Many people will say, "Having an operation, it's so scary, it will surely bleed a lot." In fact, this is not the case, the general surgery, intraoperative bleeding is very little. What is the reason for this? Let me explain it briefly.

Doctors perform surgery not only to address where the patient's pain lies, but also to minimize a range of complications that can be brought on by the patient during and after surgery. And blood loss is an unavoidable problem during surgery, but the surgeon can minimize the trauma to reduce blood loss. First of all, the preoperative must be familiar with anatomical knowledge, every step in the operation must be based on, otherwise the surgical process inadvertently injured the large blood vessels, not only may make excessive intraoperative bleeding, affecting the quality of the operation, but also more likely to damage the patient's life. Therefore, the choice of preoperative incision location, surgical path and separation process is particularly important, as far as possible to avoid the large blood vessels, to reduce the damage to blood vessels, and effectively reduce blood loss. Secondly, in some surgeries, adrenaline and other vasoconstrictor drugs are injected subcutaneously into the wound before surgery, thus reducing the blood flow rate and concentration, and effectively reducing the amount of bleeding.

Thirdly, with the development of medical technology, medical and surgical instruments have become more sophisticated. The surgical electric knife instantly heats the tissue when it comes into contact with the muscle through the high-frequency, high-voltage current generated by the tip of the effective electrode, thus realizing the separation and coagulation of the muscle tissue and achieving the purpose of cutting and hemostasis. The use of the intraoperative electric knife effectively reduces the amount of bleeding in the incision area. In addition, the surgical process is a cooperative process between the main surgeon and the assistant surgeon. While the main surgeon cuts the tissue, the assistant will continuously clean the residual blood in the surgical area with a suction device in order to find the bleeding point and perform ligature hemostasis or gauze pressure hemostasis to maintain the cleanliness of the surgical area.

Respondent: Jie Wang M.S.

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First of all, let's say that people see surgical incisions on TV as if they don't bleed, with a well exposed view of the incision and no blood seen spurting out. Whereas we bleed in real life from even a small breach. What's going on here? Below I will tell you what I know about this problem, and see if I can solve the doubts in your mind. The first thing to point out is that less bleeding from the incision firstly reduces the damage and secondly helps to expose the surgical field for the operator to operate. So how exactly is this achieved? Let's talk about it.

1, first of all, surgeons in different patients before the case should be discussed, especially some difficult cases are to discuss. Develop a surgical program, which includes the location of the incision as well as surgical access, find ways to minimize trauma, but also avoid the important large blood vessels and nerves. Let's just say that if an artery is inadvertently damaged, even if it is a small artery, the view of the surgical incision can cause blood to gush out at once.

2. An electric knife is used during the operation. The electric knife heats up the tissue at the moment of incision, so that the corresponding small-diameter blood vessels are directly electrically closed, and bleeding can be significantly reduced. This is also the reason why the burning protein flavor appears during the operation.

3, some surgery before the wound will be subcutaneous injection of epinephrine and other vasoconstrictive drugs, which can effectively reduce the incision surgery area bleeding.

4. In addition to the surgeon in charge, there is also a first or second assistant in general surgery. These assistants are the surgeon's assistants, who are responsible for cleaning the surgical area with gauze or suction. A good assistant is able to adequately clean the surgical area and is the surgeon's right-hand man.

Basically the above factors are involved as long as the operator does not damage the slightly larger arteries are not going to be a lot of bleeding in the surgical area, which is why the surgical incision will be cleaner than a normal wound.

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In some TV and movie productions, it seems that you can always see the skin, neatly cut by the surgeon, without a bit of blood, during an operation.

In fact, when I saw this scene, I couldn't help but spit out another medical pseudo-science brought to you by a movie or TV show.

What is it like in real life to have skin cut during surgery?

In fact, by the small experiences in our reality, we can not launch the case of cutting the skin during surgery. In our daily life, we often come across cases where a small cut is made and there is a lot of blood flow. Therefore, when the skin is cut during surgery, it is absolutely impossible to have no blood at all, and only a small amount of bleeding can be achieved.

Here's an explanation of what doctors do to make bleeding smaller.

Before the doctor performs the surgery, he or she will strictly determine the location of the incision based on the knowledge related to anatomy, avoiding large blood vessels as much as possible, reducing the damage to the blood vessels near the incision, and effectively minimizing the amount of bleeding.

When it is really impossible to avoid blood vessels, electro-knife related techniques are also used to separate and coagulate the incision tissue. And in some localized surgeries, a ration of epinephrine is injected to further minimize bleeding, plus a skilled surgeon.

