Sef lucrari dr. Tamas.

surgical fundamental skills

the surgical cleaning and suture for a superficial wound

a superficial wound-diagnosis:
localisation:superficially respecting the deep fascia

superficial wound-diagnosis:
placed superficially respecting the deep fascia

cut wound- glass

etiology
burn boiled water

complex trauma - chopped

superficial wound-diagnosis:
placed superficially respecting the deep fascia

cut - ax

injury mechanism

avulsion transmission band

superficial wound-diagnosis:
placed superficially respecting the deep fascia

injury mechanism

MP joint opened

puss collection inside PIPjoint

superficial wound-diagnosis:
placed superficially respecting the deep fascia

injury mechanism

bite - human

bite wounds - baracuda

distal phalangs ostheitis

perficial wound-diagnosis:
placed superficially respecting the deep fascia

localisaton anatomic region

small penetrating wound

perficial wound-diagnosis:
placed superficially respecting the deep fascia

localisation anatomic region

colabated right lung

superficial wound-diagnosis:
placed superficially respecting the deep fascia

localisation

bite cervical wound

uperficial wound-diagnosis:
placed superficially respecting the deep fascia

superficial wound- elbow

localisation anatomic region

lateral
medial

superficial wound-diagnosis:
placed superficially respecting the deep fascia

clinic diagnosis

shape
ethiology
localisation
bleeding(colour, volume,
speed)

difficult to diagnose

(small wounds, localisation:carpal tunnel , Guyon, epitrohleoolecranian)

+ function loss

adduction abduction

claw (old injuries on the ulnar nerve)

lost- recent injuries on the ulnar nerve

the cleaning and suture of a superficial wound

1.preparing the operating room, the patient,the surgical

team
2. local anesthesia
3. surgical treatment: wound cleaning

excision of the non-viable / contaminated tissue

surgical haemostasis
surgical exploration (anatomic layer and injured elements

the cleaning and suture of a superficial wound

preparing the operating room, the patient,
the surgical team

local anesthesia

testing the patients reactivity to the

anesthetic injection steps

testing the patients reactivity to the anesthetic injection main rules

anamnesis dialog with the patient regarding the personal medical

history
- alergia
- operations / proceedures involving anesthesia and the patients
reaction on this occasion
- chronic medication interpheering with the proceedure( anesthetic
injection)
- alteration of the normal hemostasis and coagulation

testing the patients reactivity to the anesthetic

injection main
rules
monitoring the
vital functions

preparing the dilutions

- protocole

intradermic injection

- proceeding

local result

local anesthesia

local anesthetics
- lidocaine (xiline)
- bupivacaine
- marcaine

local anesthesia

technique regionale anesthesia

definition
Regional anesthesia (RA) determine the transmision
block for the sensitive and simpatethic impulses, for the
motor impulses in the peripherique nerves , after injecting
the local anesthetics.
RA doesnt interphere with brain activities.

local aneshesia

technique regional anesthesia

brachial plexus block

interscalenic acces

axilary acces

local anesthesia
brachial plexus block- steps

coditions
1.
2.
3.
4.

acces way (skin aspect, mobillity)

blood tests (coagulation)
patient cooperative
age (over 16 )

the cleaning and suture of a superficial wound

lavage
detersive fluids

-peroxids ( oxigenate water)

- Iode (betadine)

-fluid sterile soaps

-salline solution

the cleaning and suture of a superficial wound

wound lavage
quantity: 1 10 liters

the cleaning and suture of a superficial wound

wound lavage
technique:

- applying directly in the wound

- dead spaces exploration
- finding the foreign bodies/ small pieces of bone
- performing the lavage several times during the surgery
of the wound

the cleaning and suture of a superficial wound

FSC

first surgical cleaning

excision of dead / contaminated tissues

the cleaning and suture of a superficial wound

FSC

FIRST SURGICAL CLEANING

excision of dead / contaminated tissues

using the scalpel

using the scissors

FSC

FIRST SURGICAL CLEANING

dead tissues- diagnosis

- shape
- colour
- volume/tonus
- contractillity
- vessels blocked by
thrombosis

the cleaning and suture of a superficial wound

physiological haemosthasis

the body capacity to stop the bleeding from small

and medium vessels using its own means
steps:vessel constriction+plattelets(temporarly)
plasmatic(coagulation)
trombodinamic(clot retraction)

