What are the five duties of surgery?
1. To remove what is superfluous (unnecessary) 2. To restore what has been dislocated 3. To separate what has grown together 4. To reunite what has been divided 5. To redress the defects of nature
What are the 6 key reasons why surgery is performed?
1. Therapeutic e.g. bone breaks 2. Diagnostic e.g. exploratory/ biopsy 3. Increase suitability for use e.g. neutering and dehorning 4. Palliative e.g. amputation - neoplasia, chronic pain, disability, mutilation 5. Biomedical 6. Cosmetic e.g tail docking
Cutting, sharp or separate
Creating an opening for discharge of bodily wastes
To modify or reshape
To fix or secure
To strengthen - usually with a suture
Viewing of - normally with a scope
What is considered cold steel?
Scalpel and Scissors
Best for dense tissue like the skin - Minimises collateral damage and crushing
Best for loose tissue like adventitia and fat - More crushing Can be used in dense tissue by slide cutting
What is electro surgery?
Cautery (burn) and Cutting - More collateral damage than cold steel
What can cautery be used for?
Disbudding of calves Hand-held units - handy for small animal surgery
What can lasers be used for?
To remove, vaporise or weld tissue - intense beam of monochromatic coherent radiation in IR, visible or near UV spectrum
What is used for tissue desiccation?
- Cryosurgery - liquid nitrogen - Photodynamic Therapy- oxygen free radicals release by light application
What is an arthroscope?
A lensed eyepiece fitted with a camera and a light source
What are the advantages of arthroscopy?
- Minimally invasive - Decreased hospital stay - Better view arthroscopically than operatively due to magnification and field of view plus optimal lighting
What are the disadvantages of arthroscopy?
- More Costly - Can take longer - Some joints e.g. canine stifle are too small
What are the two most common complications of surgery?
- Haemorrhage - Infection Must discuss the potential adverse outcomes and help owners make decisions
What makes a good surgeon?
- One who weighs the risks of a procedure against the benefits - One who fully informs the patient / owner - One who calls on their experience and skill to plan and carry put the procedure safely
What are Halsted's Principles?
1. Gentle Tissue Handling 2. Eliminate Dead Space 3. Meticulous Haemostasis 4. Close/ normal approximation of tissues 5. Aseptic Technique 6. Minimise foreign bodies 7. Avoid tension on sutures/ tissues
Handle tissues gently... Rough Handling...
- Increases likelihood of post-op infection by creating necrotic tissue - Delays the rate of healing - Increases surgical shock - Increases pain and dysfunction
What does Effective Haemostasis do?
- Allows better surgical conditions - easier to see - Lessens the chance of Haemorrhagic shock - Lessens the chance of post-op infection - Preserves blood supply
What does using aseptic techniques do?
Reduces the chance of post-op infection - Performed in theatre to protect the patient from contact and air-borne bacteria
- Prepare patients skin to protect from their own flora - Surgeons wear protective clothing to protect the patient from us - Use drapes to isolate the surgical area
Avoiding tension on wound areas...
- Tight sutures tear through tissues - this reduces wound strength - Death of tissues increases the risk of infection and delays the healing of the wound (no blood supply = no healing)
Avoiding creating or leaving dead space between tissues...
- Can lead to accumulation of blood and serum in tissue spaces - Delays healing - Greatly increases the likelihood of wound infection
Meticulous approximation of all wound layers...
- Promotes rapid healing - Increases wound strength - Lessens the chances of infection