Instruments.pptx

Ppt on instrument

1. COMMON INSTRUMENTS IN DERMATOLOGICAL PROCEDURES

2. Comedone expressor Parts: Central handle 2 hemispherical cups at either ends with perforation in centre and blunt margins Expressor is sinous in shape to facilitate better handling of the instrument and aid effective extraction of contents by localizing the force/pressure

3. Sterilization: Autoclave, hot air oven, 2% glutaraldehyde, boiling Uses : 1. To express open and closed comedones in acne 2. To express contents of nevus comedonicus, senile comedones Method of use: The central perforation of the cup fits over the plugged follicular ostia of open comedone and pressure is applied perpendicularly over the lesion. The contents of comedone collect in the cup of instrument. In case of closed comedones, an artificial opening is made using a sterile lancet or needle and then it is expressed as said above

4. Molluscum extractor Parts: Central handle Round/oval shaped loop at either end Variants Fox curette (round cutting edge) Piffard curette (oval cutting edge) Size : 1-10mm Commonly used : 3-4mm

5. Uses: 1. Extraction of molluscum contagiosum 2. Curettage of seborrheic keratosis, stucco keratosis, verruca plana, actinic keratosis

6. Scoop Parts: Central Handle; oval, spoon shaped, shallow pointed expansion at either ends Sterilization: Autoclave, hot air oven, 2% glutaraldehyde, boiling Uses: 1. To scoop out contents of cyst, abscesses, ulcers 2. To scoop out the granulation tissue in & around ingrown toe

7. Hypodermic needle

8. Needle as an extractor : Milia, Comedones, Molluscum contagiousum Needle as a cutting instrument: 1. Drainage of paronychial abscess/small abscess 2. Ear and nose piercing 3. Subcision of scar as in acne 4. Drainage of pustular lesion in acne 5. For hair transplantation 6. Seroma/Hematoma drainage in skin grafting

9. 7. Intradermal tests : Prick test, Mantoux test(tuberculosis), Pathergy test (Behcet's disease, Pyoderma gangrenosum, Sweet's syndrome), Kveim test(Sarcoidosis), Frei test(Lymphogranuloma venereum), Ito Reenstierna test(Chancroid), Montenegro test(Leishmaniasis), Histamine or pilocarpine test, ASST(Autoimmune urticaria) 8. Chemical cauterisation of xanthelasma 9. Blisters/Vesicles drainage 10. To transfer minigrafts in vitiligo surgery 11. Intralesional cryotherapy 12. Fine needle aspiration cytology 13. Intralesional injection : corticosteroids, 5 fluorouracil, bleomycin, interferons, sodium stibogluconate Needle as a hook : Nerve biopsy, knot opening, suture cutting

10. Skin biopsy punches Metal punch Plastic punch

11. Sterilization: 1.Metal Punches - Autoclave, Hot air oven, 2% glutaraldehyde, boiling 2. Plastic - 2% glutaraldehyde Uses : 1. For doing skin biopsy which has diagnostic, therapeutic( excisional biopsy of small nevus, tiny solitary molluscum, pyogenic granuloma, digitate wart) and prognostic implication For cosmetic purpose upto size 3 punches are used on face 2. For punch grafting in localised stable vitiligo 3. Lipoma excision by narrow hole etrusion technique 4. For hair transplantation surgery 5. Acne surgeries-Punch excision, punch elevation, punch graft 6. Punch excision of small tattoo and melanocytic nevus

12. Bard-Parker handle Parts 1. Long body 2. Grooved tapered blunt tip

13. Sterilisation : Autoclave, hot air oven, 2% glutaraldehyde, boiling Variants : Size no.3 accomodates blades of no. 10,11,12 and 15 Size no.4 accomodates blades of no. 20 to 25 Uses : The surgical blade is mounted onto the grooved tip of handle for use in various procedures

14. Surgical blades

15. Sterilization : Presterilized by gamma irradiation Parts: Belly with one sharp edge and one blunt edge. The body has a linear slot to fit it snugly into the groove at the tip of a Bard-Parker handle SIZE OF BLADE SHAPE USES 11G Triangular with narrow tip For stab incision 15G Small with round belly -Slit skin smear in leprosy, leishmaniasis -For incision over areas with thin skin eg Eyelids, face 20-24G Long with round belly -Incision and excision -Prepar Tzanck smear -Smear from molluscum contagiosum, paring of wart,corn

16. Forceps Parts : Forceps are V shaped metallic instruments with two blades/arms, which are fused together at one end and free at the other to clasp tissues. The free tips may be serrated, plain or toothed. Serrated and toothed forceps aid better grip Sterilization: Autoclave, hot air oven, 2% glutaraldehyde, boiling

17. Plain forceps Less traumatic and used to hold delicate structures like nerve or biopsy tissue

18. Adson forceps Have wider blades with long tapered ends bearing small teeth and relatively less traumatic. They can be used for holding skin except eyelids, suture removal and punch graft of skin

19. Iris Forceps They have a plain tip with a lock in the upper part of the instrument. They have a narrow blade with more gradual taper than the Adsons forceps and are used in miniature punch graft, acne surgeries

20. Jewellers forceps They have elongated plain handles which rapidly tapers to a fine tip. They can be curved or straight Used for atraumatic handling of skin grafts, hair transplant, suture removal and clasping small bleeders during electrocoagulation

