Basic Surgical Skills By Prof Mahmoud Meleis

1. Basic Surgical
Skills
MAHMOUD MELEIS, MD
ALEXANDRIA UNIVERSITY

2. Please feel free to download
the lecture from the link below
 https://www.dropbox.com/s/ocyhfvny0qfuc4w/BSS.pptx?dl
=0

3. Agenda
 Instrument handling
 Basic hand ties
 Ligature
 Suturing
 Patient positioning
 Self gowning & gloving (closed technique)
 OR etiquette

4. 1 .Scalpel
 Sizes:
 10 & 20 (left side) for abdominal incisions
 Use BELLY for cutting
 15 & 11 for precise & stab incisions (abscess)
 Use tip for cutting
 Always incise in a direction away from you
 Grips:
 Power Pencil (more precise for 15 & 11)

5. 1 .Scalpel
 For fine incisions or skirting around umbilicus during laparotomy

6. 1 .Scalpel
 How to insert & remove scalpel

7. 1 .Scalpel
 How to incise using scalpel

8. 2 .Scissors

9. 2 .Scissors
 To cut at depth or stabilize the tip

10. 2 .Scissors
To Cut from left to right
Always keep your eyes on the scissor’s tips

11. 2 .Scissors
 Sharp tipped scissors are NEVER used inside the body
 For opening tissue planes:

12. 3 .Needle holder
 Needle held at the TIP of holder, needle makes a right angle, with the
holder

13. 3 .Needle holder
 How to reverse needle in needle holder

14. Palming needle holder
 Palming an instrument when tying stitches, or need to carry out some
other short action
 Technique:
 Do NOT retain the needle in the holder if you intend to palm it.

15. 4. Artery, Clamp, Hemostat

16. 4. Artery, Clamp, Hemostat
 Unclamping using Left hand

17. 4. Artery, Clamp, Hemostat

18. Forceps

19. Handling threads
 One handed reef knot
 Two handed reef knot
 Unstable monofilament tie
 Aberdeen knot
 Slip knot
 Tying at depth
 Instrument tie

20. 1 .One-handed reef Knot
 Subtypes:
 Index finger knot
 Middle finger knot
 Start with index finger if SHORT thread in AWAY from you & VV

21. 1 .One-handed reef Knot

22. Unstable vs stable knots
Granny & Reef knot
 Half hitch:
 A SINGLE index OR middle finger knot (either Rt over Lt or Lt over Rt)
 Threads must CROSS in order to get a stable knot
Granny knot Reef (surgeon) knot
2 half hitches in SAME direction 2 half hitches in OPPOSITE direction
Threads are crossed after each hitch
Ex: 2 index knots or 2 middle knots Ex: 1 index followed by 1 middle knot
Less stable
Because threads of the two half hitches
cross rather than run parallel
So less area of contact
More stable

23. How to cross hands during
tying a REEF knot
 Crossed Horizonal plane,
OBSTRUCTSfield
 Incorrect & LESS control
 Cross your hands in SAGITTAL plane

24. 2 .Two handed reef knot
 Used when the 2 ends of the thread are the SAME length
 Safest knot, as tension can be controlled in all steps

25. How to tie a monofilament
thread (Prolene & PDS)
 Unstable tie: even when doing a reef knot & crossing hands with
each hitch due to thread memory

26. How to tie a monofilament
thread
3 .Aberdeen knot

27. 4 .Slip knot
 Used with CARE, as knot may become loose or thread may get
frayed
 Effective when tying in deep cavities

28. 5 .Tying at depth

29. 5 .Tying at depth
 Form the hitch outside the cavity then push it down with your INDEX
FINGER
 Avoid putting tension on the structure your are tying by tightening
perpendicular to it

30. Instrument tie
 Instrument must be PARALLEL to skin wound

31. Ligatures

32. Ligatures
Pedicle transfixion
 First methods:

33. Ligatures
Pedicle transfixion
 Second method: (figure of eight or Henley)

34. Suturing
 Simple interrupted suture
 Simple buried (inverted) suture
 Vertical mattress
 Horizontal mattress (+ figure of 8 + ½ buried suture)
 Simple running suture
 The art of assisting
 Simple running locking suture
 Subcuticular running suture

35. 1 .Simple interrupted suture

36. 2 . Simple buried (inverted)
suture
 For subcutaneous tissue approximation

37. 3 . Vertical mattress

38. 4. Horizontal mattress

39. 5. Simple running
(continuous) suture

40. 6. The art of assisting

41. 7. Subcuticular suture

42. Revision

43. Thanks for your attention
 Please feel free to download the lecture from the link
below
 https://www.dropbox.com/s/ocyhfvny0qfuc4w/BSS.pptx?dl
=0