Halsted's Principles & Asepsis Flashcards
What are the surgical principles attributed to Halsted?
Haemostasis
Aseptic Technique
Light touch (atraumatic Sx)
Supply of blood preserved
Tension-free closure
Even tissue apposition
Dead space obliterated
In order to implement Halsted’s principles, what must we have comprehensive knowledge of?
instrument handling
tissue dissection and manipulation
suturing
knot tying
haemostasis
wound closure
When handling and using instruments, what do we want to avoid?
Crushing, drying, heat loss, haemorrhage, loss of vascular supply
What are the two ways to hold a scalpel?
fingertip grip
pencil grip
What is the goal when cutting with a scalpel?
to make a full thickness skin incision
What are some practical tips when working with scalpels?
Larger blades for long, straight skin incisions
Smaller blades for thinner skin, curing incisions, those needed to follow contours
Small pointed blades for stab incisions or sharp dissection in restricted areas
What grip is most commonly used to hold scissors?
thumb-ring finger (tripod) grip
What are three commonly used scissors?
Curved Mayo
Curved Metzenbaum
Operating (utility) scissors
What are the various ways to hold needle holders?
Tripod Grip
Thenar Grip
Palmed Grip
Modified Grip
What crushing forceps are these and what are they used for?
Allis (top) - saw-toothed edge designed for grasping & retracting collagen-rich tissues
Babcock (bottom) - non-crushing tip for delicate tissues
What are these three types of Non-Crushing Forceps?
A. Doyen
B. DeBakey
C. Satinsky
What are these three types of haemostatic forceps?
A. Halsted Mosquito
B. Kelly
C. Crile
What is the purpose of hemostatic forceps?
To stop bleeding
To promote hemostasis
What are these different types of forceps?
A. Brown-Adson
B. DeBakey
C. Dressing
D. Adson
What type of manual retractors are these?
A. Senn
B. Army-Navy
What are these types of manual retractors?
A. Malleable
B. Hohmann Retractors
C. Spay (Snook) Hooks
These are the same kind of retractor. What kind is it?
Balfour Retractors
What kind of retractor is this?
Finochietto rib retractor
What are these self-retaining retractors?
A. Gelpi
B. Weitlaner
C. Ring retractor
What are the names of these suction tips?
A. Poole
B. Frazier
C. Yankauer
What are important things to remember about Tissue dissection and manipulation?
- Deliberate & cautious dissection
- Respect the tissue planes & important anatomical structures
- Blunt dissection is more effective when plane of lest strength is identified
- Do the Necessary!
- Use stay sutures
What is the purpose of suturing?
- Maintain tensile strength throughout healing
- Allows precise wound edge approximation & prevents strangulation of ligatures
The healing process is influenced by…
tension on the suture & the technique used
Accurate suture placement & minimal tension = optimal scar tissue and healing
knot security is related to the …
coefficient of friction of the suture
What is the rule of thumb for suturing?
4-5 throws for conventional Sx + 2-3 additional throws when starting & finishing a continuous pattern
What are acceptable basic suturing knots to know?
Simple, square, Surgeon’s
What are bad suture knots?
Granny, Half-hitch
What are three types of suture needles?
Taper, conventional cutting, reverse cutting
What suture materials are absorbable?
Polydioxanone (PDS II)
Poliglecaprone (Monocryl)
What suture materials are non-absorbable?
Braided or monofilament Nylon
What is the Three Clamp Technique?
Placement of a ligature with one clamp above the intended ligature, one clamp below the intended ligature, and one to stabilize the tissue?
What is the purpose of surgical haemostasis?
To promote haemostasis
Allows maximum visibility in Sx field
Reduces post-op oedema, infection risk, perioperative complications of blood loss or hypotension
Allows reduction of important surgical time.
What suture material is ideal for wound closure?
suture size 3/0 or 4/0 non-absorbable monofilament nylon
Monocryl can be used for intradermal & SQ suture