To summarize all of this, it's also hard to do surgery skin without bleeding like on the TV show.

Before I answer that question, let me first tell you a little bit about when I first started my career as a doctor, when surgery was performed and the lead surgeon had a scalpel in one hand and a hemostat in the other before he cut through the skin. As an assistant I had the hemostat in one hand, a wet piece of gauze to pinch dry in the other, some sutures to prepare, and a suction tube (Cold War era, I think).When the attending surgeon cut the skin, the incision was bleeding at that time, bleeding parts, suction suction clean, clamped with hemostatic forceps, assistants with suture ligation to stop bleeding, bleeding parts with gauze fast pressure to stop bleeding. So surgery at that time, just like now skin scratches and injuries, surgical incision bleeding is more obvious.So it used to be that TV footage could show it, but most of the surgical footage in most of the movies and TV shows had a little bit of gore, so maybe there was a little bit of artistic manipulation!

Why does the cut skin not bleed during surgery? This should be with the development of science and surgical technology, surgery from the original cold weapons (scalpel, scissors, hemostatic forceps), the gradual development of electro-knife, low-temperature plasma knife, lasers, ultrasonic knife and so on, that is, energy instruments, right! It can be said that there is a revolutionary change in surgery. Skin incision is now most often used is the electro-knife, the same skin incision compared to the past bleeding decreased significantly, almost no, that is, you said the skin will not bleed. The modes of electrocautery in surgery are divided into electrocutaneous and electrocoagulation modes.Generally, after cutting the epidermis and dermis with a traditional scalpel, an electric knife is then used, which heats the tissue instantly when the high-frequency, high-voltage current comes into contact with the muscle, thus achieving separation and coagulation of the muscle tissue for the purpose of cutting and hemostasis, so there is almost no bleeding at all.

To summarize the above, this issue shows a good phenomenon, right? Is with the progress of science and technology, a variety of advanced surgical instruments, surgical equipment, artificial intelligence, luminal mirror and so on application, it is estimated that the future of surgical bleeding is less, the patient trauma is small, less damage to other tissues, surgical recovery fast, the closer the recovery of the normal function of the body, to the majority of patients with more tangible benefits!

1. Misunderstandings caused by photo-visual renderings.

In fact, as a doctor, I personally do find it quite unacceptable that most of the surgical footage in most movies and TV shows - it's just too gory. The biggest comment many interns make when they first go on the operating table with us is: why is it different from the TV? We always joke that if the world's doctors were as good at surgery as they are on TV, they would have been sued and changed careers. ......

Artistic Creation ...... is not the same as the actual situation。

Of course, the title says that the skin doesn't bleed when cut inside a TV show, so that seems to be a modern TV show that's improved ...... I specifically remember in Grey's Anatomy, at one point they cut the intestines and they were actually red with blood ...... At the time, I was like, hmmm. It's just as much fun to watch.

2. The use of surgical energy devices has significantly reduced bleeding.

In fact, since about a hundred years ago, surgeons have had a very important additional weapon:Surgical energy devices led by the electrosurgical knife.

Seriously, when I was in medical school, one of the most important things to do was to stop the bleeding: a bunch of clamps and then slowly tying knots or sutures. But in fact, in most surgeries, these situations have been relatively rare ...... Originally, to do a major surgery may have to stop the bleeding and ligature countless times, but with the energy device, surgeons are much easier. The reason for this is that most modern surgeries are able to cut and stop the bleeding without any obstruction. Simply put, a knife down.The flesh was separated and the small veins on it were stopped.

What is the principle? In the case of the electrosurgical knife, the principle is this: bake the paste, and the blood vessels clot ......emmmm Sounds unbelievable, doesn't it, but that's basically what it is.

Energy devices are great for stopping bleeding. For example, many of the minor surgeries that we do as an outpatient, since we don't have an electrosurgical knife, we are able to feel first hand how much blood can come out of the skin if it's cut with a scalpel ...... When you come across areas that have a rich blood supply, you'll really miss the electrosurgical knife.

3. Skilled surgeons.

I don't know if you've ever heard of a theory calledwhite surgery...... This concept is very prevalent in Asia. It is the surgeon through a full understanding of the anatomy of the blood vessels, so that the entire operation process can not see obvious active bleeding, surgery is very clear. Nowadays, many first-class surgeons in China remove some internal organs with bleeding of only a few tens of milliliters (or even less), which is a result of merit on the one hand, and the use of various modern instruments on the other.

