Dr Zaeem Fezea Dahla Consultant General surgeon LEARNING OBJECTIVES To understand The principles of skin and abdominal incisions The principles of wound closure To know the principles in performing ID: 914360
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Slide1
Basic surgical skills and anastomosis
Dr
. Zaeem
Fezea
Dahla
Consultant General surgeon
Slide2LEARNING OBJECTIVES
To understand
The principles of skin and abdominal incisions
The principles of wound closureTo know the principles in performing:Bowel anastomosesVascular anastomosesTo be aware of:The principles of drain usage , diathermy, ligasure and harmonic scalpel
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Basic surgical skill & anastomosis Dr. zaeem dahla
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Slide3INCISIONS
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Basic surgical skill & anastomosis Dr. zaeem dahla
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Slide4Factors considered when planning askin
incision
Skin tension lines (Langer s lines)
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Slide5Anatomical structure
Incision
should be avoid bony
prominences, and crossing skin creases if possible, and take care of underlying structures , such as nerves and vessels.Cosmetic factors. Adequate access for the procedure.Sunday, October 01, 2017
Basic surgical skill & anastomosis Dr. zaeem dahla
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Slide6Abdominal incisions
As for skin incisions, all abdominal incision should be planned in advance of surgery and taking into consideration access to the abdominal organs ,surface anatomy, pain control and cosmetic outcome .
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Slide7WOUND CLOSURE
There is no ideal wound closure technique that would appropriate for all situation.
The suturing for any incision or wound need to take into consideration
Site
, tissue involved ,&
technique of closure
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Slide8suture materials
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Slide9Types of wound healing
Healing by primary intention
(clean wound) Healing by secondary intention (infected unclean or contaminated wound) Healing by tertiary intention ( skin grafting or delayed closure)Sunday, October 01, 2017
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Slide10Suture characteristics
There are five characteristics:
Physical structure
(monofilament or poly filament)Strength (depends on constituent material , thickness ,how it is handled in tissue )
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Slide11suture characteristics
Tensile behavior : what occur in the tissue
Absorbability
Biological behaviorSunday, October 01, 2017Basic surgical skill & anastomosis Dr. Zaeem dahla11
Slide12Suture techniques
Interrupted sutures
.
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Basic surgical skill & anastomosis Dr.
zaeem
dahla
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Slide13Continuous sutures
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Slide14Mattress sutures
.
e
ither vertical or horizontalSunday, October 01, 2017
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Slide15Subcuticular suture
.
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Slide16Needle types
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Slide17Knotting techniques
Knot tying is one of the most fundamental techniques.
The general principles in knot tying include
The knot must be tied firmly without tension or strangulationThe knot must be unable to slipThe knot must be as small as possible to minimize the amount of foreign bodyNo tension
During tying the suture must not be sawed as this weakens the thread.The suture material must be laid square.
The standard surgical knot is the reef knot
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Slide18Sunday, October 01, 2017
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Slide19The tensile strength of suture material can be expressed as the force required to break it when pulling the two end apart. This depend on whether the material used for synthesis are absorbable or non absorbable.
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Basic surgical skill & anastomosis Dr.
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Slide20Alternative to sutures
Skin adhesive strips .
Tissue glue
Staplesclips
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Basic surgical skill & anastomosis Dr. zaeem dahla
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Slide21THE PRINCIPLES OF ANASTOMOSIS
Bowel anastomosis
Ensure good blood supply to both bowel ends before and after anastomosis.
Ensure the anastomosis not under tension.Avoid risk of mesenteric vessels not involved by suture or clamps.Use atraumatic bowel clamps to minimize contamination
Interrupted or continuous single layer suture technique is adequate and safe.Stapling devices are an alternative when speed is required or access is a major factor.
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Basic surgical skill & anastomosis Dr.
zaeem
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Slide22Sunday, October 01, 2017
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Slide23VASCULAR ANASTOMOSIS
Need to be extremely accurate closure and immediately watertight at the end of operation when vascular clamps removed ,
Knots security is important.
Use monofilament and a traumatic needle .
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Slide24DRAINS
Drains are inserted to allow fluid or air that might collect at an operation site or in wound to drain freely to the surface.
Three basic principles apply in the use of drains;
Open drains work in gravity principle.Semi open work in principle of capillary effect.Closed system drains work in principle of siphon or negative suction .Sunday, October 01, 2017
Basic surgical skill & anastomosis Dr. zaeem dahla
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Slide25A
dvantages
and Disadvantage of using drains
To remove any intraperitoneal or wound collectionAct as signal for any postoperative internal hemorrhage or anastomotic leakageProvide track for later diagnostic and therapeutic options.
Increase chance of infection(FB)Increase chance of anastomotic leak
Increase abdominal painIncrease hospital stay.Decrease pulmonary faction.
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zaeem
dahla
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Slide26Specialist use of drains
Chest drains
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Slide27T-tube drain
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Slide28The principles of diathermy
This one of way used in surgery to cut tissue or to coagulate site of bleeding to do hemostasis in surgical site.
The heat produced depend on:
The intensity of the currentThe wave from the currentThe electrical property of the tissue through which the current passesThe size of two electrodes Sunday, October 01, 2017
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zaeem dahla
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Slide29Sunday, October 01, 2017
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Slide30Complication of diathermy
Electrocution
Explosion
BurnsChannelling this can happened when the intensity of current is great, for examples
Coagulation of the penis if use diathermy.Coagulation of spermatic cord when the electrode applied to the testis .
pacemakers
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Slide31The principles of ligasure
& harmonic scalpel
Ligasure
use fusion technology is a vessel sealing system that is used in open and laparoscopic surgery, it was a combination of pressure and energy to create vessel fusion.Harmonic scalpel ; use ultasound technology to cut tissue while at same time sealing them
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Slide32THANKS FOR ATTENDENCY
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