General surgical principles Flashcards
What are Halstead’s principles of surgery?
Gentle tissue handling Strict asepsis Meticulous haemostasis Preservation of blood supply Obliteration of dead space Accurate tissue apposition Minimal tension
How should an incision be made?
One single line
Using a scalpel with disposable blades
When using scissors for surgery, should you use the entire blade?
No - use tips only
Scissors can be Mayo or Metzenbaum and straight or curved. When would you used straight and curved scissors?
Straight - cut
Curved - dissect, finer cutting
Are electrosurgical instruments less or more traumatic than scalpels/scissors?
More traumatic - only on anaesthetised patients
How should you use an electrosurgical instrument?
Ensure good plate contact Don't coil up handpiece lead Keep electrode clean Use with care around delicate tissues Lowest power possible
Why do electrosurgical incisions take a long time to heal?
Can burn skin
When are electrosurgical instruments useful?
For fat tissues
Reducing risk of haemorrhage
Should you use tissue forceps on tissues?
No - only dressing forceps
Unless removing the tissue being handled
What are retractors?
Instruments either manual or self-retaining
Allow to expose surgical field with least trauma possible
What should be used for wound irrigation?
Saline
E.g. if washing abdomen after intestinal spill
After flushing a body cavity with saline, what should you do?
Remove the saline with suction
What are some complications of improper tissue handling?
Incisional hernias Seroma/abscess formation Infection (due to contamination) Increased post-op pain Poor cosmetic results
What happens if dead space is left after surgery? (Halstead’s principles - dead space should be obliterated)
Forms seroma or abscess
What factors influence what suture material is used?
Tensile strength (should be equal strength to tissue)
Structure of suture - mono or multifilament, adsorbable, non-adsorbable, synthetic or natural
Local wound conditions
Healing rate
(Cost and surgeons preference)
How is suture diameter measured?
Metric = in 1/10 of a mm USP = arbitrary units (1/1000 of an inch)
What is the difference between monofilament and multifilament sutures?
Mono = a single strand of suture Multi = multiple strands braided/twisted
What are the advantages of monofilament sutures?
Little drag
Withstand contamination better
What are the disadvantages of monofilament sutures?
High degree of memory =
Difficult handling
Worse knot security
What are the advantages of multifilament sutures?
Easier to handle
More pliable as less memory
Higher surface area = better knot security
What are the disadvantage of multifilament sutures?
More drag
Harbour bacteria
All sutures cause some reaction within tissues. Which causes more reactions - synthetic or natural suture material?
Synthetic - less reactions (hydrolysis)
Natural - more reactions (enzymatic)
Give examples of when non-adsorbable sutures may be used
Skin
Securing implants
Hernia repairs
What are the advantages/disadvantages of using a swaged on needle?
Less traumatic as new sharp needle each time
Expensive
