anatomy-with-cinical-correlations-I-II.pptx

Anatomy correlation - based of skull

1. Surgical Instruments The surgical instruments are divided in to the main and instruments of special function . The main instruments are used in all operations. Instruments of special function are only used during the specific surgical interferences (skull trepanation, operations on the organs of abdominal cavity, etc ). All the time of using any surgical instrument it is necessary to keep some general principles . 1 . During the operation must be used the only adjusted and arranged instruments. 2. Each instrument must be used only according to its direct function. 3 . During the operation the surgeon should hold any instrument in hand easily and with self-confidence.

2. 4. With the instrument all the manipulation must be done lightly, rhythmically, purposely, and carefully. 5 . During working with the instruments the special attention must be paid to tender attitude towards the live tissue. The main surgical instruments can be divided into four groups : 1. Cutting instruments of tissues (knives, scalpels, scissors, saws. etc.) 2. Instruments for stopping the blood flow (different kind of clamps) 3. Assisting instruments (forceps, retractor, probes, etc) 4. Tissues suturing instruments (needles, needle-holders, thread Michele clips.)

3. I. Cutting instruments of tissues Scalpel is the main instrument for cutting the tissues. There are sharp-tipped and round-shaped as a belly scalpel. It is used in the position of bow (violin), pen and table-knife. Bow position is more comfortable during the equal depth superficial incision. Pen position gives a chance precisely keep the hypothetical length and depth of the cutting. Therefore it is comfortable to exactly make refined manipulations. Table-knife position is comfortable during the cutting of elastic and tough tissues, when there is a need of strength development. At the time of amputation an amputation knife is held as a sword . A scalpel is a fine edge cutting instrument with a blade that allows the surgeon to exert maximum control while cutting tissues, and is used to make incisions in the skin or other tissues. Scalpels are available in both disposable and stainless steel varieties, and in a range of sizes.

4. Scissors are used to cut tissue or other materials during operative procedures and come in a range of sizes and types. All scissors are classified as either sharp or blunt and straight or curved. The most frequently is used crooked blunt-tipped scissors (cooper). The straight sharp-tipped scissors are used to cut the small soft formations and take out the stitches. During the using of the scissors the thumb distal phalange is put in one ring and the fourth finger distal phalange in the second ring. The third (middle) finger is put under this last and the index finger in the lock . By this rule the scissors are reliably fixed in hand and their movement is done according to the plan. The scissors not only cut the tissues but also crush them.

5. General surgical instruments: I Tissue dissection instrument . 1-bellied scalpel; 2.-sharp-tipped scalpel; 3.-resection scalpel; 4.-amputating knife; 5.-blunt scissors; 6.-sharp-tipped scissors; 7-cooper s scissors; 8- Richter s scissors; 9.-blood vessel scissors. II Hemorrhage stopping instrument . 10-11 – Kocher s straight and curved clamp; 12-13 – Billroth straigth and curved forceps; 14-15 – straight and cuver Mosquito forceps; 16 –dissector; 17 – blalock vascular clamp.

6. There are two basic types of scissors, one for soft tissues and one for firmer tissues such as sutures. Insert the thumb and ring finger into the rings (or bows) of the scissors so that just the distal phalanges are within the rings . Any further advancement of the fingers will lead to clumsy hand ling and difficulty in extricating the fingers at speed. Use the index finger to steady the scissors by placing it over the joint. When cutting tissues or sutures, especially at depth, it often helps to steady the scissors over the index finger of the other hand. Cut with the tips of the scissors for accuracy. II Instruments for stopping the blood flow (clamping) hemostats. To stop the blood flow in wound is used the vessels clamps. There are Pean’s , Bilrot’s , Kocher’s clamps . At the ends of Pean and Bilrot’s clamps are enclosed with notches. With the notches of the ends, Kocher’s clamps are enclosed with teeth. The rule of using vessel clamps is the same as scissors.

7. III Assisting instruments The most frequently is used the forceps . There are three kinds of forceps: anatomical, surgical and paw like, one. Anatomical forceps are enclosed with wide (transversal) notches, surgical forceps, hard, teeth and paw like-toothed paws. Anatomical forceps are used to hold the tender tissues. Surgical forceps holds tissues more firmly, but at the same time somehow damage them. Therefore forceps are used to hold relatively raugh tissues. Paw like forceps less damage tissues and hold them quite firmly . Forceps should be held from the middle part. From one side with the thumb and the second side with the index and middle fingers.

8. III Fixation instruments. 18- surgical forceps; 19 –anatomic forceps; 20 – paw like, 21-22 –sharp and blunt hook; 23 – papet hook; 24 – single sharp hooh ; 25 – grooved probe. 26 – buttened probe; 27- Kocher probe; 28 – Buialski probe; 29- Linen holder; 30- Korcangi . IV Tissue connecting instrument. 31- Deshan s needle;32- Reverdin’s needle; 33 – Hegar’s needle holder; 34- Toprover’s needle holder; 35 – Matieu’s needle holder; 36- Pricking needle; 37 _ sharp needles; 37-straight needle; 38-forceps for putting Miscel’s clips; 9 – Mischel s clips remover; 40-Michel’s clip.

