A slide on Basic surgical skills update.pptx

A slide on Basic surgical skills update.pptx

1. Basic surgical skills Dr T. Atim Urologist

2. INTRODUCTION skill’ is the ‘ practiced ability’ to perform the technique or the ‘expertness’ in performing it . In other words, the development of surgical skill through practice is a must for the attainment of surgical techniques .

3. Universal precaution Measures designed to prevent transmission of diseases (from blood and body fluids) Treat everyone’s bodily fluids as if they have potential infections Precautions Contact Droplet A irbone

4. Universal precaution

5. HOW TO HAND WASH

6. HOW TO HAND SCRUB

7. SCRUBBING Remove jewellery. Use soap, brush, running water to clean. Scrub arms up to the elbow. After scrubbing, hold up arms to allow water to drip off elbows. Turn off tap with elbow.

8. SCRUBBING Dry with sterile towel. Hold hands away from body, higher than elbows and below the clavicles. Only sterile surfaces can touch sterile surfaces.

9. SCRUBBING

10. GOWNING

11. GLOVING

12. INSTRUMENTS Tissue forceps Needle holders Scissors Retractors Choose shortest instrument. Fine scissors only used for cutting the tissues.

13. INSTRUMENT HOLDING Use 3 finger control Extend index finger along the instrument Place only finger tips through handle loops Rotation comes from wrist Quicker to pickup, put down

14. INSTRUMENT HOLDING

15. Scalpel Sizes 10 & 20 for abdominal incisions Use BELLY for cutting 15 & 11 for precise and stab incisions (abscess) Use TIP for cutting Always incise in a direction away from you

16. Scalpel Pencil grip – allows sharp precise small incisions Fingertip grip – maximum length of the blade is in contact with the skin Palm grip – Unpopular (precise movements are difficult)

17. Scalpel Use smaller knife. Hold knife like a pen Size of blades #10 blade – large incisions #11 blade – stab incisions #15 blade – for precision WORK

18. Scalpel For fine incisions or skirting around umbilicus during laparotomy

19. Scalpel How to insert and remove scalpel

20. Suturing Goals of suturing are as follows: Provides tension for wound closure. Preventing post operative haemorrhage. Protecting tissues from underlying Infections. Reducing post operative pain

21. SUTURE MATERIALS Can be classified as; Absorbable : cat-gut, vicryl Non absorbable : silk, prolene , nylon Natural : silk, cat-gut Synthetic : prolene , vicryl Mono-filament : prolene , cat-gut Multi-filament : silk, vicryl

22. QUALITIES OF A SUTURE MATERIAL Adequate tensile strength. Functional strength. Easy to handle. Flexability & elasticity. Knotable . Uniformity. Absorbabilty . Smooth surface.

23. BASIC SUTURING TECHNIQUES Needle should be grasped with needle holder approx 1/3 rd distance from the eye & 2/3rd from the point. Needle should be placed perpendicular to surface being entered & pushed through tissues following curvature of needle, rotating wrist.

24. S cissors

25. Scissors To cut at depth or stabilize the tip

26. Scissors To Cut from left to right Always keep your eyes on the scissor’s tips

27. Scissors Sharp tipped scissors are NEVER used inside the body  For opening tissue planes :

28. Needle holder Needle held at the TIP of holder, needle makes a right angle, with the Holder

29. Palming needle holder Palming an instrument when tying stitches, or need to carry out some other short action Technique: Do NOT retain the needle in the holder if you intend to palm it

30. Artery , Clamp, Hemostat

31. Artery , Clamp, Hemostat Unclamping using Left hand

32. Artery, Clamp, Hemostat

33. Forceps

34. Handling sutures One handed reef knot Two handed reef knot Aberdeen knot Slip knot Tying at depth Instrument tie

35. TYPES OF KNOTS

36. SQUARE KNOT OR REEF KNOT Formed by wrapping the suture around the needle holder once in opposite directions between ties. 3 ties are recommended

37. GRANNY’S KNOT OR SLIP KNOT Grannys knot involves a tie in one direction followed by tie in same direction & third tie in opposite direction to square the knot & hold it permanently

38. SURGEONS KNOT Formed by 2 throws of suture around the needle holder on the first tie & one throw opposite direction in 2nd tie.

39. One-handed R eef Knot Subtypes: Index finger knot Middle finger knot

40. One-handed R eef Knot

41. Unstable vs Stable knots Granny & Reef knot Half hitch: A SINGLE index OR middle finger knot (either Rt over Lt or Lt over Rt ) Threads must CROSS in order to get a stable knot

42. Unstable vs stable knots Granny & Reef knot Granny Knot Reef (surgeon) Knot 2 half hitches in SAME direction 2 half hitches in OPPOSITE direction Threads are crossed after each hitch Ex: 2 index knots or 2 middle knots Ex: 1 index followed by 1 middle knot Less stable Because threads of the two half hitches cross rather than run parallel So less area of contact More stable

43. How to cross hands during tying a REEF knot Crossed Horizonal plane, OBSTRUCTS field Incorrect & LESS control Cross your hands in SAGITTAL plane

44. Two handed Reef knot Used when the 2 ends of the thread are the SAME length Safest knot, as tension can be controlled in all steps

45. How to tie a monofilament thread - Aberdeen knot

46. Slip knot Used with CARE, as knot may become loose or thread may get frayed Effective when tying in deep cavities

47. Tying at depth

48. Tying at depth Form the hitch outside the cavity then push it down with your INDEX FINGER Avoid putting tension on the structure your are tying by tightening perpendicular to it

49. Ligatures

50. Suturing Simple interrupted suture Vertical mattress Horizontal mattress Simple running suture Simple running locking suture Subcuticular running suture

51. SIMPLE INTERRUPTED SUTURE

52. SIMPLE INTERRUPTED SUTURE Suture is passed through both edges at an equal depth & distance from the incision & knot is tied. Common. Stronger. Used in areas of stress. Each suture is independent & loosening of one suture will not produce loosening of other.

53. SIMPLE CONTINUOUS SUTURE

54. SIMPLE CONTINUOUS SUTURE Initially, simple interrupted suture is placed & needle is reinserted in a continuous fashion such that suture passes perpendicular to incision line below & obliquely above. Suture is ended by passing a knot over the untightened end of suture. Distributes tension uniformly

55. HORIZONTAL INTERRUPTED MATTRESS

56. HORIZONTAL INTERRUPTED MATTRESS Used for high tension areas with fragile skin. Knot is parallel and adjacent to the wound edges

57. VERTICAL MATTRESS SUTURE

58. VERTICAL MATTRESS SUTURE Most commonly used in anatomic locations which tend to evert, such as the posterior aspect of the neck, deeper wounds It has a far-far-near-near order of bites. The knot will is perpendicular and adjacent to wound edge. Good for deep lacerations

59. SUTURE REMOVAL Average time frame is 7 to 10 days. Face 3 – 5 days Oral mucosa 3 to 5 days Neck 5 to 7 days

60. Thank You