Chapter 17: Instrument and Tissue Handling Techniques Flashcards
List Halsted’s Principles
- Gentle tissue handling
- Meticulous hemostasis
- Strict aseptic technique
- Preserve blood supply
- Eliminate dead space
- Accurate tissue apposition
- Eliminate tension
A Gentleman Halstead Always Observes The Principles***
What grips are acceptable for scalpel handles?
- Fingertip grip - Places maximum length of blade in contact with the tissue. Offers greatest accuracy and stability
- Pencil grip - Uses finger motion, more accurate for short and delicate maneuvers
What are the 4 motions of a scapel?
- Sliding - precise depth, length and control of direction
- Pressing - stab incisions into a chamber
- Sawing - continuation of a cut without removal and reinsertions of the blade ie. pedicle cut
- Scraping - separating tissue layers
What forces are used when cutting with scissors?
What grip is recommended?
- Closing
- Shearing
- Torque
Tripod grip (thumb-ring finger) - provides maximal control
What are the benefits of curved and straight scissors?
- Curved - greater maneuverability and visibility
- Straight - greater mechanical advantage for cutting dense tissue
What part of the scissors should be used to cut and why?
Close to the tips
Cutting near the fulcrum results in greater crushing, injury to the tissue, jagged incisions and potential inadvertent trauma
What are the recommended suture tag lengths?
Synthetic material - 3mm
Surgical gut material - 6mm
What are the 4 acceptable grips for needle holders?
- Tripod - fast grasping and release, good for delicate work
- Thenar grip - Saves time during continuous patterns but needle release is less precise
- Palmed - strongest, provides greatest needle pressure and control in dense tissue and maximal wrist rotation. Needle release and grasping requires adjusting
- Pencil grip - For spring handles in ophtho surgeries
What are the 2 clamping techniques for hemostats?
- Tip-clamping - hemostats with transversely oriented serrations. Tip pointing down towards the vessel tip
- Jaw clamping - Hemostats with longitudinally orientated serrations (Rochester-Carmalts). Designed to grasp larger amounts of tissue with the tips pointing away. Facilitates ligature placement but causes increased tissue trauma
What are the 2 options of gripping a hemostat?
- Tripod grip
- Palmed grip - for removing a hemostat with your nondominant hand
What is a common hazard of self-retaining retractors?
Ischemia at the pressure points
Name the three main types of suction tips:
- Poole
- Frazier
- Yankauer
What is considered ideal dissection technique?
Bloodless and precise dissection, causing minimal complications, including seroma and hematoma incidence
What are the characteristics of an ideal closure technique?
- Maintains tensile strength throughout healing
- Technically quick and simple
- Precise wound edge approximation
Name these interrupted suture patterns and state whether they are apposition, everting or inverting:
A - Simple interrupted (appositional)
B - Modified Gambee - (appositional)
C - Horizontal mattress (everting)
D - Vertical mattress (appositional)
E - Cruciate (appositional)
F - Lembert (inverting)
