribution. Even magnetic resonance films cannot be refined to this extent-at the very least, it is impossible to make judgments on the spot for postoperative analysis, or if the patient dies unexpectedly. It is still similar to say these words when doing a death analysis.

When the surgeon is at the scene, he must have a clear understanding of the tension of the suture.

Now, Ling Ran has changed from the 4-0 line to the 10 line, which means that he knows that the Achilles tendon to be sutured by the 10 line is much shorter and requires a lot of pulling force. However, whether it is blood vessel distribution or Magnetic resonance cannot provide such information.

At least Dr. Qu didn't know how he judged such information, and he didn't hear which imaging department of Danah could do it.

Zhu Tongyi looked at the crowd and laughed: ”Since we can't guess, we just ask, it's teaching surgery.”

After speaking, Zhu Tongyi moved the call button without hesitation, and said, ”Ling Ran, how do you judge the broken ends are uneven, and then how much tension to use?”

Compared with the previous question, the latter question is more targeted.

To pull a shorter rubber band, you need more pulling force. If it is an engineering experiment, this is a very simple problem. Some instruments can test the tensile force of a material, the tensile strength and yield strength of a material, and so on.

However, the living Achilles tendon cannot play in this way, and the corresponding equipment is not prepared in the operating room.

So, how does Ling Ran judge how much tension to use?

If you cannot make a corresponding judgment on this, it is not meaningful to just judge that the broken ends are not uniform.

In fact, ordinary doctors do not care about the amount of pulling force when performing such an operation. They just need to sew up. Regarding the problem of uneven ends, more people use methods such as replantation, such as autologous gracilis muscle transplantation, autologous fibula short muscle transplantation, etc., to bring the short Achilles tendon to a section of the tendon and let both sides The length is almost the same, or the transplant is a little longer, which can relatively reduce the possibility of fracture.