Chapter 2401： 【2341】Cut it right

Chapter 2401 [2341] Cut it right

First of all, you need to understand the anatomy of the human body, the heart and mediastinum, the large blood vessels, the thymus, etc. are almost partially hidden behind the sternum. It is equivalent to saying that it is almost impossible for you to do surgery to bypass the sternum, the big stone that is blocking the road. Splitting the sternum is better than taking a detour without knowing how many other bones are broken. The human chest is not without other bones except the sternum. Moreover, this approach is the fastest, and splitting the sternum can quickly expose these important organs such as the heart and mediastinal vessels. Since thoracotomy is chosen, the first must be to ensure that the surgical field is spacious, bright and thorough, so that the doctor can work quickly and solve the operation as soon as possible. This method is like choosing a mid-abdominal incision in the case of abdominal surgery exploration. Both the thoracic cavity and the abdominal cavity can be imagined as sacks. The knife is split in the middle, and it is easiest to see what is inside and what is broken.

When it comes to splitting bones, it is natural to think of the orthopedic knife mentioned earlier. For a large bone like the sternum, which is like a big tree trunk, it is faster for doctors to use a chainsaw directly. The chainsaw the doctor was holding was definitely not the one used on the construction site outside.

The orthopedic knife can be made very light, like a chainsaw used for surgery, it is made into a hand drill. As long as the power is sharp enough, the effect is the same. The size of the tool depends on the size of the target, but it is not necessary to use a large tool for splitting a bone instead of splitting a big tree.

When splitting a big tree with a chainsaw, it is not a random split. The incision should be neatly cut and two sections split instantly, so as to easily clean up the mess afterwards.

The surgical chainsaw called the sternum saw should also have a plan and purpose when splitting the sternum. The midline tangent should be cut, and the incision should be neat. First, it is beautiful. The second is that the incised bones need to be re-tied after the operation, so that the alignment is easy and the incision is easy to heal. The third most important thing is that the surgical field of view behind the sternum can be standardized, which is beneficial to the subsequent visceral surgery. If the incision is skewed, after you open the incision, you must not readjust the surgical field, which will cause pain for the patient and the doctor.

The important node is here, the center line should be cut accurately.

The question is not whether you can pinpoint where the midline is when you feel the sternum through the skin before surgery. If you go in and cut the skin, the previously predicted line is definitely gone, and you need to re-determine the midline position.

After the operation, the doctor needs to sort out the midline of the sternum all the way. The process of groping all the way is the preparation work before splitting the sternum. Speaking of how difficult this process is, a human bone is not simply a piece of bone, but a skeletal muscle and other various things attached to it. When repairing bones, it is necessary for doctors to use tools by hand like dust and wires on the metal components of the machine, to clean up and strip off these attached components before starting. The sternum is a very important large bone in the human body, and there are many muscle groups attached to it.

The gloved hand of the main knife went in and felt it, and felt the ribs on both sides to determine the outer edge of the sternum, and then set two or three midpoints as the midpoint lines connecting the upper and lower sides. After that, the nurse handed over a middle-bend, which is usually what we call a middle-bend hemostat.

Why cardiothoracic and extraneural surgery are known as two special specialties of surgery, here is the reason. People have to deal with not only internal organs, but also hard objects such as bones. Orthopedics do not need to deal with internal organs. Other surgical departments rarely touch bone hard objects.

(end of this chapter)