Term
|
Definition
| goal-orientated violence to tissues |
|
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Term
| what are the basic principles of good surgical technique, which results in better surgical result? |
|
Definition
-minimise tissue damage
-minimise blood loss
-avoid wound dehiscence |
|
|
Term
| 3 techniques for skin incision |
|
Definition
-stainless steel scapel
-electrosurgery
-laser |
|
|
Term
| why does skin incision by electrosurgery or laser have a 3-10 fold fr risk for SSI? |
|
Definition
| -likely due to thermal damage of tissues |
|
|
Term
| when should skin incision by electrosurgery or laser be used? |
|
Definition
-only in specific circumstances
e.g. massive excision in which risk of blood loss outweighs risk for infection |
|
|
Term
| why is the steel scapet the instrument of choice for most incisions? |
|
Definition
-causes minimal collateral damage
-good primary healing |
|
|
Term
| what blade numbers are used for a small handle (no. 3)? |
|
Definition
|
|
Term
| what blade numbers are used for a larger handle (no. 4)? |
|
Definition
|
|
Term
| how should the blade be placed on the handle? |
|
Definition
with an instrument (needle holder)
in order to avoid penetrating the glove |
|
|
Term
| how is the blade handle held? |
|
Definition
fingertip grip is most common:
-tips of third, fourth, fifth fingers placed underneath handle
-thumb on the side
-index finger rests on top surface of blade to create controlled, downward P |
|
|
Term
|
Definition
-slide cutting - incision made in one smooth pass of scapel (most common)
-stab incision - point of blade is pushed through the tissue in one small site |
|
|
Term
| what must be remembered when incising, in order to facilitate a smooth cut? |
|
Definition
| tension should be placed on the tissue with the free hand |
|
|
Term
| why is blunt dissection used? |
|
Definition
| -in order to avoid damaging deeper structures during surgical approach |
|
|
Term
| how is blunt dissection carried out? |
|
Definition
-usually along natural tissue planes or parallel to tissue fibres
-can be performed digitally and w. scissors |
|
|
Term
| why should excessive dissection and undermining be avoided? |
|
Definition
| creates dead space which impedes wound healing and potentiates infection |
|
|
Term
| classic tripod grip of scissors |
|
Definition
-thumb and last digit of third finger in rings of scissors
-index finger stabilises along the shaft towards the blade |
|
|
Term
| in deeper dissection is scissor or digital dissection preferred? |
|
Definition
| -digital - scissor is potentially dangerous as vessels or nn. could be severed w/o being seen |
|
|
Term
|
Definition
-quite large
-thick, rounded, quite long tips
-used for c.t., fascia, sutures |
|
|
Term
|
Definition
|
|
Term
|
Definition
-thinner than mayo scissors
-tip shorter and thinner than mayo, but still blunt
-used for more delicate soft tissue |
|
|
Term
|
Definition
|
|
Term
|
Definition
| prevent blood loss from incised or transected vessels |
|
|
Term
| why is proper haemostasis important? |
|
Definition
-prevents surgical field from being obscured by blood
-dec. risk for infection
-minimises blood loss and post-op haematoma and seroma formation which may delay healing or potentiate wound dihiscence |
|
|
Term
|
Definition
-mechanical - pressure, ligatures (hemosats, suture, vascular staples)
-thermal
-chemical
-physical |
|
|
Term
|
Definition
-applied directly to vessel w. a single gauze to control haemorr. from smaller vessels
-not adequate for medium size or larger vessels
-minimally traumatic but appropriate time for clotting has to be allocated before packing is removed |
|
|
Term
|
Definition
a type of pressure hemostasis
-can be used to control hameorrhage from open body cavities or large body wounds |
|
|
Term
| Hemostat ligatures - method |
|
Definition
i.e. clamp - tissue within the hemostat is crushed, which effectively occludes the vessel
-can be applied fro smaller, non-critical vessels and held for a few mins |
|
|
Term
|
Definition
| commonly used for larger vessels |
|
|
Term
| suture ligation - no. of sutures |
|
Definition
-small vessels - 1 circumferential ligature
-vessels w. a lumen / pulsating vessels - 2 ligatures - cicumferential followed by trans-fixation ligature (small amount of tissue is incorportated) more deeply |
|
|
Term
|
Definition
-hemostat perpendicular to long axis of vessel
-clamp least amount of tissue poss., use smallest hemostat poss., use only tips of instrument |
|
|
Term
|
Definition
vessels up to 7mm
(alternative for suture ligation) |
|
|
Term
|
Definition
-electro-coagulation is commonly used
-heat generation from high freq alternating electrical current
-causes protein denaturation inside tissue cells
-do not use current >4MHz - IC fluids will boil and cause vessel to explode |
|
|
Term
| thermal hemostasis - electo-coagualtion - use |
|
Definition
|
|
Term
|
Definition
-AD can be used to control haemorrhage
(potent alpha-2-agonist - causes vasocon.)
-used to control superficial bleeding of mucosal and subcut tissues (areas w. difficult / no access e.g. nose bleed) |
|
|
Term
|
Definition
soluble, sponge type materials
-control haemorr. by promoting clot formation and provide a scaffold
-can be used for low P bleeding
-however, can delay wound healing and promote inf. |
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