Xu Qiu casually explained: "What is revealed is the body of the pubic bone. The outer side is the lateral edge of the lower pubic limb, here is the lower limb of the ischiatric limb and ischiatric tubercle..."

Everyone was shocked.

Can the structure be identified if it is twisted like this?

"And here, the posterior femoral muscle group, adductor muscle, and quadrilateral femoral muscle. These muscles will be cut through the tendon starting point and the bleeding will be minimized." Xu Qiu's voice sounded again.

The experts present all looked a little strange.

Tendonal starting point...

They didn't even find all their muscles, and they actually hoped that they would find the tendon starting point of their muscles. Is this the anatomical structure in the eyes of the big guy?

At this moment, everyone suddenly understood the mentality of the little attendees in the hospital when they looked at them.

The gap between people can be so big...

...

While Xu Qiu was speaking, the knife in his hand moved faster and faster.

After stripping out the ischial tubercle, Xu Qiu went around the medial side and freed the sacrotubule ligament.

For routine surgery, the next step is to peel off the ischium cavernosal and obturated internal muscle from the subperiosteum.

Because these areas are distributed with blood vessels and nerves in the perineum, this approach can avoid damage.

But the good news is that even a good blood vessel and nerve are left without any protection.

Xu Qiu went sideways and performed subosseous peeling from the medial edge of the ischium and lower pubic limbs. After a while, the transverse perineum, penis foot and urethral sphincter were separated.

Further down, he flexibly walked around the lower edge of the pubic joint, cut open the urethral reproductive diaphragm, and performed joint dissection with the pubic bone.

laugh--

The scalpel fell again, and the rectus abdomen and cone muscles in the pubic joint were also opened.

Another knife cut off the groin ligament.

When all the anatomical structures were disconnected from the body, Xu Qiu waved gently.

"Bone biting forceps."

“Wird saw.”

Two orthopedic devices fell into Xu Qiu's hands one by one, and the supramole of the pubic bone and the ischium below were finally removed!

"The first step is completed." Xu Qiu put down the wire saw.

For a complete pelvic resection, the first thing is to remove the pubic bone and ischia.

Then, the hip bone removal.

Immediately afterwards the ilium bone.

The sartois muscle and inguinal ligament are cut off near the anterior superior iliac spine.

After that, all ligaments, muscles, tissues, etc. connected to the pelvic structure must be removed to make the pelvis completely free, and then the entire pelvis is separated from the body.

Before the end, there will be reconstruction of the digestive system, urinary system, etc., and ultimately reconstruction of the pelvic ring.

This is a big project.

Therefore, when Xu Qiu announced that the first phase was successfully completed, everyone present looked no more relaxed, but instead became much more solemn than before.

The complexity of the surgery area was beyond their imagination. It was extremely difficult to identify the structure from the bloody thighs and pelvis. They could not imagine how Xu Qiu successfully removed the pubic bone and ischia.

They were not even sure that Xu Qiu had really completed the separation of these two anatomical structures...

If the person in front of him was not Xu Qiu, but an unknown little doctor, they would even feel that the surgeon was lying to them, and they would start to describe it by scratching their legs randomly...

...

In the second hour of the operation, Xu Qiu exposed the attachment points of the abdominal muscles, latissimus dorsi and gluteal muscles on the iliac crest along the opened incision, and then performed sharp separation and pushed to the medial side.

The step of exposing the iliac bone is not the most difficult in clinical surgery.

It has many iconic structures, such as the femoral blood vessels, femoral nerves and sperm cords in front of the inner wing.

On the contrary, finding the ilium can also derive the location of these structures.

But for wearing it, every time a layer of skin is cut and an extra incision is made, there is only a piece of purple-red flesh and blood below, and the blood vessels are crushed by strong impact force. Various structures have long been misaligned, which is a huge challenge for the practitioner.

Even Xu Qiu could only rely on experience and the foundation laid by various master-level lower limb surgeries to infer the location of various anatomical structures.

Click—

Xu Qiu exerted force on his hand, and all the muscles below the attachment point were cut off above the apex of the sacroiliac joint.

The nerves and blood vessels of the related muscles have already been ligated.

At the same time, the muscles on the large trochanter and the tendonic dead center on the fascia lata were cut off...

After doing all this, the ilium and lower bone were removed in a whole piece.

Everyone was so drunk.

During the operation, the twelve key points mentioned by Xu Qiu, such as the ligation of internal and external arteries and veins on both sides, and the ligation of the left lumbar vein, were completed with the progress of pelvic resection.

Next is digestive tract reconstruction.

To be more specific, it is actually the removal of the sigmoid colon and rectum, then the establishment of an artificial anus, reduce intestinal fistula, decompression of the small intestine, and omental resection.

Reconstruction of the urinary tract is also in this step.

Bilateral ureteral anastomosis, bladder repair and fistula, stump flap metastasis covering the lower abdominal segment of the abdominal cavity, etc., will also be performed simultaneously.

"How to do this step?" Everyone had the same doubts.

In addition to the complete pelvic resection, the most important thing for this surgery is actually the reconstruction of the digestive tract.

This is the core system of nutrition. The integrity of its repair and reconstruction directly determines the patient's prognosis and affects the patient's survival to a certain extent.

However, this is also the most difficult to deal with.

The patient's injuries are too serious, and the lower part of the digestive tract is almost completely damaged. Reconstructive surgery of the digestive tract will destroy the normal anatomical and physiological structure of the gastrointestinal tract.

Xu Qiu may be able to restore the function of the digestive tract as much as possible, but it is impossible to restore all the defective mucosa.

The mucosa is related to blood supply and oxygen supply, permeability, and also contains intestinal bacteria...

After the gastrointestinal reconstruction surgery, patients are likely to experience insufficient blood and oxygen supply to the mucosal membrane. While the permeability increases, bacterial ectopicity in the intestinal areas will also lead to the growth of a large number of endotoxins, thus destroying the mucosal barrier and causing gastrointestinal dysfunction and serious complications!

How should Xu Qiu deal with it?

As everyone speculated, Xu Qiu had already figured out everything.

The colon-replacement bladder surgery, which was pioneered before, played an unexpected role at this moment.

The experience of surgery was integrated and finally brought back to this extremely difficult step.

"The proximal colon has a significantly stronger ability to absorb water electrolytes than the distal colon..."

"Partial resection can avoid gastrointestinal disorders to a certain extent and reduce the absorption of endotoxins!"

Xu Qiu dropped the scalpel without hesitation.

Everyone's pupils contracted and their attention was entirely focused on the surgery area.

As time passed, a look of surprise appeared on their faces.

"Did the ileocecal part, ascending colon and part of the transverse colon retain?"

"This will make it more difficult to rebuild anal..."

Everyone felt incomprehensible.

Even the two directors of Union Alliance were a little confused at this moment.

Both of them participated in the total pelvic resection, but they had never seen such an operation.

Why?

What is its function?

Various problems arose from the minds of everyone. They just couldn't keep up with Xu Qiu's hand speed before, but now their minds are almost unable to keep up with...

——
Chapter completed!