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List Halstead's principles

Gentle tissue handling
accurate haemostasis
preservation of vascularity
surgical asepsis
no tension on tissues
approximation of tissues
obliteration of dead space


What 4 basic techniques do all surgeries require?

incision and excision of tissue
maintenance of haemostasis
handling and care of exposed tissues
use of sutures, knots and other materials for closure and support


What instruments can be used to incise or excise tissue? 4

scalpel, scissors, electrosurgery, lasers


How can a steel scalpel be handled?

PENCIL GRIP - short, precise incisions
FINGERTIP GRIP - commonly used, larger incisions
PALM GRIP - when greater pressure must be applied


What sizes do scalpel handles come in?

3 (small), 4 (large) and size 7 (fine)


What scalpel blades are commonly used for the different sized scalpel blades?

For handle size 3/7, use blade 10 (curved), 11 (pointed) and 15 (small curve)

For handle size 4, use 20,21,22 and 23 (all curved)


What is press-cutting?

Use of s scalpel where you hold it in the pencil grip and apply pressure in the direction of the movement of the blade and is used to create incisions in hollow organs or cavities.


What is slide cutting?

A method for using the scalpel. Most commonly used and safest method of cutting and uses the pencil or fingertip grip.


What is sawing?

uses the pencil grip and allows a small incision to be deepend without removing the blade form the wound, but this method is traumatic and is more difficult to control depth.


What is craping?

analaogous to shaving hair or whiskers and may be used to develop pouches below the skin or fascia, to elevate muscles sub-peritoneally and to separate body cavity adhesions


After scalpels, what is the second commonest method to cut tissue?



What are some different types of scissors and what are their uses?

Mayo = heavy scissors, for dense collagen rich tissue
Metzenbaum = fine scissors, for blunt dissection and sharp dissection of delicate tissues
Heavy suture scissors = use for large guage sutures to prevent dulling the blades of surgical scissors
Ligature cutting scissors = should be used for fine guage suture


When are scissors best suited? What about straight and curved scissors?

For cutting flaccid tissues not under tension and stabilise the tissues as they cut while allowing good control of depth. Straight scissors provide a much better mechanical advantage for cutting whereas curved scissors provide increased mobility and motility.


What are the 4 different scissor grips?

wide-based tripod grip
thenar eminence third finger grip
backhand grip thumb and third finger
backhand thumb-first finger


Which scissor grip describe using hte tips of the thumb and third finger int he ringers with the index finger on the shank for support?

wide-based tripod


When do you use a thenar eminence third-finger grip?

more useful for needle holders than scissors


What grip do you use to cut toward the surgeon's dominant side?

backhand grip thumb and third finger


Which scissor grip do you use when making a cut towards the surgeon?

backhand thumb-first finger


What is 'scissor cutting'?

uses the blades and is applicable to short incisions


What is 'push cutting'?

suitable for long insicions in sheets of tissue. scissor blades are partially closed and then pushed through the tissue in one motion (tailor's cut)


What is 'blunt dissection'?

inserting closed scissor blades into tissue plance to be separated and then opening them. the scirssors are then withdrawn before closing the blades and repeating the manoeuvre. This is used for dissecting structing (vessels, nerves, muscle bellies) separated by more delicate tissue (fat, loose areolar fascia)


How does electrosurgery and lasers work? Benefits? Negatives?

transmit energy directly to tissues, resulting in vaporising of the tissue along the incision. there is greater collateral damage via thermal necrosis, but haemostasis may be provided


Advantages of electrosurgery

reduced blood loss (improved haemostasis)
decreased need for ligatures
reduced operating time


Disadvantages of electrosurgery

delayed wound healing and reduced resistance to infection
risk of fires and burns and the expense of the equipment


What does a continuous undamped sine wave provide?

maximum cutting with minimum coagulation and lateral thermal necrosis


What do interrupted, damped sine waves do?

maximise coagulation and minimise cutting


What are the different types of surgical haemorrhage?

primary - bleeding immediate
delayed intermediate - bleeding within 24 hours of surgery (e.g. slipped ligature)
delayed secondary - bleeding more than 24 hours after surgery (e.g. necrosis of ligated vessel)


Why is haemostasis important in surgery?

obscures surgical field
increases likelihood of infection
extravasated blood irritates tissues, delays wound healing and increases infection
preventive haemostasis avoids surgical panic which often causes more trauma
hypovolaemia and death possible


What is preventive haemostasis?

minimises primary haemorrhage (i.e. direct BV trauma)


How is preventive haemostasis done?

choosing a surgical approach that avoids major BVs
avoiding or retracting BVs
identifying BVs and provide haemostasis before cutting
gentle dissection

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