9. Retractors. Surgical use a variety of instruments to hold back tissues so that the area of body they are operating in is easily accessible. These instruments are collectively referred to as surgical retractors. They play a critical role during surgery, as they ensure that there is a clear view of the surgical site and also help keep the tissues being retracted from being damaged. Surgical retractors come in a wide assortment of shapes, sizes and designs. They are typically referred to in terms of type of tissue or organ to be retracted: some examples include abdominal retractors, lung retractors, and skin retractors. Many varieties, such as Balfour retractor are named after the person who invented them, while the basic purpose of all these instruments is the same, their specific function can vary. Some surgical retractors keep the edges of an incision separated. Others hold back organs that may naturally block the operative field to give the surgeon clear access.

10. Instruments used to force tissues apart and then hold them in position, such as rib spreaders, may also be considered retractors. The two main types of surgical retractors are hand-help and self-retaining . Hand-held retractors are designed to be held by assistants during the surgical procedure. Self-retaining retractors can be adjusted and locked in place so they maintain their position without further manual intervention. Both types have advantage and disadvantages. While hand- helds can offer more flexibility than self-retaining styles, it may be more difficult to maintain the correct level of retraction with them. They are many different shapes of surgical retractors, designed based on their function. Both the handles and the blades of retractors come in many styles. Blades can be straight, or curved narrow or wide, and have a smooth, hooked or raked shape.

11. Handles can include notches, rings, or hooks to make them comfortable and easy to handle. The instruments also come in a variety of sizes to accommodate surgery in all patients from children to adults. Stainless steel is often used to make surgical retractors, as it is very strong and easy to sterilize. It does have some drawback however, which can be hazardous during a surgical procedure. It becomes very slippery when wet and is highly reflective in bright light. To Eleminate these issues, retractors can also be made of a variety of polymeric materials. Any material used to make a retractor needs to have the ability to be sterilized in an autoclave. Senn and Hohman are types if hand-held retractors that feature both blunt and sharp ends for pushing body parts out of the way while a surgeon is performing. There are two kindes of probes, buttoned probe, grooved probe. Buttoned probes are used to make exact direction of the hole drains. To reveal foreign bodies mostly is uses grooved probe also during the cutting of the tough tissues (fascia, aponeurosis ).

12. IV Tissues sewing instruments Surgical suture Needle-Types and Uses. Surgical suture needle is main medical equipment used in any wound care procedure. There are four different types of surgical needles. The first body type of needle is of straight type which is used suture easily accessible tissue that can be manipulated directly by hand. Straight type of needle is helpful in microsurgery for nerve and vessel surgeries . The second type of needle is half-cured skin type. This type of needle is only by expert paramedical staff and surgeon because of its body shape which is quite difficult to handle. The third type of needle body type is curved needle. This type of body needle requires less space for maneuivering as compared to straight needle. Curved needle is also available in different sizes (such as quarter-inch, three eights-inch, half-inch, and five eights-inch circle). For skin closures three-eights-inch circle is commonly used.

13. Last in line ( the fourth type ) is compound curved surgical needle. This type of needle is most complex type of needle in all types. The needle curvature was in fact developed for anterior segment ophthalmic surgery. Four different types of surgical suture needles are available. The straight needle is good for easily reachable tissues manipulated easily by hand. The half-curved skin needle is for skilled paramedics and surgeons since these are difficult to handle due to its shape. The curved needle needs less space for maneuver compared to the straight type. The compound curve surgical suture needle is especially perfect for ophthalmic surgery at the anterior segment.

14. Types of suture thread . Absorbable and not absorbable sutures. Sutures thread can be divided in to two types-those which are absorbable and will break down harmlessly in the body over time without intervention, and those which are non-absorbable and must be manually removed if they are not left indefinirely . Monofilament and multifilament suture threads . Suture thread can also be divided into two types on the basic of material structure. monofilament suture thread and multifilament or braided sutures thread. Braided sutures thread provide better knot security whereas monofilament sutures provide better passage through tissues . Synthetic and Natural Suture threads . Surgical sutures can also be divided into two types on the basic of raw material origin, i.e. natural and synthetic sutures. Natural sutures thread include silk and catgut suture threads whereas all other suture thread are synthetic in nature.

15. Absorbable sutures include: Polyglocolic Acid suture, Polygloctin 910, Catgut, Poliglecaprone 25 and Polydioxanone suture threads . Non Absorbable suture thread include: Polypropylene sutures, Nylon ( poylamide ), Polyester, silk and stainless steel sutures . Monofilament suture thread include: Polypropylene sutures, Catgut, Nylon, stainless steel, Poliglecaprone and Polydioxanone sutures. Multifilament or braided sutures thread include: Poliglactin 910.