Basic Surgical Skills

Orthopedics and Traumatology Department

Coass Week 2

The operating room

Anesthesiologists Nurse anesthetists Circulating nurse Surgeon Surgical assistants

Anatomy of Skin and Deeper Areas

Skin and Deeper Areas

Dermis Dense vascular layer that nourishes the epidermal layers. contains collagen which gives it toughness and strength. Numerous vessels course beneath the dermis in the subdermal plexus, which supplies oxygen and nutrients to the uPPer layers of skin. The subdermal plexus is the main blood supply to any surgically created local flaps of the skin. And it is these blood vessels that supply the life sustaining oxygen and nutrition. Deeper Areas Subcutaneous tissue is composed of connective tissue, nerves, capillaries, veins,lymphatic vessels, adipose (fat) tissue and various glands (sweat and sebaceous)' Fascia = connective tissue layer that envelops muscle. Periosteum = dense connective tissue layer attached to the underlying bone and is responsible for supplying the bone with nourishment through its blood supply.

The Wound

Stages of tissue injury (wounding)

Stage 1: Inflammation (Vasodilation)

(Day 0 -Day 7) Stage 2: Proliferation (Day 7 -Day 21) Stage 3: Scar maturation (Day21 - l year)

Stage 1: Inflammation (Vasodilation)

Stage 2: Proliferation

Stage 3: Scar maturation

Summary

Factors That Affect Wound Healing

Age

Weight
Nutrition Dehydration Blood supply immune responses Chronic illness Drugs and radiation therapy Smoking

Three methods of wound healing

Wound Classification
Wounds are classified according to the estimate

of bacterial contamination and the possible risk of infection.

Wounds are classified in 4 different level
Clean wound Clean contaminated wound Contaminated wound

Infected wound

JENIS-JENIS LUKA
Trauma Tumpul Luka lecet ( Abrasion) Luka memar (Contusion) Luka robek/koyak (Laseration) Trauma Tajam Luka iris (Incised Wound) Luka tusuk (Stab wound) Luka bacok (Chop wound)

LUKA LECET (ABRASI)

Suatu kerusakan yang mengenai lapisan atas dari epidermis akibat kekerasan dengan benda yang mempunyai permukaan kasar sehingga epidermis menjadi tipis, sebagian atau seluruh lapisannya hilang. Sembuh tanpa sikatriks.

LUKA MEMAR (CONTUSIO)

Suatu pendarahan dalam jaringan di bawah kulit akibat pecahnya vena dan kapiler yang disebabkan oleh trauma tumpul

LUKA ROBEK (LASERASI)

Luka terbuka akibat trauma benda tumpul yang menyebabkan kulit teregang ke satu arah, dan bila batas elastisitas kulit terlampaui, maka akan terjadi robekan. Robekan terjadi baik di epidermis, dermis, maupun jaringan lemak. Ciri khasnya yaitu terdapat jembatan jaringan dan akan menimbulkan jaringan parut pada saat sembuh

LUKA IRIS (INCISED WOUND)

Luka akibat benda bermata tajam yang terjadi dengan suatu tekanan ringan dan goresan pada permukaan tubuh. Ciri khasnya yaitu panjang luka lebih besar dari dalamnya luka

LUKA TUSUK (STAB WOUND)

Luka akibat benda /alat yang berujung runcing dan bermata tajam atau tumpul yang terjadi dengan suatu tekanan tegak lurus atau serong dengan permukaan tubuh. Ciri khasnya yaitu dalamnya luka lebih besar daripada panjang luka.

LUKA BACOK (CHOP WOUND)

Luka akibat benda/alat yang berat dengan mata tajam atau agak tumpul yang terjadi dengan suatu ayunan disertai tenaga yang besar. Ukurannya biasa besar dan hampir selalu menimbulkan kerusakan pada tulang

Basic Principles in Surgery

1. 2. 3. 4. 5.

6.
7. 8. 9. 10. 11.

Hemostasis Handling of the Tissue lncision Planning Relaxed Skin Tension Lines Undermining Choice of Suture Materials Closing With Sufficient Tension Tissue Moisture Debriding Necrotic (Dead) Tissue Dead Spaces Postoperative Wound Stress

Relaxed Skin Tension Lines

Undermining and Deep Closure

Undermining and Deep Closure

Dead Space

Anesthetics

Local Anesthetics

*Maximum dosage limits must be individualized in each patient. Epinephrine is a vasoconstrictive agent that allows an increased amount of local anesthesia to be injected.

Local Anesthetics

Local Anaesthetics

Pehacain

Injection Technique

Scrubbing
Scrubbing consists of:1. Hand-washing 2. Gowning 3. Gloving

Scrubbing
Prior to scrubbing, always place the surgical

scrub suit and cap on your head AII vour hair should be covered Eye protection is required

Scrub Sink

Steps in hand-washing

Surgical Instruments

Scalpel Tissue Scissor Forceps Skin Hooks Retractor Needle Holder Hemostat Suction Cautery Suture Scissors Towel clip Staple Gun Additional equipments (various scopes, anesthesia cart)

Scalpel

Tissue Scissors

Forceps

Skin Hooks

Retractor

Needle Holder

Hemostat (clamp)

Suction

Cautery

Suture scissors

Towel Clip

Staple Gun

Laryngoscope

Endotracheal Tube

Oropharyngeal tube

Endoscope

Anesthesia cart

Polypropytene (Prolene) Mesh

Sutures

Sutures

Suture size, diameter, tensile strength

How to read the suture package?

Typical suture choices

Thank You