Lecture 7: Principles of Tissue Handling (Exam 1) Flashcards
Why is good surgical tech important
Affects the outcome
Define heuristics
Elements of a skill
What are the 3 types of heuristics in surgery
- Cognitive
- Perceptual
- Motor
Define Cognitive heuristics
Planning movements
Define perceptual heuristics
Recognizing tissues
Define motor heuristics
Handling tissues
There is a trade off btw/ what when discussing surgical movements
Speed & accuracy
How do good surgeons perform
Less repetition & fewer mistakes than the novice
What surgical principles are attributed to Halsted
- Handle tissue gently
- Control hemorrhage meticulously
- Observe strict aseptic tech
- Preserve blood supply to tissue
- Eliminate dead space
- Appose tissues accurately w/ min tension
What surgical skills are need for safe, efficient, & reproducible surgical tech
- Instrument Handling
- Tissue dissection & manipulation
- Suturing
- Knot tying
- Hemostasis
- Wound closure
What do we need to protect tissues from
- Crushing
- Drying
- Heat loss
- Hemorrhage
- Loss of vascular supply
List the four motions of the scalpel
- Sliding
- Pressing
- Sawing
- Scraping
List the use of scissors
- Cut or dissect tissues
- Cut inanimate objects
- Should be used only for their intended
Pros of curved scissors
Greater maneuverability & visibility
Pros of straight scissors
Greater mechanical advantage for cutting dense tissue
inefficient use of needle holders accounts for what
More wasted time than poor tech w/ any other surgical instrument
What should not be used on tissue slated to remain in the px
Allis & Babcock forceps
What can hemostatic forceps be used for
- Isolation of bleeder
- Blunt dissection
What should be considered by towel clamps
- Know what you are penetrating under the drape
- May be used to assist in closing wounds under tension
- Consider substituting nonpenetrating clamps in the overdrape
What should be avoided when using retractors
- Avoid sensitive structures (vessels & nerves)
- Avoid excessive opening
What suction tip is used for body cavities
Poole tip
What suction tip is used for oral cavities
Yankauer tip
What suction is used for neurosurgery & bulla osteotomy
Frazier tip
What precautions are there with tissue dissection & manipulation
- Cautious & deliberate dissection
- Dissect along tissue planes (sharp or blunt)
- Pay attention to lines of tension
- Limit tissue manipulation
- Know when to use fingers instead of instruments
- Use the right instruments
- Consider stay sutures instead of forceps
- Keep tissues moist & patient warm!
What needs to be done for proper suturing
- Use the right suture pattern
- Use the right needle
- Correct needle placement is critical
- Minimize tissue handling when placing sutures
- Do not over tighten (achieve apposition & avoid ischemia)
What needs to occur for proper knot tying
- Secure knots
- Appropriatley buried
- Absorbable suture is only absorbable when it is buried in tissue
- On abdominal closures leave some space btw/ the knots & the skin
- Continuous closures are faster
Describe the Aberdeen knot
- Alternative to the square knot @ the end of a continuous line, when the surgeon is left w/ a loop & a free end
- Knot volume is 32 to 56 per cent of traditional square knots
- Knot holding capacity is 24 per cent greater than traditional square knots
