Transcript 1. dia - u-szeged.hu

Institute of Surgical Research
„A” Module - Surgical Technics
A1. MODULE – Asepsis and antisepsis
A2. MODULE – Surgical deontology
A3. MODULE – Surgical interventions
A4. MODULE – Bleedings
A4. practical: skin incisison,
handling surgical bleedings,
wound closure: continuous suture, clips
A5. MODULE - Wounds
A6. MODULE - Clinical aspects of shock
Skin incision 1.
- skin scalpel (#20 blade, #4 handle),
- the surgeon and the assistant stretch the skin with
sterile towels on both sides of the operative field.
Skin incision 2.
Incision is - perpendicular to the skin,
- made with a single, definite cut.
Direction of the incision depends on the
location of the organ being operated:
- parallel to Langer’s lines (better wound
healing, less scar formation),
- toward oneself, from left to right.
Skin incision 3.
Depth must be the same in the whole length:
1. insert the tip of the scalpel
perpendicularly into the skin,
2. cut at 450 angle with the edge (not with
the tip!),
3. finish the incision with holding the scalpel
perpendicularly.
Discard the scalpel into the container!
Handling surgical bleeding 1.
Methods:
• oozing: tamponade with dry or wet (warm
saline) towels, Spongostan, Surgicel, etc.
• small vessels: electrocoagulation (diathermy)
thermal effect of high frequency alternating current
Must not be used to cut skin, only deeper layers
(burn injury)!
Handling surgical bleeding 2.
• larger vessels: ligature
1, soak up blood: with sponge (assistant)
2, clamp: with artery forceps (mosquito,
Péan, etc. - surgeon)
3, ligature: with threads (depending on the
size of vessel),
- tie the first knot („half-hitch”),
- remove artery forceps,
- tie the second knot.
Handling surgical bleeding 3.
• diffuse, anatomical bleeding: suture
- with two stitches
- „8” form
• preventive hemostasis:
- clamp with two artery forceps,
- cut the vessel between them,
- ligate both ends.
Handling surgical bleeding 4. (video)
Wound closure
Suturing with continuous sutures
• Simple continuous suture
• Intracutaneous suture (Suture
Tutor)
Wound closure with Michel clips
Wound closure 1. Simple continuous suture
Wound closure 2. Simple continuous suture (video)
Wound closure 3. Intracutaneous suture
- by the Suture Tutor program
CONTINUOUS WOUND CLOSURE
Inserting the suture (intracutan suture)
Summary
1 █ : the subcuticular plane
2 █ video: the 1st stitch
3 █ : grasp the end of the thread with a
forceps
4 █ video: intracutan suturing
Completing the closure
1 █ video: the last stitch
2 █ video: to close the wound pull the
ends of the suture
3 █ video: secure the suture ends.
Wound closure 4. Michel clips
Practical tasks
In the teaching lab:
In the operating room:
Half group
Other half
1. Practical test:
Interrupted (simple or
Donati) sutures: 2-3
sutures
2. Simple continuous suture
with atraumatic thread and
instrument tie.
3. Intracutaneous suture by
the Suture Tutor computer
program (survey).
35 min
1. Gloving alone.
2. Skin incision (team work surgeon, assistant, scrub
nurse) on tissue.
3. Handling bleeding with
ligatures.
4. Wound closure with simple
continuous suture.
5. Wound closure with Michel
clips.
35 min
REPEAT: gloving alone
Have a good practice!