21. Epilation forceps Small forceps with serration at the tips Used for epilation, suture removal

22. Allis forceps Parts: Interdigitating tips for better grip, which is aided and secured by the lock present at the upper end of the instrument. The two prongs of the instrument are riveted at the distal end and acts as a fulcrum Uses: Corn enucleation, cyst excision

23. Cheatles forceps Parts: L-shaped forcep without teeth or lock. Distal part is sinous and always placed immersed in antiseptic solution Uses: to handle instruments, dressing materials

24. Artery Forceps Parts: Possess blunt, tapering tips with serration for better grip Variants: Straight, curved. Smallest are called mosquito forceps

25. Uses Catch the bleeders Hold the free end of suture Blunt dissection of lipoma, cyst Crushing pedicle of pedunculated neoplasm e.g. acrochordon For removal of nail plate during partial nail avulsion For three point traction during circumcision To pluck hairs for trichogram

26. Sponge holding forceps Tips of these forceps are fenestrated and serrated to aid grasping cotton swab during preoperative antiseptic preparation of operative area

27. Needle holder Parts: tips can be either smooth or serrated and provided with a groove. Lock is present in the proximal part which aids in grasping needle

28. Iris Scissor These have long rivet-to-tip ditance and a short shank with a sharp tip. They can be straight or curved. One of the blades can be serrated to improve tissue grip while cutting. They are used in fine dissection; the serrated variant is helpful during procedures with thin skin

29. Castroviejo iris scissors Delicate scissor with small cutting tips that can be straight or curved. Used in surgeries involving mucosa, areas with thin skin e.g eyelids, harvesting suction blister grafts

30. Straight scissors/Dressing scissors Used to cut dressing or suture. This has a thick blunt blade that is introduced beneath the dressing and protects skin from injury and sharp blade, which cuts the dressing

31. Curved scissors These are sharp curved used for cutting and curves aid negotiation through difficult to access areas during deeper dissection

32. Skin hook Parts: Handle, hook

33. Sterilization: Autoclave, hot air oven, 2% glutaraldehyde, boiling Variants : Fraizer(single hook) Cottle(bipronged hook) Rakes(multi-pronged hook) These causes minimal trauma to delicate skin margins during suturing and handling of tissues and hence preffered to forceps Uses Hold skin margins during suturing especially when handling thin skin e.g eyelids Retract skin margins during deeper dissections and undermining Hold vital structures like nerve during biopsy Rakes are used for retracting large wound areas

34. Nail nipper/Nail splitter Parts: Handle with stout, sharp cutting edges Uses: cutting of nail plate during partial nail avulsion

35. Nail spatula Parts: Central handle, flat rectangular curved plates on either ends Uses: 1. Separation of nail plate from nail bed and proimal nail fold 2. Separation of dressing from the skin or punch graft

36. Chalazion clamp

37. Parts: Consists of two arms attached at one end and free at other end; screw to approximate the clamp and retain in that position; free end are expanded and perforated with a large flat, thin rim Uses 1. Mucocele excision 2. As hemostat during excision of lip pyogenic granuloma or any neoplasm 3. To prevent excess bleeding during tongue biopsy

38. Dermabrader Parts: Handle with or without thumb rest, slightly curved expanded rectangular tip with sharp teeth arranged in rectangular rows and columns along conve surface of tip

39. Uses In Vitiligo - Dermabrasion of recipients are during suction blisters or split skin grafting and to stimulate melanocyte proliferation and migration Dermabrasion of lichen amyloidosis, lichen simplex chronicus Spot dermabrasion of acne scars Full face dermabration for facial rejuvenation Debulking of rhinopyma Treatment of multiple adenoma sebaceum Tattoo removal Freshen the surface during ear lobe repair

40. Sim's anterior vaginal wall retractor Parts: central elongated metal arm with expanded, oval, fenestrated ends that make an angle with the body of instrument. Expanded ends have serration for better grip Used along with Sim's speculum for visualization of cervix and fornix

41. Sim's speculum Smooth curved plate with central depression facilitates visualization of cervi and posterior fornix and aids collection of vaginal discharge from posterior fornix

42. Cusco's speculum

43. Cusco's speculum is used for introducing an intrauterine contraceptive device, taking a Pap smear, cauterization of vaginal erosion and for colposcopic examination. It is preferred in cryosurgery because it protects the anterior and posterior vaginal wall. The advantage of Cusco's speculum is that it is self-retaining. Therefore, an assistant's help is not needed to keep the speculum in place. It also acts as the vaginal wall retractor. However, it reduces the space in the vaginal cavity and therefore is not a preferred instrument for vaginal surgery. Since it covers most of the vaginal wall, small lesions on the vaginal wall may be masked by the blades of the device

44. Humby's knife Parts: Handle at one end and a flat , long metallic blade with adjustable screws and roller at other end. Screws facilitate adjustment of thickness of skin graft and roller flattens the skin surface before cutting the skin

45. Liposuction cannula All liposuction cannulas have basically the same structure: Distal Tip : This is the front part of the cannula that enters the skin and fat. It will have one or more openings, which the fat will enter to be removed. Hollow Metal Tube : This is the channel through which fat travels from the body into the collection receptacle. The diameter of a cannula refers to the width of the tube, while the length is a measurement of the cannula from end to end. Shorter cannulas are used for areas such as the face, while longer cannulas are used for procedures such as back liposuction and outer thigh liposuction. Proximal End . This is the back part that is attached to a syringe or suction device, allowing the cannula to pull fat from the body.