How can it not bleed? It's just less blood that comes out. We have capillaries all over our body. So is the skin. Cutting through the dermis is a sure way to bleed. Only to minimize bleeding, the doctor will try to avoid the large blood vessels. But when there is no other way to avoid it, the doctor will also cut the slightly larger blood vessels, and then ligate and sew them up later. It's not like making an "S" shape to avoid surgery, right? Nevertheless, the doctor will still do some measures to try to avoid damage.

1. The principle of no damage if you can

During the operation, the doctor will certainly pay attention to try not to damage the blood vessels, the main reason is to be afraid of affecting the blood supply of the wound, which in turn affects the healing of the wound. The skin is fine, at most, fat liquefaction, wound crack, at least visible can still be dealt with, if the wound in the stomach crack, things can be a big thing~.

Secondly, it is also about the risk of surgery. Less bleeding during surgery can effectively reduce the risk of surgery, and the surgical field of view is also an important reason. The more blood vessel damage, the more bleeding, the more blurred surgical vision. Imagine, the tissues are blocked by blood how to operate?

Of course, these are not the most important things. The most important thing is that after the blood vessel is damaged, the doctor is responsible for sewing it up, if the damage is too much, isn't it a waste of time? So you don't have to worry about the doctor destroying too many blood vessels during the surgery, the doctor is more anxious than you are.

2、Try to avoid large blood vessels

In surgery, the principle of "choosing the lesser of two evils" exists for vessels that are unavoidable and must be "touched". In the presence of both large and small blood vessels, the incision of tissue will generally avoid large blood vessels, choose to cut small blood vessels. This is mainly due to the following considerations: a. large blood vessels bleed a lot, cut off for fear of not being able to stop the bleeding, can not close the scene, b. many large blood vessels are supplied to important tissues and organs, cut off for fear of affecting the local blood supply of the organs and tissues, there is a risk of causing ischemia and necrosis of the local organs and tissues, c. for fear of the organization of the blood supply is less to affect the surgical healing of the incision.

3. Adequate ligation and careful suturing

During the procedure, each bleeding area is carefully ligated and stitched carefully. If there is no bleeding, the doctor will also decide whether a stitch is needed depending on the situation. After all, human life is at stake, now does not mean that bleeding does not mean immediate bleeding, in case the outside are sewn up inside the bleeding can be bad, so we must be doubly careful. Some people may have questions: are stitched up, the tissue will not be ischemic necrosis? Don't worry, the doctor sewed only a small part of the blood vessels. The human body has a huge network of blood vessels, one side is sewn, there are other places of blood vessels to form side branches of blood supply. As long as the critical blood vessels are not sewn up, ischemic necrosis is unlikely to occur.

Author

Chen Dashu, female, graduated from Southeast University School of Medicine with a master's degree, specializes in the diagnosis and treatment of all kinds of common diseases and critical illnesses in Obstetrics and Gynecology, especially in the direction of prenatal diagnosis and gynecological endocrinology, and has long been solving all kinds of problems for patients.

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It's important to be clear that cutting the skin surgically is going to bleed, just relatively little and with the surgeon's care it won't.

Skin injuries why bleeding, because in the human skin will be distributed in a large number of capillaries, blood vessels are always flowing full of red blood cells, when the skin is injured, the blood will flow out of the wound, which is the body's hemostatic mechanism will start, blood vessels began to contract, platelets began to gather, consume the body blood vessels within the coagulation material, slowly stop the bleeding. General capillary bleeding hemostasis process is like this.

Surgical wounds are generally purposefully created by the surgeon, before the incision, the choice of incision sites will avoid large blood vessels, but there is no way to avoid the capillaries in the skin, but the doctors involved in the surgery will be pressed on both sides of the incision, so that blood pressure in the capillaries to stop the flow of blood, which will significantly reduce the amount of bleeding from the capillaries, and at the same time after the incision, the general doctor will use the electro-knife to the bleeding of the obvious places After these operations, the bleeding of the surgical wound will be significantly reduced, but there will still be a very small amount of blood seepage.

So, when we accidentally get injured, we can stop the bleeding by applying pressure, whether it's a large blood vessel injury or a small skin wound. But also be careful, the compression should not be too tight, not bleeding on the line, and not too long. If the wound is still bleeding under compression, then go to the hospital as soon as possible.

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The skin will definitely bleed whenever it's cut, whether it's from a life injury or surgery, and it's not a small amount because of the rich network of blood vessels inside the skin.

