Principles of general surgery

principles of general surgery, Occupational therapy, medicine, general surgery

1. PRINCIPLES OF GENERAL SURGERY Dr MH Abdul Rahman General Surgeon Assistant Professor,Dept of General Surgery

2. Principles of General Surgery Develop a Surgical diagnosis Basic necessities of surgery Aseptic technique Incisions Tissue handling Hemostasis and wound healing Promotion of hemostasis and wound healing

3. Decontamination and debridement Edema control Management of General health and Nutrition

4. Human tissues due to their innate properties react to injury with less predictability, With experience certain set principles are evolved for optimal healing. These are called BASIC PRINCIPLES OF SURGERY.

5. DEVELOPING A SURGICAL DIAGNOSIS Decisions on surgery made from Identifying signs and symptoms Complete and thorough history Physical examination Radiographic findings Laboratory investigations Record keeping/Documentation Differential diagnosis

6. BASIC NECESSITIES FOR SURGERY CONSENT ACCESS ANESTHESIA VISIBILITY HEMOSTASIS ASSISTANCE

7. ASEPTIC TECHNIQUE Minimizing wound contamination from pathogenic microbes Instrument sterilisation Disinfection

8. Universal precautions Surgical staff and surgeon preparation Clean and sterile technique

9. INCISIONS Use of sharp blade of proper size Firm continuous strokes Avoid injury to vital structures Respect skin lines

10. TISSUE HANDLING Respect tissue Avoid excessive crushing, pulling, extremes of temperatures, dessication , harsh chemicals and tissue damage for proper healing. Use of instruments and retractors for minimal tissue handling e.g.,Forceps , Retractors

11. Use of irrigation, protection of soft tissue while cauterisation

12. HEMOSTASIS Prevention of excessive blood loss helps in Preserving patients oxygen carrying capacity Increasing visibility Prevent formation of hematomas Prevent infection

13. Means of promoting hemostasis Applying pressure on bleeding vessel, hemostat Use of cautery Suture ligation Vasoconstrictor substances Procoagulants (Thrombin, Collagen)

14. WOUND HEALING Aseptic technique Sterile precautions Proper tissue handling Avoid hematoma Avoid dead space Avoid infection Adequate nutrition Physiotherapy, Functional Activity and Mobilisation

15. DECONTAMINATION AND DEBRIDEMENT Decontamination is to remove debris, foreign bodies, reduce bacterial count, minimize infection Use of irrigation, dressing Debridement is to remove necrotic, devitalized tissue Can be Mechanical, Chemical, Surgical.

16. EDEMA CONTROL Collection of fluid in interstitial space Factors responsible are Tissue injury Inflammatory mediators

17. EDEMA CONTROL Edema controlled by Gentle tissue handling, Anti inflammatory drugs, Elevation, Compression bandage ‘RICE’ technique in trauma

18. GENERAL HEALTH AND NUTRITION Assessment of Height Weight Built Nourishment Vitals

19. Proper nutrition is essential for Ability to resist infection Essential nutrients for anabolism Nutrients for cell repair

20. Medical impairing wound healing Catabolic states DIABETES MELLITUS END STAGE RENAL DISEASE DECOMPENSATED LIVER DISEASE MALIGNANCY INTERFERENCE IN DELIVERY OF OXYGEN AND NUTRIENTS TO WOUND COPD CONGESTIVE HEART DISEASE ADDICTIONS(SMOKING,ALCOHOL) DRUGS, AGENTS, IMMUNOLOGICAL STATES AUTO IMMUNE DISEASES CHRONIC STEROID INTAKE MALIGNANCY RADIATION

21. SURGEON’S ROLE Diagnosis and evaluation, Swift Decision making, Education and preparation of patient, Management of complex challenging situations with skill and knowledge

22. Surgeon’s Role Increasing chances of normal healing of surgical wound by evaluating and optimizing patients general health status before surgery For malnourished patients Improving nutritional status to maintain positive nitrogen balance and anabolic metabolism

23. MULTI DISCIPLINARY TEAM WORK

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