Introduction to surgery ,for medical students

1. By Dr.Osama Zeb
PGR-Surgery
Hayatabad Medical Complex

2.  the branch of medical practice that treats
injuries, diseases, and deformities by the
physical removal, repair, or readjustment of
organs and tissues, often involving cutting
into the body.

3.  Up until the industrial revolution, surgeons were
incapable of overcoming three principal obstacles
which had plagued the medical profession from
its infancy. These obstacles are:
 •Pain
 •Bleeding
 •Infection
 Advances in these fields have
transformed surgery from a risky
"art" into a scientific discipline
capable of treating many diseases
and conditions.

4.  The purpose of surgery varies, but it may be
recommended for making or confirming a
diagnosis, removing damaged
tissue or an obstruction,
repairing or repositioning
tissues or organs, implanting
devices, redirecting blood
vessels, or transplanting
tissues or organs

5.  •Pediatric
 •Cardiothoracic and Vascular
 •Plastic or reconstructive
 •Maxillofacial
 •Gastroenteric
 •Neurosurgery
 •Urology
 Orthopedic

6.  Diagnostic,
 exploratory,
 reconstructive,
 curative,
 palliative,
 transplant,
 elective,
 urgent,
 emergency

7.  •Pain
 •Swelling
 •Vomiting
 •Cough
 •Bleeding
 •Dysphagia
 •Change in bowel habits
 •Abdominal distension
 •Difficulty in micturation
 •Joint stiffness

8. Langer’s Line
 Langer’s Line correspond
to the natural orientation of
Collagen fibers in the dermis,
and are generally parallel to
the orientation of the underlying
muscle fibers.Incisions made
parallel to Langer's lines
may heal better and produce
less scarring than those that
cut across.

9. 1)Midline Incision
Almost all operations in the
abdomen and retroperitoneum
Advantages:-almost bloodless-
no muscle fibers are divided-no
nerves are injured-good access
to upper abdominal viscera-very
quick to make as well as to
close-can be extended full
length of abdomen curving
around umblical scar.

10. 2)Para median Incisions
The incision runs 2-5cm lateral to the
midline, cutting through the skin,
subcutaneous tissue, and the anterior rectus
sheath. The anterior rectus sheath is
separated and moved laterally, before the
excision is continued through the posterior
rectus sheath and the transversalis fascia,
reaching the peritoneum and abdominal
cavity.
The incision will take a long time and is
often technically difficult, however it does
prevent any division of the rectus muscle
and provides access to lateral structures.
A paramedian incision can damage the
muscles’ lateral blood and nerve supply,
which may result in the atrophy of the
muscle medial to the incision

11. Kocher Incision
A Kocher incision is a subcostal
incision used to gain access for
the gall bladder the biliary tree.
The incision is made to run
parallel to the costal margin,
starting below the xiphoid and
extending laterally. The incision
will then pass through the all the
rectus sheath and rectus muscle,
internal oblique and transversus
abdominus, before passing
through the transversalis fascia
and then peritoneum to enter the
abdominal cavity.

12. Lanz Incision and Gridiron
Incision
The Lanz and Gridiron incisions
are
two incisions that can be used to
access the appendix,
predominantly for
appendicetomy.

13. Pfannenstiel incision
A Pfannenstiel incision
is a type of abdominal surgical incision
that allows access to the abdomen.
It is used for gynecologic and
orthopedics surgeries,and it is the most
common method for performing
Caesarian sections today.

15.  Wounds can be caused in a number of different
ways by a variety of different objects, be it blunt,
sharp or projectile. They are classified into several
categories dependent on the cause and resulting
injury:

16. Incised wound
 A clean, straight cut
caused by a sharp edge
(i.e. a knife). Tends to
bleed heavily as
multiple vessels may be
cut directly across.
Connecting structures such
as ligaments and tendons
may also be involved.

17.  Laceration
A messy looking wound
caused by a tearing or
crushing force. Doesn’t tend
to bleed as much as incised
wounds but often causes
more damage to
surrounding tissues.

18.  Abrasion
A wound caused by a
scraping force or
friction. Tends not to be
very deep but can often
contain many foreign
bodies such as dirt (i.e.
after a fall on loose
ground).

19.  Puncture
A deep wound caused by
a sharp, stabbing object
(i.e. a nail). May appear
small from the outside
but may damage deep
tissues. Particularly
dangerous on the chest,
abdomen or head where
major organs are at risk.

20.  Avulsion
A wound caused by a
tearing force in which
tissue is torn away
from its normal
position. May bleed
profusely depending
on the size and
location. The tissue is
often completely
detached.

