General principles of surgery

List halsteds principles of surgery

Gentle tissue handling

Meticulous haemostatis

Preservation of blood supply

Strict asepsis

Minimal tension

Accurate tissue appposition

Obliteration of dead space

What are the ways of holding a scalpel?

What are these for?

Pencil grip, short prescise cuts

finger tip grip, long strokes, whole arm

palm grip, thick structures. less control.

What are two diffect cutting techniques with a scalpul, describe these.

Press cutting - pull tissue same diection as moving blade

Slide cutting - ppull tisue apart away from blade direction (good for controlling depth). Hold blade at 90 deg for a sqaure edge.

What are scissors best fro cutting?

Tissues that are not under tension

What are mayo scissors useful at cutting ?

fasica

What part of the scissors should be used to cut?

tip - forces are striinger at larger distance from h inge. W

What grip should be used for forawrd cutting?

Wide-based tripod grip (same as needleholder)

What two holding techquies can be used to cut backward with scissors?

Backhand thumb + third

• avoids walking arounf

Backhand, thumb, index finger grip

What is the difference in action of a monopolar / bipolar electrosurgical intrument?

Monopolar

• both cut and coagulare

• has a handeice and groundplate

Bipolar

• can only coagulate

• handpeice only

• works betrer than mono in a wet field as current travels between two points

What is more traumatic?

• scalpel and scissors

or

• electrosurgical instraments

Electrosurgical as they hit a larger surface area

How / when should you use an electrosurgical instument?

On anaesthetised patients to control small bleeding vessels

ensure good ground plate contact under patient - avoids overheating

dont coil up handpeice lead

keep elcetrode clean

se lowest power possible, dont use on anything flammable

Why do we lavage tissue?

What can be used?

Avoids drying out of tissue s

removed bacteria

• can use sterile isotoonic saline or wringer solution

List the three suction tips from smallest to largest

1. Frazier-Ferguson

2. Yankauer

3. Poole

List and give defining factors of different forceps (6)

1. adson - tissue, teethed.

2. dressing - no teeth.

3. Debakey - fine jaw pattern

4. Allis - only for tissues to be exised. traumatic. good for holding atuour out the way. has a ratchet.

5. Babcock - similar to allis, less traumatic. long flat edge.

6. Doyen forceps - designed for holding bowel. cureved jaws occulde lumen.

List the two non-self retaining retractors

finger held - good for delicate tissues. Lagenback lip

hand-held - thicker tissues. Hohmann

List the four types of self-retaining retractor.

1. Balfour - abdominal wall retraction of larger animals.

2. Gosset - abdominal wall

3. Finochietto - rib retractors

4. Gelpi - used to separate tisues. CAUTION - sharp tips.