Institute of Surgical Research Surgical Techniques A2. Practical Module

Surgical Deontology Basic surgical instruments; Textiles in the operating room; Suture materials; Tying surgical knots; Asepsis and the patient: preparing the operative site

Holding scissors

Holding scalpels „fiddle bow”„pen”

Holding forceps „pen” „knife”

Holding locking instruments

Holding hemostatic forceps

Holding needle holders Hegar Mathieu Holding a Hegar -type needle holder

Basic surgical knots Half hitch Square knot Sailor’s knot Surgeon’s knot

Tying surgical knots 1. The ends of sutures and ligatures are joined with surgical knots. Requirements: - quick - strong - safe Incorrect knots can lead to severe postoperative complications ! Loose knot = haemorrhage, thicker scar Fully tightened knot = blocks local blood supply, slow wound healing

Tying surgical knots 2. A half hitch = the threads form a closed loop. Two identical half hitches tied above one another = granny knot but this slips easily, therefore it must not be used in surgery !

Tying surgical knots 3. In surgical practice a knot consists of at least two mirror image half hitches, one placed on the other: base half hitch + second half hitch (in the opposite direction). Before tying a half hitch the threads should be crossed! The number of half hitches depends on the types of threads (synthetic threads require extra ones - up to 6 or more).

Tying surgical knots 4. Methods of tying knots in surgery: - two-handed knot: both hands take an active part in the formation of the knot - one-handed knot: one hand is active, the other holds the thread, then the knot is tied with both hands - instrument tie: with needle holders, mosquitos (1. in a deep cavity; 2. with atraumatic needles; 3. with short suture materials

Tying surgical knots 5. Methods of tying two hand knots: - two-handed square knot - surgeon’s knot - Viennese knot - instrument tie Methods of tying one-handed knot and instrument tie will be taught by the Suture Tutor program.

Tying knots: Two-handed square knot

Tying knots: Surgeon’s knot

Tying knots: ‘Viennese’ knot

Tying knots: Instrument tie

4. Repeated d isinfection with iodine tincture on a smaller area 3. Disinfection with iodine tincture (from the central area to the periphery) Preparing the operative site 1. (cleansing) 1.Cleansing with benzine (from the central area to the periphery ) 2. Repeated c leansing with benzine IT IS FORBIDDEN: to return to a cleansed area with the same sponge!

Preparing the operative site 1. Instruments for skin cleansing

Skin cleansing Preparing the operative site 2.

Draping Preparing the operative site 3.