Chapter 133 Perfect Suture
There were few patients and the ward rounds were quick. After the ward rounds, Zhang Lin and Xiao Wu sent the patients to the operating room.
Meniscus suturing and cruciate ligament reconstruction are landmark surgeries of knee arthroscopy. Although Director Han is very reassured about Yang Ping, he still has to go and have a look at these landmark surgeries to see how powerful Yang Ping's arthroscopic surgeries are.
Huang Jiahui was waiting in the operating room early, waiting for the instrument cart. She neatly stacked twenty individually sterilized meniscus suture guns on the instrument cart, and locked the instrument cart in an out-of-the-way corner next to it.
This corner was the best place for her to find after thinking over and over again.
It is convenient to observe the progress of the operation without hindering the personnel in the operating room.
She originally had enviable long hair, but since joining this industry, she decisively cut it short, just short enough to tie it up.
Today she tied up her hair, covered it with a net, and then put on a sterile cap, but no hair was exposed at all. When training to wear a sterile cap, she practiced countless times in front of the mirror at home until no hair was exposed.
Anesthesia has been administered. Song Zimo hung the patient's X-rays and MRI films on the reading lamp, guided Xiao Wu and Zhang Lin to get into position, and then went to wash his hands, disinfect the sheets, and make preparations for every detail. All meticulous.
When Yang Ping washed his hands and came in, everything was ready and waiting for the stage to start.
When Yang Ping was putting on surgical gown, Director Han came in.
"Hello, director!" everyone greeted.
"Hello, Professor Han!" Jiahui greeted Director Han who came in and bowed.
"Hello!" Director Han saw that she was holding a laser pointer in her hand and guarding the sterile boxed equipment, and knew that it was the equipment dealer who was following her.
"Which company are you from? New here?"
Director Han has never seen this little girl before.
"Professor Han, I'm new here. I work at Ruixing Medical, which makes sports medicine products." Jiahui introduced herself.
Director Han picked up a separately packaged meniscus suture gun and looked at it: "Ruixing! Domestic products should be supported more. This suture gun sometimes jams, so be careful!"
"The connection between the first and second needles is not precise. Sometimes the strength is not well controlled, resulting in an error of 0.5 mm. The first needle has not yet come off the gun, and the second needle is eager to enter the advancement track, causing the gun to jam. First After the needle is injected, you cannot release the trigger. You still have to squeeze the trigger, and then step back until the first needle is confirmed to come out of the gun. Then release the trigger and give the second needle. This way there will be no jamming of the gun. This design Needs improvement.”
Yang Ping has studied Ruixing's equipment very deeply. Before Huang Jiahui reminded him, he had already known about this flaw and already had countermeasures. He just didn't care.
"You are right that you have studied the equipment very deeply. Doctors must be proficient in the research of the equipment themselves and cannot rely on explanations from manufacturers and TV stations." Director Han admired Yang Ping's attitude very much.
"What's going on with this patient?" Director Han asked while watching the film.
"Male, fourteen years old, professional football player, suffered a compound tear of the medial meniscus of his left knee. The tear was located in the back corner and body." Yang Ping introduced Luo Xiaohu's condition to Director Han.
"Yeah! Looking at the magnetic resonance, the meniscus is severely torn and the suturing technique is difficult. Do it slowly and don't rush." Director Han told Yang Ping.
Huang Jiahui moved a stool for Director Han to sit on.
Complete the preoperative check, exterminate the blood, and inflate the tourniquet.
Yang Ping started to open with a sharp knife, and skillfully opened the outside. The puncture awl entered with the sheath, then straightened the knee joint, entered the suprapatellar bursa, pulled out the puncture awl, and inserted the lens.
While talking, the arthroscopic exploration of the knee joint was completed. The medial meniscus was torn. No other obvious abnormalities were found. The medial meniscus was sutured.
Director Han moved to the side of the screen and looked at the video image above: "The tear is very serious. One piece has turned up. Is it freshly torn?"
"It's only been two days since the tear. This is the patient introduced by Su Nanchen, an athlete from the provincial youth football team." Yang Ping began to insert the needle on the inside to guide the opening.
After opening, insert the probe into it. The probe is an extension of the arthroscopic surgeon's fingers. You can further understand the structural lesions and injuries by fiddling, touching, etc.
Yang Ping closed the water inlet pipe to reduce the agitation of the torn meniscus by running water, and used a probe to push the torn meniscus back into place and smooth it out. For fresh tears, suture directly without freshening the edges of the tear.
"Sewing gun!"
Xiao Su also researched the manufacturer's equipment in advance. When Huang Jiahui asked her to take a test on sterility knowledge and record, she also asked Huang Jiahui for details of these equipment.
Yang Ping took the suturing gun, entered from the medial port, and began to suture the posterior corner of the meniscus. The muzzle of the gun was pointed at the planned puncture point, and the trigger was pulled. The needle tip penetrated the meniscus with the thread anchor until it penetrated the meniscus attachment part. of the joint capsule, the wire rivet remains outside the joint capsule.
He held the trigger tightly without letting go, pulled back slightly, and the first needle came out smoothly. At a distance of 0.5 centimeters from the first needle, the muzzle of the gun was pressed against another planned puncture point of the meniscus, and he pulled the trigger. The second needle went in smoothly and the gun was pulled back to withdraw.
Tighten the suture. The two thread anchors were inserted vertically. Now when pulled, they become transverse. They are pinned behind the joint capsule and become the anchoring points of the threads. The knots are all pre-made and irreversible, they can only be tightened, not loosened.
