Institute of Surgical Research A Module Surgical Technics

Institute of Surgical Research „A” Module - Surgical Technics A 1. MODUL – Asepsis and Antisepsis A 2. MODUL – Surgical Deontology A 3. MODUL – Surgical interventions A 4. MODUL - Bleedings A 5. MODUL – Wounds sterile bandage replacement, suture removal, open wound management, bandaging. A 6. MODUL - Shock

About wounds - revision Classification based on: 1. morphology / origin, 4. depth, 2. infection 5. factors affect wound healing, 3. time elapsing from the trauma, 6. wound closure. Ad 1 a. Ad 2. Intection morphology Clean Puncture/Stab w. Spoiled Incised wound, Dirty Cut wound, Bruised/crush w. Bite wound Lacerated wound Shot wound Ad 3. Injury Time Acute Chronic Ad 4. Depth • Superficial • Partialthickness • Full-thickness • Deep wounds Ad 5. Factors affect wound healing Per primam Per secundam Per tertiam Ad 6. Wound closure • Temporary management • Surgical closure

About wounds - in general Basic principles: Accidental (non surgical) wounds should be considered infected, therefore we should remove: - the causative agents - the devitalized tissues Accidental wound should be transformed to surgical one. Phases Management Inspection Under sterile circumstances (hat, mask, gloves) Anamnesis Elucidation of the circumstances of injury Tetanus Rabies Diagnostic procedures Exclusion of accompanying injury • Examinations of the circulatory, sensory and motoric functions • Exclusion of bone fractures (X-ray) Wound management The accidental wound care should be based on the depth of injury and the danger of infection with primary- or delayed wound closure (see next table).

Types of wound closure Definite primary wound management (within 12 hrs) Immediate wound closure Always perform primary wound closure: penetrating injury of the abdomen chest dura mater - Primary delayed suture (3 -8 days) - Early secondary wound closure (> 14 days ) - Late secondary wound closure (4 - 6 weeks ) When primary wound closure is contradicted: infectious signs severely spoiled foreign body pouched, greatly bruised wounds special injury forms of some professions (e. g. surgeons, butcher, veterinarian, pathologist, bacteriologist) bite, shot, deep incised wound hostility wound

Primary wound closure - debridement Local anesthesia Excision Primary suture Drain

Ad 1 a. morphology Ad 2. Intection Puncture/Stab w. Clean Incised wound, Spoiled Cut wound, Dirty Bruised/crush w. Bite wound Lacerated wound Shot wound Ad 3. Injury Time Ad 5. Factors affect wound Acute healing Chronic Per primam Per secundam Ad 4. Depth Per tertiam • Superficial • Partial-thickness • Full-thickness • Deep wounds Ad 6. Wound closure • primary wound closure • primary delayed wound suture • early secondary wound closure • late secondary wound closure Ad 1 a. morphology Ad 2. Intection Puncture/Stab w. Clean Incised wound, Spoiled Cut wound, Dirty Bruised/crush w. Bite wound Lacerated wound Shot wound Ad 3. Injury Time Ad 5. Factors Acute affect wound Chronic healing Per primam Per secundam Ad 4. Depth Per tertiam • Superficial • Partial-thickness • Full-thickness • Deep wounds Ad 6. Wound closure • primary wound closure • primary delayed wound suture • early secondary wound closure • late secondary wound closure

TYPES OF BANDAGES Depending on the function: - adherent/taped bandages: (to fix covering bandages or for the approximation of edges of small wounds) - covering bandages: (to protect the wound absorb secretion. Prevention from secondary infection and mechanical trauma) - pressing bandages: (for temporary handling of capillary and venous bleedings under 40 -60 mm. Hg. ) - wedging bandage (used for temporary handling of capillary arterial and venous bleedings until surgical management. Should be relieved in every 2 hrs) - compressing bandages: (to prevent postoperative bleeding on the limbs, and for the prophylaxis of thrombosis and for the reduction of chronic lymph-edema. Always placed from distal to proximal - fixing/retention bandage (to immobilize the injured body part or to fix the reposition).

Layers of bandages 1. Layer in direct contact with the wound (sterile, hypoallergenic, not irritating, non-sticking) - simple sheet (e. g. Mull sheet: good fluid absorbent, but easily sticks to the wound) - impregnated sheet (vazeline, paraffin: ie. “Jelonet”, non-sticking) (with saline which melts when gets into contact with body fluids i. e. Mesalt. ) 2. Absorbent layer (to absorb and store blood and excretions) 3. Fixing layer to secure the bandage (adherent tapes i. e. Centerplast, Leukoplast or Mefix, Mepore; the latter two for bigger surfaces).

Special compression bandage: ear bandage Special retention bandage: rucksack bandage

Special retention bandages: Desault-bandage Charnley-loop

TASKS OPERATING THEATRE COMPUTER ROOM 1. Sterile bandage removal from surgical wound Removal of sutures 1. Steam bandage 2. Sterile bandage removal open wound management 2. Compression bandage: ear bandage 3. Retention bandages

OPERATING THEATRE: WOUND MANAGEMENT 1. Surgical wounds – sterile bandage replacement, removal of sutures STERILE EQUIPMENT SURGEON 2. Sterile gloving 3. Desinfection (Betadine solution) 4. Removal of sutures 5. Sterile covering (sterile gauze) NON-STERILE ASSISTANT 1. Removal of the former bandage (pouring fluid on the sponge) 6. Fixing 2. Spoiled wounds – open wound management STERILE EQUIPMENT SURGEON 2. Sterile gloving 3. Wound cleansing (H 2 O 2) 4. Rinsing with saline 5. Desinfection (Betadine solution) 6. Sterile covering (sterile gauze) NON-STERILE ASSISTANT 1. Removal of the former bandage (pouring fluid on the wound) (pouring fluid on the sponge) 7. Cover, fixing

COMPUTER ROOM: BANDAGING 1. Covering bandages 2. Steam bandage Layers: - Ointment: (Burow-ointment, aids demarcation of the necrotic area), - Steril gauze sheet: - Plastic layer: (for isolation of heat and steam) - Fixing layer 3. Special compression bandage: ear bandage 4. Retention bandage: wrist and elbow

4. Special retention bandage: Desault-bandage