the cleaning and suture of a superficial wound

surgical haemostasis(temporarly / permanently)

surgical means

scalp injury

termical haemostasis bipolar electrocoagulation

the cleaning and suture of a superficial wound

surgical haemostasis(temporarly/ permanently)

surgical means

monopolar coagulation

electric scalpel

the cleaning and suture of a superficial wound

surgical haemostasis(temporarly/ permanently)

surgical means

forceps - ligation

surgical haemostasis

background , comparation between the surgical

and physiological process

high speed
accurate
stable long time
resistent to high blood pressure
resistent when the region/segment is mobilised

surgical haemostasis

technique ( haemostatic forceps and

ligation )
- haemostatic forceps(PEAN , KOCHER)
PEAN

KOCHER

surgical haemostasis

techniques ( forceps and ligation)

-position on the surgical table

surgical haemostasis

presenting

techniques ( forceps and ligation)

-manipulation and utillity

final knot

ligation wire

4
3

second surgical knot

first surgical knot

surgical haemostasis

bipolar forceps/ electric scalpel

bipolar forceps

monopolar( electric scalpel)

surgical haemostasis

electric scalpel

Bipolar forceps manipulation

the cleaning and suture of a superficial wound

surgical examination of the wound

identifying the thickness (the layer)

identifying the injured structures

cut median nerve

proximale ending

the cleaning and suture of a superficial wound

deep wounds -interesting the deep

fascia -protocole
Reconstruction-timing:
1.vessels
2.tendons,muscles
3.nerves
4.soft tissues

injured structures repairing-timing:

1.vessels
crucial step: vessels repair, surgical step to assure the survival
of the injured segment

microsurgical suture

special vascular forceps-clamps

the cleaning and suture of a superficial wound

reparation timing:
2. tendons, muscles

tendons repair
(tenorafia)

the cleaning and suture of a superficial wound

reparation timing:
3.nerves
neurorafia= nervs suture

the cleaning and suture of a superficial wound

reparation timing:
4.skin

FSC

FIRST SURGICAL CLEANING

LAST STEP: suture, drenaige, bandage

suture

the techique that restore the

continuity of the anatomic layers or maintain the
wounds borders attached one to another,in
order to stimulate the scarr formation

Wound suture
-instruments
needleholder
manipulation

microsurgical needleholder

scissors
surgical forceps

wound suture
-materials you need: needles + threades

curve needles, triangular section

wound suture
-materials you need: nontraumatic

wound suture
-materials you need: nontraumatic

wound suture
techniques :
-primary repair (within the first 6 hours)

-delayed

wound suture
-discontinuous
separate points

wound suture
-continuous

intradermal suture

wound bandage

bandage

means or
techiques to protect the
wound against the
agression from external
medium

goal:

maintains the sterillity

allowes the scarr formation

wound bandage - indications

surgical wounds (after surgery)

goal=

protection

ulcerations/dirty wounds

goal= absorbent

wound bandage- indications

cut/crushed wounds (soft tissue trauma)

whith bleeding- goal= hemosthatic

wound bandage- indications

pansament care fixeaz atela

leziuni care necesit imobilizare

wound bandage- indications

important edema

wet bandage,to assure

contention and reduce the tissue volume

wound bandage
Materials
- sterile gauses

-adhesive tape

-sterile detersive fluids

- sterile bands

wound bandage
special materials
- steri-strip

-cosmopore

wound bandage
- transparents, occlusive

Special materials
-grasolind

wound drainage

goal evacuate the secretions

reduce the dead space
reduce the infection risk
help the wound cure

wound drainage
Materials
- drainage sistem
-tubes
-sirings or bags

imobilisation sistems
goal

reduces pain
reduces edema
keeps the wounds borders together
(bones segments)
stops the bleeding

helps the scar formation

techniques
indications:

fractures, dislocations,trauma

techniques
indications:

Limb injuries ( tendons, vessels,

nerves)

techniques
indications:
- crush sindrome
- complex surgery involving wide arias of
skin

techniques
Basic rules
avoid direct contact with the wound
- funcional positions

techniques
rules

early mobilisation (dinamic splints)

no compression

Thank
you!!!