MTL - Doctor’s Life Simulator-Chapter 71 Isn't there a major flaw in this flap selection?

Since Li Lian'an had completed all three operations, the big screen directly cut into Qin Lang's surgical field of vision.

In the operating room, Qin Lang began to dissect the blood vessels in the recipient area. He saw the pair of powerful scalpels, exploring the dorsal artery and vein of the dorsal foot artery, and very neatly began to peel off the adventitia.

Under the microscope, Qin Lang quickly isolated one artery and two veins.

"Flying clouds and flowing water!"

Several directors wanted to habitually drag the picture on the screen back and observe it carefully, just like watching a small movie secretly in the dormitory back then. It's dragging back and forth, and I can't wait to zoom in!

"Qin Lang cuts it with one hand. Separation is simply art!"

Shen Jiacheng sighed again, how could such a good seedling come to Wei Guoqiang's hands, his heart even moved, and he was pulled down by zero points in a while.

Prepared for Li Lian'an, I will take away Qin Lang!

On the big screen, after a while, Qin Lang began to cut the skin flap, and this was what all the chief physicians were most concerned about.

"Which flap will Qin Lang choose for repair?"

After all, there are many choices of **** for this type of operation, which are related to the technique, experience and design concept of the chief surgeon.

For example, in the First Hospital of Zijingang University Affiliated University, their departments have tried sural nerve nutrient vascular flaps, saphenous nerve nutrient vascular flaps, and peroneal artery and posterior tibial artery branch **** to repair ankles and heels and the wound near the proximal end of the dorsum of the foot.

However, these flap designs are often incapable of repairing and reconstructing wounds on the distal dorsum of the foot, toes and even the soles of the feet.

There is also a dorsal lateral cutaneous neurovascular flap of the fourth dorsal metatarsal artery perforating branch to repair the toe wound, but this method cannot solve the large defect of the foot and the plantar defect.

In the past, Director Shen tried a retrograde island flap with the medial plantar artery as a vascular pedicle. Although it can solve some plantar wounds, the scope is limited and it is only suitable for small wounds.

In Shen Jiaqi's mind, various plans flashed over and over, and then he saw Qin Lang's unexpected plan!

Director Qian Mubai on the side also sucked in a breath of cold air, slightly regretting:

"He is using the anterolateral femoral flap, using the descending branch of the lateral femoral circumflex artery as a vascular pedicle flap... How could it be this flap!"

Seeing Qin Lang's operation, the directors were a little surprised, and a question came to mind.

Sure enough, Director Tian Bo on the side finally caught the opportunity and sneered:

"Director Wei, your choice of the anterolateral thigh flap is indeed a bit unexpected. It is also ingenious. Indeed, using this flap has the advantages of concealing the donor site and large flap area. The flap has a constant vascular pedicle, The vascular pedicle is longer, which makes the wound repair more flexible, and can be cut in the supine position, and there is no need to change the flavor during the operation. But this has a huge defect.”

As a senior expert in hand surgery, Director Tian Bo has studied the wounds of the heel, sole, and dorsum of the foot for so many years. He would never have thought of using the anterolateral thigh flap, but all failed.

Tian Bo recalled his rich and varied failure experiences, and he said:

"The subcutaneous fat in the anterolateral thigh donor flap area is thick, so this flap has always been bloated after the flap survived after surgery, and it needs to be re-operated to remove fat, which increases the number of hospitalizations and the number of operations. It will greatly prolong the course of the patient's disease and make the patient extremely tormented."

Tian Bo looked at Wei Guoqiang sharply: "Director Wei, in my experience, this flap selection is not the best solution."

After Tian Bo finished speaking, Deputy Director Shen Jiamo, who was beside him, also recognized:

"Director Wei, I also agree with Director Tian's point of view. In fact, I have also tried to use the anterolateral thigh flap to repair the defect of the dorsum of the foot and the sole of the foot, but the final result is that the survival rate of the flap is not high, and secondly , the skin flap is bloated and unsightly, and the second-stage fat removal is time-consuming and labor-intensive, and the patient feedback is very poor."

Wei Guoqiang didn't understand why the two directors proposed the defect in the choice of the anterolateral thigh flap, but he didn't know why Qin Lang chose this way.

However, Wei Guoqiang was very calm, and pretended to be relaxed and said: "Everyone, continue to look down, such a choice has its own reasons."

Seeing Wei Guoqiang's gesture, Shen Jiacheng stopped talking and continued to watch the screen.

Tian Bo squinted his eyes, and said in his heart, "I want to see what kind of flowers you can make."

The observation room fell into silence again.

In the operating room, Qin Lang continued to quickly cut out the flap, still following his rhythm and technique, accurately cutting the flap according to the shape of the wound.

After completing this step, he began to cut the subcutaneous tissue, the deep fascia from the edge of the flap, and peeled the flap under the deep fascia, ensuring that the perforator of the descending branch of the lateral circumflex femoral artery was located within the flap.

"Amazing, although I don't agree with the general direction of the flap selection, Qin Lang's operation is still at the textbook level, which is pleasing both physically and mentally."

Shen Jiayang really never tires of Qin Lang's operations, but he is still a little worried.

After all, the concept of design thinking of surgery is much more important than the specific operation. If there is a defect in the thinking, it cannot be compensated by the operation.

Hanging from the heart, continue to watch, on the big screen, Qin Lang dissects the descending branch of the lateral femoral circumflex artery and its accompanying vein to the required length in the space between the rectus femoris muscle and the vastus lateralis muscle, and carries the part along it. The fascia lata was stripped and the free anterolateral thigh flap was removed. UU reading www. uukanshu.com

This hand, the perfect flap peeled off, even Tian Bo had to cheer! And then incompetent rage in my heart:

"This Qin Lang is really a bald monk. He was born with such material. This Li Lian'an in front of Qin Lang is not only the material of the blacksmith's shop, but also the one who was beaten! I, Tian Bo, are sleeping in the toilet, not far from the shit!"

When Tian Bo was chanting one-liners, Qin Lang started to ligate the lateral circumflex femoral vein at the proximal end.

Looking at Qin Lang's process so far, Shen Jiacheng held his breath, because he hadn't yet seen where Qin Lang's game was broken.

Wei Guoqiang was also panicked in his heart, but his face was calm as usual. From time to time, he would face Dean Hang and Director Qian with a slight smile.

On the big screen, after Qin Lang cut the skin flap, he started to completely stop the bleeding at the donor site, and divided it into intermittent sutures to the muscles and the fascia lata.

Looking at Qin Lang's stitching, several chief directors were amazed, even Qian Mubai was amazed: "I have to say, Qin Lang's stitching is the top three among all the people I have ever seen. of."

The doctors Qian Mubai had met were many of them world-class. To be able to get such an evaluation showed that Qin Lang's skills were profound.

And after this step was completed, Qin Lang started an operation that no one expected.

"What is he doing?"

Shen Jiacheng stood up from his seat, and he finally got the change he was expecting.

Tian Bo's face is also ugly, because of this step, he has never thought of it, seen it, heard of it.

Wei Guoqiang's eyes lit up: "Come, come, he is finally here!"

PS: Thanks to Da Rong Rongzai for 500 coins, 100 coins for blood knives, and 100 coins for blood knives, thank you for your support~