Chapter 2401 【2401】Correct

First of all, it is necessary to understand the anatomical structure of the human body. Almost part of the heart, mediastinum, large blood vessels, thymus, etc. are hidden behind the sternum. It is equivalent to saying that it is basically impossible for you to do surgery around the big stone that blocks the road, the sternum. It is better to split the sternum than to break many other bones when detouring. It is not that the front chest of the human body has no 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, mediastinal vessels, and the like. Since a thoracotomy is chosen, the first thing to do is to ensure that the operative field is spacious, bright and thorough, so that the doctor can work quickly and resolve the operation early. This method is to choose the midline abdominal incision as in abdominal surgery exploration. The chest cavity and abdominal cavity can be imagined as sacks, and the knife is split in the middle. 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 big 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. If he took that on the stage, he would probably scare people to death first.

The orthopedic knife can be made very light, like a chainsaw used in surgery, and made like 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. It’s just that chopping a bone is not chopping a big tree, so why use a big tool.

The chainsaw chops a big tree, not randomly, but with a neat incision and splits in two sections, so that it is easy to clean up the mess afterwards.

The surgical chainsaw is called a sternum saw. When splitting the sternum, there must also be planning and purpose. The incision is made on the median line, and the incision is neat. First, it is beautiful. The second is that the cut bones will be tied up again after the operation, and then the alignment will be easy and the incision will heal easily. The third most important thing is that it can standardize the surgical field of view behind the sternum, which is beneficial to the subsequent visceral surgery. If the incision is crooked, after you open the incision, you cannot readjust the surgical field, which will cause pain to the patient and pain to the doctor.

The important node is here, and the midline must be cut accurately.

The question is not whether you can find out where the midline is when you touch the sternum through the skin before the operation. If you go in and cut the skin, the previously predicted line must be gone, and you need to re-determine the midline position.

After the operation, the doctor needs to figure out the midline of the sternum all the way, and this process of groping all the way is also the preparation work before splitting the sternum. Speaking of how difficult this process is, a human bone is not just a single bone, but skeletal muscles and other random things attached to it. When repairing bones, it is necessary for the doctor to clean up and peel off these attached components before using tools like brushing off the dust and wires on the metal components of the machine. As a very important large bone in the human body, the sternum has many muscle groups attached to it.

The chief surgeon reached in with his gloved hand and touched the ribs on both sides to determine the outer edge of the sternum, and then set two or three midpoints as a line connecting the upper and lower midpoints. After that, the nurse handed over a pair of middle-bend, which is what we usually call a middle-bend hemostatic forceps.

Here is why it is said that cardiothoracic surgery and neurosurgery are two special specialties of surgery. What people have to deal with is not only internal organs, but also hard objects such as bones. Orthopedics does not need to deal with internal organs. Other surgical departments rarely touch hard bones.