The main reason for creating the impression that the skin is not bleeding when it is cut during surgery is because some surgical techniques prevent or minimize intraoperative bleeding:

1. Preoperative blood drive + tourniquet:

During some limb surgeries, in order to minimize bleeding as much as possible, the surgeon will use a wide rubber band to bind the limb in a circle, distally and proximally, thus driving the blood back inside. A tourniquet is then tied proximally to prevent blood from flowing back into the limb. This ensures that the blood flow to the limb is cut off within half an hour and bleeding during the surgery is minimal.

2. Local injection of epinephrine:

Epinephrine has a vasoconstrictive effect and is often mixed with local anesthetic and injected locally into the surgical site, which helps to prolong the action of the local anesthetic, as well as having the effect of reducing bleeding.

3. Incisional electrocoagulators stop bleeding:

Electrocoagulators are surgical instruments that utilize electrical impulses to generate high temperatures at the contact surface between the tip and the skin. The high temperature allows the local tissues and blood vessels to contract thereby stopping the bleeding.

4. Suction to remove blood:

During surgery it is inevitable that blood and other body fluids will flow out and accumulate in the surgical operation area, which can block the surgical field of vision. This is where an assistant is needed to help suck the blood away, thus ensuring a good view for the surgeon. This assistant's job is very important.

5. Gauze pads + retractors:

In order to further minimize bleeding blocking the surgical field of view, it is also common to press a base layer of gauze or cotton pads on both sides of the wound after incision of the skin, and to press it down with a surgical retractor. On the one hand, the outflow of blood is suctioned off, and on the other hand, localized pressure is applied to reduce bleeding.

In life, we bleed a lot when we accidentally cut our skin. But why doesn't the cut skin bleed in surgery? Here is an explanation.

First, surgical incisions are made to avoid large blood vessels and vital nerves, while wounds are not. The preoperative surgeon designs the skin incision based on the location of the lesion and knowledge of the anatomy, and chooses the least destructive approach with maximum exposure of the lesion.

Secondly, local anesthetic and epinephrine are often injected subcutaneously into the incision, which can serve to reduce bleeding and the wound will not.

Thirdly, there will be gauze to press the skin edge of the incision, which will effectively minimize bleeding.

Fourth, the incisions are cut in layers and segments.

These points are the answer to this question. However, no matter how well it is done, there is no 100% guarantee that no blood will come out of the incision at all. After all, the surrounding capillaries are many and abundant.

See here, also warmly remind everyone. It is important to take care of yourself on a daily basis. Avoiding unnecessary trauma is the key to preventing certain important diseases.

Thanks to Gnosis for the invite, here's what's amazing about modern medicine: the technique of stopping bleeding.

Bleeding has been a major constraint in surgery since ancient times. Modern surgical techniques have advanced, and many complex surgeries, such as heart and brain; and many prolonged surgeries can be done, such as brain surgeries of more than 10 hours and complex organ transplants. Even so, in fact, bleeding is still a major constraint to surgical procedures.

In other words, if bleeding is completely resolved, surgery can really "do it all"!

Cutting through the patient's tissue inevitably brings on bleeding.

First, we have microscopes and various magnifying glasses. You can magnify a blood vessel as thick as a water pipe.

But some blood vessels are born with the lesion or stand in the way of our goal. To move forward, these vessels must be cut. Not only that, but there are many capillaries in the body that don't matter and can't be avoided.

Once a blood vessel is severed it inevitably brings blood flowing across the room and a bright red in front of you.

So we have the high-frequency electrosurgical knife, which actually looks less like a knife and more like a pen.

The electrode tip of the scalpel can produce high-frequency high-voltage current in contact with the muscle to heat the tissue, to achieve the separation and coagulation of the muscle tissue, thus playing a cutting and hemostasis purpose. It is like a "soldering iron. In fact, the principle and the ancient leg broken, with teeth biting a towel, and then use a red-hot iron in the affected area fiercely, although stopped the blood, but also open skin, many patients will pass out directly.

There is no doubt that the electric knife is much more precise now. But by the way, despite the precision, you can still smell a roast on a surgical table nowadays, and even some "meat" if it's fat, or intestinal surgery.

There's a more precise version of the "electric knife".

He is called bipolar electrocoagulator, superficially looks like a tweezers, only two tweezers tip of the tissue is subject to the thermal effect of the current, while the tweezers tip of the tissue outside the less or not affected, and can even be targeted at a capillary hemostasis, rather than the whole piece of tissue, safer.

The development of science and technology continues to benefit mankind. Surgery is no longer a bloodbath, and bleeding is almost invisible on many operating tables.

In fact, there are many other "black technologies" in surgery, such as navigation, microscopy, monitoring, etc. Dr. X will tell you more about them later. Dr. X will tell you more about it later.

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