operative technique Flashcards
What are Halsted’s principles?
H - Haemostasis A - Asepsis L - light tissue handling S - sustain vascularity T - Tissue tension absent E - effective tissue approximation D - dead space obliteration
What are the 3 different grips for a scalpel?
pencil grip
fingertip grip
palm grip
What is press cutting?
pencil grip
apply pressure in direction of movement
incise hollow organs / cavities
What is slide cutting?
pencil / fingertip grip
pressure at right angles to movement of blade
What do electrosurgery and lasers do and what are their advantages / disadvantages
vaporise tissue along the incision
ADVANTAGES - less blood loss, less need for ligatures, less operating time
DISADVANTAGES - thermal necrosis, delayed wound healing, less resistance to infection, risk of fire, expensive
3 types of surgical haemorrhage
PRIMARY - bleeding immediately from vessel trauma
DELAYED INTERMEDIATE - bleeding within 24 hours (slipped ligature)
DELAYED SECONDARY - more than 24 hours later (necrosis)
Why is haemostasis important in surgery?
- bleeding obscures surgical field
- blood increases infection risk
- irritating to tissue and delays wound healing
- avoids surgical panic
Ways for physiological haemostasis
- pressure with a swab
- temporary packing with swabs (not big cavity)
- close wound with sutures
- haemostatic forceps
- cautery
- ligatures
- vascular clips and staples
- topical agent
- tourniquet
Electrosurgery - monopolar vs bipolar
MONOPOLAR - current between handpiece and ground plate. cuts and coagulates. Current can be applied to instruments
BIPOLAR - current between tips of forceps. Can be used in a wet surgical field
Examples of excessive tissue trauma
- inadequate incision length
- dull surgical instruments
- failure to dissect along normal tissue plains
- excessive undermining of tissue / blunt dissection
- unnecessary / improper handling
Why would you lavage a wound?
remove bacteria and foreign material dilute toxins reduce wound inf tissue hydration improve visibility warm the patient
What do you use to lavage a wound?
sterile
isotonic
non - toxic
normothermic
What is a surgical drain needed?
when any dead space will be left
closed contaminated wound
a seroma
immediate closure of a traumatic wound
When should a wound be left open?
dirty traumatic wound with delayed closure
prevent infection if non aseptic procedure (castation)