Use the knot pusher to send the knot to the appropriate position, and the thread cutter to cut the thread. The first stitch is completed, very beautiful, with appropriate tightness and accurate position.
The tear opening is complex and irregular, and the suture gun needs to enter from different directions. Sometimes it is easier to enter through the inner opening, and sometimes it is easier to enter through the outer opening. Yang Ping had already planned how many stitches to sew and how to distribute them. He first sewed up the stitches at the inner port; then moved the camera to the inner port, entered the suture gun from the outer port, and sewed up the stitches at the outer port.
Each stitch was placed quickly and at once, very easily and skillfully. There were six stitches in total. After the stitches were completed, the horizontal, oblique, radial, flap-shaped and several cracks were all sewn up.
The meniscus was perfectly put back to its original appearance. A quick look at the video of the suture showed that it looked like a normal meniscus with several stitches.
Open the water pipe and flush the joint cavity. Then close the water inlet pipe, suck the water from the joint cavity, and exit the lens. Yang Ping stepped back and Song Zimo did the finishing work.
Wipe away the water on the surface of the knee joint with dry gauze, disinfect the skin with 75% alcohol, and sew two small incisions with one stitch on each side. Apply pressure bandage with cotton pad and elastic bandage, loosen the tourniquet, and the operation is completed.
Director Han stared at the screen. In just ten minutes, the operation was over, and the conversation topic was not even opened.
The stitching was perfect. A broken meniscus was restored to its original shape step by step. It was smooth and neat, and the edges of the wound were neatly aligned. There were no wrinkles after stitching, giving it an artistic visual enjoyment.
This kind of effect cannot be achieved without a lot of surgical experience. To achieve smoothness and no wrinkles, the tension of each needle must be well controlled. It is not to control the tension of each needle independently, but to coordinate several needles. , to achieve tension balance.
"Perfect!" Director Han gave him a thumbs up.
Huang Jiahui was standing aside just now. She had been very nervous, thinking silently in her heart not to jam her gun.
She watched the entire operation process, and Yang Ping's proficiency with the suture gun was as if he designed the instrument. It was even more perfect than the company's surgery demonstration video.
I just heard Yang Ping talk about how to deal with a jammed gun in an understated way. It turned out that he had already had countermeasures. He still used his own products even though he knew about this flaw. I couldn't help but feel a little more grateful in my heart.
"Teacher Yang, are our instruments still handy?" Jiahui asked fearfully, and quickly went over to help Yang Ping untie the straps on the back of the surgical gown.
“Not bad, very good!”
"Thank you, Teacher Yang!"
"You should also prepare the equipment and consumables for anterior and posterior cruciate ligament reconstruction." Yang Ping told her.
This little girl hurriedly asked her brother to ask her out last night just to tell her about the shortcomings of the meniscus suturing gun. Whether it was because she was really honest or for other reasons, at least she was very attentive and would not treat people who are attentive.
"Okay, I'll send it over right away, including the information." Jiahui was very excited.
The surgery center actually had some prepared, but since Yang Ping brought it up, Jiahui would definitely not say that the surgery center had them and asked others to get them.
If you say it will be delivered, it will be delivered! Don't leave troubles to customers, try to keep troubles on your own side. This is what my brother told me.
"Is this domestic equipment okay?" Director Han asked.
Yang Ping said: "It's very convenient! It's no worse than imported ones."
"If you need equipment and consumables, please tell me at any time so that you can complete the operation with peace of mind." Director Han will do a good job in ensuring the operation at any time.
After the operation, the anesthesia subsided, and Fatty Liang's skills became deeper and deeper. Zhang Lin helped the patient put on a knee brace, and Song Zimo gave the patient a pair of crutches to use: "Don't bear weight on this leg for six weeks, and recovery will begin in the afternoon." Training, the doctor will give you detailed instructions later.”
The explanations in the operating room only focus on the key points, and the patients will not be able to remember them if they say too much.
Xiaowu captured several pictures of key nodes in the video system, then got them on his mobile phone and sent them to Yang Ping and Song Zimo. Song Zimo would communicate with the patient's family later.
At the door of the operating room, family members were waiting. When they saw Luo Xiaohu coming out on crutches, his parents immediately came to help him.
"The operation is so fast, why did you just go in for a while?"
Father Luo asked worriedly.
Are you worried that something might go wrong if the surgery takes a long time? The operation time was too short, and I was worried that it might have been done carelessly?
Song Zimo showed the picture on his phone: "Dr. Yang is very skilled at doing this kind of surgery, so he did it quickly. Look, this is the meniscus before the surgery, and this is the meniscus after the surgery. It's sutured. How beautiful!"
Father Luo looked at the pictures carefully and was very satisfied. The messy cracks before suturing and the smooth meniscus after suturing were almost invisible. He was not a doctor, but he had an intuitive understanding.
Just like the quality of wound suturing, patients can see it without even knowing it. The stitches are neat and the skin is evenly aligned, beautiful! The stitches are poor, long and short, staggered, and the skin is unevenly aligned, which is unsightly!
This level was finally passed, and Father Luo was relieved of his worries.
Yang Ping sent the picture to Su Nanchen, with a text briefly describing what he saw during the operation. It was recommended by others, and he wanted to hear back after the operation.
Thanks for the reward of 1,500 starting coins for playing badminton!
(End of chapter)