Institute of Surgical Research „A” Module - Surgical Technics A1. MODULE – Asepsis and antisepsis A2. MODULE – Surgical deontology A3. MODULE – Surgical interventions A4. MODULE – Bleedings A4. practical: skin incisison, handling surgical bleedings, wound closure: continuous suture, clips A5. MODULE - Wounds A6. MODULE - Clinical aspects of shock

Skin incision 1. - skin scalpel (#20 blade, #4 handle), the surgeon and the assistant stretch the skin with sterile towels on both sides of the operative field.

Skin incision 2. Incision is - perpendicular to the skin, - made with a single, definite cut. Direction of the incision depends on the location of the organ being operated: - parallel to Langer’s lines (better wound healing, less scar formation), - toward oneself, from left to right.

Skin incision 3. Depth must be the same in the whole length: 1. insert the tip of the scalpel perpendicularly into the skin, 2. cut at 450 angle with the edge (not with the tip!), 3. finish the incision with holding the scalpel perpendicularly. Discard the scalpel into the container!

Handling surgical bleeding 1. Methods: oozing: tamponade with dry or wet (warm saline) towels, Spongostan, Surgicel, etc. small vessels: electrocoagulation (diathermy) thermal effect of high frequency alternating current Must not be used to cut skin, only deeper layers (burn injury)!

Handling surgical bleeding 2. larger vessels: ligature 1, soak up blood: with sponge (assistant) 2, clamp: with artery forceps (mosquito, Péan, etc. - surgeon) 3, ligature: with threads (depending on the size of vessel), - tie the first knot („half-hitch”), - remove artery forceps, - tie the second knot.

Handling surgical bleeding 3. diffuse, anatomical bleeding: suture - with two stitches - „8” form preventive hemostasis: - clamp with two artery forceps, - cut the vessel between them, - ligate both ends.

Handling surgical bleeding 4. (video)

Wound closure Suturing with continuous sutures Simple continuous suture Intracutaneous suture (Suture Tutor) Wound closure with Michel clips

Wound closure 1. Simple continuous suture

Wound closure 2. Simple continuous suture (video)

Wound closure 3. Intracutaneous suture - by the Suture Tutor program CONTINUOUS WOUND CLOSURE Inserting the suture (intracutan suture) Summary 1 █ : the subcuticular plane 2 █ video: the 1st stitch 3 █ : grasp the end of the thread with a forceps 4 █ video: intracutan suturing Completing the closure 1 █ video: the last stitch 2 █ video: to close the wound pull the ends of the suture 3 █ video: secure the suture ends.

Wound closure 4. Michel clips

Practical tasks In the teaching lab: In the operating room: 35 min Half group 1. Practical test: Interrupted (simple or Donati) sutures: 2-3 sutures Simple continuous suture with atraumatic thread and instrument tie. Intracutaneous suture by the Suture Tutor computer program (survey). In the operating room: Other half 1. Gloving alone. 2. Skin incision (team work - surgeon, assistant, scrub nurse) on tissue. 3. Handling bleeding with ligatures. 4. Wound closure with simple continuous suture. 5. Wound closure with Michel clips. 35 min 35 min

REPEAT: gloving alone

Have a good practice!