1. PRINCIPLES OF
ROLL NO. 1007
DEVELOPING A SURGICAL DIAGNOSIS
BASIC NECESSITIES FOR SURGERY
Prevention of flap necrosis
Prevention of flap dehiscence
Prevention of flap tearing
Means of promoting wound hemostasis
Dead space management
DECONTAMINATION AND DEBRIDEMENT
PATIENT GENERAL HEALTH AND NUTRITION
3. PRINCIPLES OF SURGERY
Human tissues ,due to their innate properties
,react to injury fairly predictably. So ,with
experience certain set principles are evolved
for optimal healing.These are called as BASIC
PRINCIPLES OF SURGERY.
4. DEVELOPING A SURGICAL
Important decisions regarding
surgery are made from :
Identifying signs and
1. Complete and thorough
2. Physical examination
Record keeping/data in an
5. BASIC NECESSITIES FOR
1. Adequate visibility is based on
Adequate access- m o uth o p e ning ,
s urg ic a l e x p o s ure , re tra c tio n
Surgical field free of excess
blood and other fluids.
6. ASEPTIC TECHNIQUE
It includes minimizing wound contamination by
pathogenic microbes through:
7. ASEPTIC TECHNIQUE(CONTD..)
Universal precautions are applied to prevent
sepsis and efforts fall under the following
Surgical staff preparation.
Hand and arm preparation.
Incisions are necessary for many
OMFS procedures. The following
Use a sharp blade of proper size .
Use firm continuous strokes.
Avoid cutting vital structures.
Incise perpendicular to the
Intraoral incisions should be
9. FLAP DESIGN
Principles of flap design help to prevent:
10. 1.Preventing flap necrosis
The tip should never be wider than the base unless a
major artery is present at the base.
The length of a flap should be no more than twice the
width. In the oral cavity, the length should never
exceed the width.
When possible, include an axial blood supply in the
The base should not be twisted, stretched or grabbed
with instruments that can interrupt or destroy the blood
supply feeding and draining the flap.
11. 2.Preventing flap dehiscence
Dehiscence (separation) is avoided by
approximate the edges over healthy bone,
handling the edges gently and minimizing
Dehiscence exposes underlying bone leading
to pain,bone loss, infection and scarring.
12. 3.Preventing flap tearing
Make incisions long enough to give adequate
Make more than one releasing incision if more
access is needed.
13. TISSUE HANDLING
Apart from careful flap design and incision
technique, the careful handling of the tissues is also
necessary for optimal and uncomplicated healing.
Excessive crushing, pulling, extremes of
temperature, desiccation and harsh chemicals
damage tissues and these should be avoided.
Toothed forceps and skin hooks are preferred to
forceps that crush the wound edges.
14. TISSUE HANDLING(CONTD..)
Avoid excessive pulling forces to retract tissue.
Use copious irrigation when drilling or cutting bone to
decrease bone damage from heat.
Protect soft tissue when drilling from frictional heat and direct
Wounds should never be allowed to desicate.
Only physiologic substances should come in contact with the
Prevention of excessive blood loss is important
Preserving patient’s oxygen-carrying capacity
To prevent formation of hematomas
MEANS OF PROMOTING WOUND
1.Assist natural clotting processes by
applying pressure on a bleeding vessel
or a hemostat.
2.Use of heat(thermal coagulation).
4.Use of vasoconstrictive
procoagulants(commercial thrombin &
DEAD SPACE MANAGEMENT
Dead space is an area that remains devoid
of tissue after wound closure.
It is created by removing tissue in the
depths of the wound or by not reapproximating
all tissue planes during closure.
These are usually filled with blood
(hematoma) which delays healing and
predisposes to infection.
DEAD SPACE MANAGEMENT
Can be managed in 4 ways:
Suture all tissue planes.
Packing(with an antibacterial medication).
Use of drains.
19. DECONTAMINATION AND
20. DECONTAMINATION AND
Debridement with copious irrigation
of wound with sterile saline during
surgery and after closure.(large
volumes of fluid under pressure)
To remove debris .
To reduce the bacteria count and
minimizes the likelihood of infection.
To remove necrotic, foreign and
devitalized tissue .
21. EDEMA CONTROL
Results from the collection of serum(fluid)in the
interstitial spaces due to the transudation from
damaged vessels and lymphatics obstruction by fibrin.
Variables help determining the degree of postsurgical
Loose connective tissue
22. EDEMA CONTROL(CONTD..)
Post-surgical edema is minimized by:
Careful and gentle tissue handling
Short term steroids(prior to surgery)
Use of ice packs(controversial)
Head kept elevated above the rest of the body for few
23. PATIENT GENERAL HEALTH AND
24. PATIENT GENERAL HEALTH AND
• Medical conditions impairing patient’s ability to
resist infection and wound healing :
1. Diseases inducing catabolic
• Poorly controlled IDDM
• End-stage renal or hepatic disease
• Malignant diseases
2. Conditions interfering with delivery
of oxygen and nutrients to wounded
• Severe COPD
• Poorly compensated congestive
• Drug addictions (ethanolism)
3. Drugs or physical agents that
interfere with immunologic or wound
• Autoimmune diseases (long-term
• Malignancies (cytotoxic agents &
25. PATIENT GENERAL HEALTH AND
SURGEON’S ROLE :
Increased chances of normal
healing of an elective surgical
wound by evaluating and
optimizing the patient’s general
health status before surgery.
For malnourished patients,
improving nutritional status so
that the patient is in a positive
nitrogen balance and an anabolic