100 units of ulinastatin were injected by pump before anesthesia induction, and dexmedetomidine 0.5ugkg was given within 10 minutes.

    Midazolam 2mg, sufentanil 40ug, etomidate 10mg and rocuronium 50mg were induced.

    Ren Haitao has thought about every step for many times. Although it is the most common anesthesia induction, he still tries his best to be flawless.

    Anesthesia induction administration, endotracheal intubation 3 minutes later.

    The patient had no problem with the oropharynx, and the prepared fiberoptic bronchoscope was not used. Connect the ventilator and expose the head operation area to Chu Zhixi.

    Sufentanil 20ug was added before the operation, propofol 4-8mgkgh and remifentanil 0.1-0.3ugkgmin were used for intraoperative anesthesia, intravenous anesthesia, and rocuronium was added intermittently.

    After everything is finished, Mr. Wu Mian and Mr. Wu have started the eschar removal operation. Ren Haitao can have leisure to see the operation at this time.

    After more than ten days of growth on the injured side, blood scab and scar tissue have been formed at the burn site. The black and dark red scabs looked as ferocious as strange armor.

    The electric leather knife buzzed, and the hard blood scab was thinned little by little. Wu Mian''s action is very fine. The blood scabs on his upper limbs are cut off evenly. Director Li of the burn department, who is holding sterile gauze, is ready to press the gauze to stop bleeding at any time.

    The blood scab under the electric peeler can be thinned at a speed visible to the naked eye, or even sunken, which is lower than the position of the surrounding skin tissue, forming a depression, and there is still no bleeding.

    "Miss Wu, how can you do this escharectomy so evenly?" director Li asked.

    "Feel." Wu Mian said softly.

    The blood scab is right in front of us, but no one knows how thick the blood scab is. Generally, the operation only needs to cut and press when bleeding.

    Some patients with large area burn may have hemorrhagic shock during operation, which are normal complications.

    It can be seen that Mr. Wu Mian''s movements are gentle and delicate. The electric peeler is really cutting scabs. There is no bleeding after opening for 5 minutes. Director Li even doubts whether Mr. Wu will cut the scabs into transparent ones.

    Thin as a cicada wing is just a description, but director Li really thinks it may become a reality.

    "Although the damaged area is about 17.2%, the damage should be as small as possible and the postoperative recovery can be faster," Wu Mian said.

    It''s easy to say, but it''s hard to do it.

    "Girl, drive."

    Finally, at 6 ′ 22 ", Wu Mian asked Chu Zhixi to start the operation.

    It''s early. Director Li is a little puzzled. Generally speaking, scabs are cut first to stop some bleeding and preserve useful blood vessels as much as possible. Even for microsurgery and micro arteriovenous anastomosis, the scab should be cut first.

    But he didn''t question Mr. Wu, but looked at him quietly.

    Finally, a trace of bright red mixed with light yellow exudate appeared in the operation field.

    Director Li has a place to use. The sterile gauze in his hand is pressed on the wound with moderate strength, which does not affect Wu Mian''s operation field.

    When the first scalp was sent, the blood scab was just cut off, and it was perfect only in terms of time.

    "Vascular blocking forceps." Wu Mian stretched out his hand and clapped a small and exquisite forceps in his hand.

    The electric peeler buzzed for the last time, and then the field turned bright red.

    Wu Mian put the electric peeler aside, holding sterile gauze in one hand and vascular blocking forceps in the other hand, dipped it in blood, and the small forceps directly extended, closed and clamped it.

    Is it caught? Director Li didn''t see what had happened, and the action was over. But he was not stunned and quickly held the vascular blocking forceps.

    Wu Mian picked up the scalp handed over by Chu Zhixi. The capillaries under the scalp are rich, which is conducive to re-establish the blood circulation and make the skin grow well after skin grafting.

    Director Li only looked at his scalp and his eyes straightened.

    Capillaries and veins are free and clean, and remain on the scalp like sparse hair. How did she do it? At this time, director Li regretted that he should see Chu know that Professor Xi Chu was right.

    Just think that Mr. Wu is an operator and watch him do the operation. But just seeing the scab cutting, it really doesn''t look good.

    He regretted, but at the beginning of the operation, there was still a chance. Director Li moved a few centimeters to Chu Zhixi''s side, with a slight movement. He tried not to let Mr. Wu see that his attention was elsewhere.

    But at this time, the scissors in the microscopic equipment in Wu Mian''s hand gently picked, and there was almost no action.

    This is... Stripping the adventitia?

    Director Li was stunned.

    Generally, you should clamp the broken end of the blood vessel with vascular tweezers, pull the adventitia outward and cut it off, so as not to bring the adventitia into the lumen during suture and cause thrombosis.

    Or use small scissors to carefully peel off and cut off the adventitia at the broken end of the blood vessel, and carefully damage the blood vessel wall all the way.

    This step depends on the level of the operator. The time varies, but as long as the level is enough, the adventitia will be carefully cut off. It''s best not to omit.

    What did Miss Wu do?

    Director Li felt remorseful again. What did he think and how did he go to see the peeling of donor skin? He should always watch Mr. Wu''s operation.

    He felt that his face was hurt by a slap on the left and a slap on the right.

    Sure enough, it was peeling off the adventitia. Director Li was right.

    The scissors in Wu Mian''s hand then took the translucent vascular adventitia as thin as cicada wings and rubbed it on a piece of gauze at hand. The scissors were returned to the instrument nurse, asked for 0.1% heparin normal saline and began to rinse the blood vessels.

    "Kaplan line, 11-0," Wu Mian said softly.

    Then, Wu Mian pulled the vascular clamps at both ends of the blood vessel close to make the opposite ends of the blood vessel close together, and made a certain point suture at the top and bottom respectively.

    Two needles were ligated on the outside of the blood vessel at the same time.

    Two point intermittent sewing method! Teacher Wu chose the most difficult two-point intermittent sewing method!

    This kind of suture has many advantages, but its disadvantages are also obvious - it is very difficult to suture.

    Director Li cheered up and watched Wu Mian knot with great concentration. During the ligation, director Li obviously felt that the strength of Wu Mian was gentle and stable. Here are capillaries. With a little more strength, the blood vessel wall will be torn.

    Sometimes when you have your own surgery, if you accidentally tear a blood vessel, you have to start all over again.

    If the donor... It''s OK to say, cut it short and do it again. If the blood vessels under the scab are torn, it will be a headache. It has always been a very difficult point of microscopic anastomosis, but Mr. Wu gently tied a thread knot to end this operation.

    Then Wu Mian sewed another needle between the two fixed-point lines. After the front wall was sewn, turn the vascular clamps at both ends upward and sew the rear wall of the blood vessel according to the above method.

    Every step was done methodically. Director Li didn''t wear a microscope. He could only judge which step of the operation was carried out from Wu Mian''s action.

    Strangely, the two-point intermittent sewing method needs an assistant to help with the thread, but Mr. Wu didn''t throw the thread over. Director Li wrote this down and prepared to ask if there was a new anastomosis after the operation.

    The operation progressed steadily step by step, and suddenly the alarm of the monitor was loud.

    The shrill alarm sent adrenaline soaring.