Principles of Operative Technique Flashcards
What are Halsted’s principles of surgery?
Asepsis Gentle tissue handling Accurate haemostasis Preservation of vascularity Careful approximation of tissues Obliteration of dead space No tension on tissues
What are the different incision methods?
Scalpel
Diathermy
Laser
What is the correct way to use a scalpel?
Hold with a pencil grip and make a single bold incision of the correct length and depth
When are scissors used?
For cutting tissues below the skin, blunt dissection or undermining tissue. They allow very controlled cutting
What is the advantage of using diathermy?
It can be very quick and has good haemostasis.
What can be done to aid haemostasis?
Pressure Packing Wound closure Haemostats Diathermy Ligatures Topical agents Tourniquet Vascular clips and staples
How does one choose a haemostatic process?
That which is least traumatic, will leave the least foreign material and necrotic tissue and is quickest. It may also depend on the tissue or vessel.
What is important to remember when ligaturing a BV?
Leave 4-5mm between ligature and clamp as the clamp changes the shape of the BV which may cause the ligature to come loose if placed too close to the haemostats.
What are the different types of ligature?
BV: Simple encircling Double Halsted's transfixing Modified transfixing TISSUE: Cruciate Simple interupted Mattress Stick ties
What ligatures are there for vasuclar pedicles?
Triple clamp tecqnique
Modified millers know
Transfixing
Divide the pedicle
How should swabs be used correctly?
Count in and out Use pressure Blot don't wipe Use single swabs Open the swab out
Why is monopolar diathermy more dangerous than bipolar?
With monopolar, if the patient is not earthed correctly then this will cause burning to the patient.
What topical haemostatic agents are there and when should they be used?
Vasocontriction e.g. ice, adrenaline
Promote clotting e.g. fibrin, collagen etc.
Phsical barrier e.g. bone wax/tissue glue
How long can a tourniquet be used for?
20 mins - then need to remove to prevent permanent tissue damage
How can operative tissue trauma be reduced?
- Handle gently - fine sharp intruments, stay sutures, surgeons fingers
- Gentle retraction - hand held rather than self retaining
- Tissue moistness
- Suction rather than swab usage
