Sleepless Doctor

　　 100 units of Ulinastatin were pumped before induction of anesthesia, and dexmedetomidine 0.5ug/kg was given within 10 minutes.

"Induction" gave midazolam 2mg, sufentanil 40ug, etomidate 10mg, and rocuronium 50mg.

　　 Every step Ren Haitao has pondered many times, although it is the most common induction of anesthesia, he still tries his best to be flawless.

　　 Induction of anesthesia, and tracheal intubation 3 minutes later.

　　 The patient’s oropharynx has no problems, and the prepared bronchoscopy is useless. Connect the ventilator to expose the head surgery area and leave it to Chu Zhixi.

　　 Sufentanil 20ug was added before the operation, propofol 4-8mg/kg/h and remifentanil 0.1-0.3ug/kg/min were used for intraoperative anesthesia maintenance, intravenous anesthesia, rocuronium was added intermittently.

　　Everything is done, Wu Mianwu teacher has already started the scab removal operation, Ren Haitao can take a leisurely look at the operation at this time.

　　 After more than ten days of growth on the injured side, blood scar tissue has formed at the burn site. The black and dark red scabs looked as hideous and terrible as weird armor.

　　 The electric leather knife buzzed, and the hard blood scab was slightly thinned. Wu Mian's movements were very fine, and the blood scabs on his upper limbs were cut off evenly. Director Li of the Burns Department holding a sterile gauze next to him was ready to press the gauze to stop the bleeding at any time.

　　 The blood scab under the electric paring knife becomes thinner at a speed visible to the naked eye, and even appears dented, which is lower than the surrounding skin tissue, forming a depression, and there is still no bleeding.

　　 "Mr. Wu, how did your scab removal operation be so uniform?" Director Li asked.

　　 "Feeling." Wu Mian said softly.

　　 The blood scab is right in front of him, but no one knows how thick the blood scab is. Generally, surgery only involves cutting, and pressing on bleeding.

　　 Some patients with extensive burns may experience hemorrhagic shock during the operation, which is a normal complication.

It can be seen that Mr. Wu Mianwu’s movements are gentle and delicate. The electric peeling knife is really cutting the scab. After 5 minutes of opening, there is no bleeding. Director Li even has a doubt whether Mr. Wu will cut the blood scabs transparently. of.

　　Thin as a cicada wing is just a description, but Director Li really thinks it might 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.

　　 This is easy to say, but if it is done, it will be difficult.

　　 "Girl, come on."

　　 Finally, at 6'22″, Wu Mian asked Chu Zhixi to start the operation for skin removal.

　　 It's early, Director Li is a little puzzled. Generally speaking, the scab is cut first to stop part of the bleeding and try to preserve useful blood vessels. Even if it is a microsurgery, a small arteriovenous anastomosis must be completed by cutting the scab first.

　　 But he didn't question Teacher Wu, but watched quietly.

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

　　 Director Li was able to use his abilities. The sterile gauze in his hand was pressed against the wound with a moderate strength, and it did not affect Wu Mian's surgical field.

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

　　 "Vessel blocking forceps." Wu Mian stretched out her hand, and a small and delicate forceps patted him.

　　 The electric paring knife buzzed for the last time, and the operation field turned bright red.

　　 Wu Mian put the electric paring knife aside, holding the sterile gauze in one hand and the vascular blocking forceps in the other, dipped in blood, and the small forceps were directly inserted in, closed, and clamped.

　　 Is it caught? Director Li didn't even see what happened, and the action was over. But he didn't froze, and quickly held on to the vascular blocking forceps.

　　 Wu Mian picked up the scalp that Chu Zhixi handed over. There are abundant capillaries under the scalp, which is good for rebuilding blood circulation and allowing the skin to grow well after skin grafting.

　　 Director Li only glanced at his scalp, his eyes straightened.

　　The capillary arteries and veins are dissected and clean, leaving them on the scalp like thin hair. How did she do it? At this time, Director Li regretted a bit, and he should have watched Professor Chu Zhi Xichu free his scalp.

　　 Guang thinks that Mr. Wu is a surgeon and watch him perform the operation. But just seeing the scabs, there is nothing really good about it.

　　 I felt regretful, but at the beginning of the operation, there was still a chance. Director Li moved a few centimeters toward Chu Zhixi's side, with slight movements, trying not to let Teacher Wu see that his attention was placed elsewhere.

　　 But at this moment, Wu Mian's scissors in the microscopic device in Wu Mian's hand lightly clicked and picked, almost no movement was seen.

　　 Is this... peeling off the adventitia?

　　 Director Li was stunned.

　　Usually, you have to use vascular forceps to clamp the outer membrane of the broken end of the blood vessel and then cut it out, so as not to bring the outer membrane into the lumen during the suture and cause thrombosis.

　　 Or use small scissors to carefully peel off and cut off the outer membrane of the broken end of the blood vessel, carefully damaging the blood vessel wall along the way.

　　 This step depends on the level of the surgeon, and the length of time varies, but as long as the level is sufficient, the outer membrane will be carefully cut off, and it is best not to omit it.

　　 What did Mr. Wu do?

　　 Director Li felt a sense of regret again. Whatever he thought, how could he go to see the skin of the donor being peeled off? You should always watch Mr. Wu's surgery.

　　 He felt that his face was hurt by being slapped left and right.

　　 It turned out to be peeling off the adventitia of blood vessels, Director Li was right.

The scissors in Wu Mian's hand then picked up the translucent vascular adventitia that was as thin as a cicada wing, and rubbed a piece of gauze on hand~www.wuxiax.com~ The scissors returned to the instrument nurse and asked for 0.1% heparin. The saline began to flush the blood vessels.

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

　　 Then Wu Mian pulled the vascular clamps at both ends of the blood vessel closer, and after the opposite end of the blood vessel was brought closer, sutured a certain point on the upper and lower sides of the blood vessel.

　　 Both needles are ligated on the outside of the blood vessel at the same time.

　　 Two fixed-point intermittent stitching method! Teacher Wu unexpectedly chose the most difficult two fixed-point intermittent stitching method!

　　 This stitching method has many advantages, but its disadvantages are also obvious-stitching is extremely difficult.

　　 Director Li cheered up and watched Wu Mian tying the knots. During the ligation, Director Li clearly felt Wu Mian's strength soft and stable. Here are the capillaries. A little bit of force will cause the blood vessel wall to tear.

　　Sometimes I do my own surgery, a cardiovascular tear is not a small one, and everything has to be done from scratch.

　　If it's a donor...Fortunately, I'll do it again after cutting it short. If the blood vessel under the scab is torn, it's a headache. Here has always been an extremely difficult point of microscopic anastomosis, but Mr. Wu gently tied a knot in this way to end this operation.

　　 Then Wu Mian sews another stitch between the two fixed points. After the anterior wall is sewn, the blood vessel clamps at both ends are turned upside down, and the posterior wall of the blood vessel is sutured according to the upper method.

　　 Every step is done well and well. Director Li is not wearing a microscope. He can only judge the step of the operation from Wu Mian's movements.

　　 The strange thing is that the two-point intermittent stitching method requires an assistant to help lift the thread, but Mr. Wu did not throw the thread over. Director Li took this down and prepared to ask if there was a new way of anastomosis after the operation.

　　 The operation was steadily advancing step by step, and suddenly the alarm sounded by the monitor.

　　 The sharp alarm sound made the adrenaline soar.