21.  Amputation
The loss of a distinct
body part such as a
limb, finger, toe or
ear. Often very severe
with profuse bleeding.
In the cases of limb
loss this is a medical
emergency

22. Factors
affecting
wound
healing
Systemic
Factors
Age
Nutrition
Trauma
Metabolic
Disease
Hypertension
Diabetes
Smoking
Local Factors
Type of
injury
Infection
Foreign
bodies
Bacteria load
Necrotic
tissue

23.  Proper care of wounds can prevent infection and speed the
body’s healing process.
Treatment
 Immediately after the injury, wash thoroughly with clean water
and mild soap. Remove any visible dirt or debris from the wound.
Apply gentle pressure to stop bleeding.
 For burn wounds, run cool water over the area or apply a cool,
wet cloth. If blisters form, do not pop or drain.
 Apply a thin layer of bacitracin antibiotic ointment or white
petroleum to the wound. Cover with a bandage.
 Clean area twice daily with soap and water, and apply a new
bandage and ointment after cleaning. Keep wound dry .There is
no need to use hydrogen peroxide or alcohol for cleaning.
Continue this care until wound is fully healed.
 Deep or gaping wounds may need stitches or other wound care
from a medical professional. Some bite injuries may also require
special attention.

24.  Tetanus is an uncommon but serious
infection that can occur after a skin injury. It
is recommended that all individuals receive a
series of three tetanus vaccinations, usually
given during infancy, and a booster shot
every 10 years. Some puncture wounds or
other dirty wounds may require a tetanus
booster if it has been more than five years
since the last tetanus shot.

25.  A dressing is a sterile pad or compress
applied to a wound to promote healing and
protect the wound from further harm. A
dressing is designed to be in direct contact
with the wound, as distinguished from a
bandage, which is most often used to hold a
dressing in place. Many modern dressings are
self-adhesive.

26. Medical uses
Stop Bleeding
Protection
from infection
Absorb
Exudate
Ease pain
Reduce
psychological
stress

27.  1. Gauze Sponge
 Type of wound used for: All wounds
 Made from 100% cotton,
gauze sponges absorb drainage
such as blood or other fluids
making them a good, all-purpose
wound dressing whether you need
to clean, dress, pack, or prep a wound.
This option is also economical.

28.  2. Gauze Bandage Roll
 Type of wound used for: All wounds
 Gauze bandage rolls are made from 100%
cotton and can be used as a first layer
dressing or for an added layer of protection.
This type of wound dressing is perfect for
wounds on limbs or on the head, as well as
wounds that are difficult to dress.

29.  3. Non-Adherent Pads
 Type of wound used for: Wounds with light to
moderate drainage; works well for acute
wounds and skin tears
 This type of wound dressing protects wounds
without sticking to the wound itself. It’s an
easy, all-in-one dressing that can be placed
over any minimally draining wound.

30.  4. Non-Adherent Wet Dressings
 Type of wound used for: Wounds with light to
moderate drainage; works well with burns
 These dressings are ideal as a primary layer
to keep the wound bed moist, which helps to
promote cell migration. Non-adherent wet
dressings conform to the wound without
sticking to the surface.

31.  5. Foam Dressings
 Type of wound used for: Wounds with
moderate to heavy discharge; works well with
pressure injuries
 Foam dressings are ultra-soft and highly
absorbent thanks to the foam material they
are comprised of. This type of wound
dressing helps to cushion and protect the
wound while maintaining a healthy level of
moisture.

32.  6. Calcium Alginates
 Type of wound used for: Wounds with
moderate to heavy discharge; works well for
arterial ulcers
 This type of wound dressing is highly
absorbent and can hold as much as 20 times
its weight in moisture. It is especially useful
in wicking moisture out of deep tunneling
areas of a wound.

33.  7. Hydrogel Dressings
 Type of wound used for: Wounds that are dry
or mostly dry; any wound with dead tissue
 Hydrogel dressings lend moisture to a wound
which can help breakdown dry and dead
tissue. By keeping the wound moisturized, it
helps to promote cell growth.

34.  8. Transparent Dressings
 Type of wound used for: Securement layer
 Transparent dressings allow the transfer of
moisture while offering a great securement
layer as well as visualization of the wound.
This is a great option for covering an IV.

35.  9. Alcohol Preps
 Type of wound used for: Use these for
prepping, not for dressing the actual wound
 Alcohol preps aren’t a type of wound
dressing but are necessary when preparing to
dress a wound.

36.  Thank you