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Principles of general surgery
- 2. PRINCIPLES OF GENERALSURGERY Dr MH Abdul Rahman General Surgeon Assistant Professor,Dept of General Surgery
- 4. Principles of GeneralSurgery • Develop a Surgical diagnosis • Basic necessities of surgery • Aseptic technique • Incisions • Tissue handling • Hemostasis and wound healing • Promotion of hemostasis and wound healing
- 5. • Decontamination anddebridement • Edema control • Management of General health and Nutrition
- 6. • Human tissuesdue to their innate properties react to injury with less predictability, With experience certain set principles are evolved for optimal healing. These are called BASIC PRINCIPLES OF SURGERY.
- 7. DEVELOPING A SURGICALDIAGNOSIS Decisions on surgery made from • Identifying signs and symptoms • Complete and thorough history • Physical examination • Radiographic findings • Laboratory investigations • Record keeping/Documentation • Differential diagnosis
- 8. BASIC NECESSITIES FORSURGERY • CONSENT • ACCESS • ANESTHESIA • VISIBILITY • HEMOSTASIS • ASSISTANCE
- 9. ASEPTIC TECHNIQUE • Minimizingwound contamination from pathogenic microbes • Instrument sterilisation • Disinfection
- 10. • Universal precautions •Surgical staff and surgeon preparation • Clean and sterile technique
- 11. INCISIONS • Use ofsharp blade of proper size • Firm continuous strokes • Avoid injury to vital structures • Respect skin lines
- 12. TISSUE HANDLING • Respecttissue • Avoid excessive crushing, pulling, extremes of temperatures, dessication, harsh chemicals and tissue damage for proper healing. • Use of instruments and retractors for minimal tissue handling e.g.,Forceps, Retractors
- 14. • Use ofirrigation, protection of soft tissue while cauterisation
- 15. HEMOSTASIS Prevention of excessiveblood loss helps in • Preserving patients oxygen carrying capacity • Increasing visibility • Prevent formation of hematomas • Prevent infection
- 16. Means of promotinghemostasis • Applying pressure on bleeding vessel, hemostat • Use of cautery • Suture ligation • Vasoconstrictor substances • Procoagulants (Thrombin, Collagen)
- 17. WOUND HEALING • Aseptictechnique • Sterile precautions • Proper tissue handling • Avoid hematoma • Avoid dead space • Avoid infection • Adequate nutrition • Physiotherapy, Functional Activity and Mobilisation
- 18. DECONTAMINATION AND DEBRIDEMENT • Decontaminationis to remove debris, foreign bodies, reduce bacterial count, minimize infection • Use of irrigation, dressing • Debridement is to remove necrotic, devitalized tissue • Can be Mechanical, Chemical, Surgical.
- 19. EDEMA CONTROL • Collectionof fluid in interstitial space Factors responsible are • Tissue injury • Inflammatory mediators
- 20. EDEMA CONTROL Edema controlledby • Gentle tissue handling, • Anti inflammatory drugs, • Elevation, Compression bandage • ‘RICE’ technique in trauma
- 21. GENERAL HEALTH ANDNUTRITION Assessment of • Height • Weight • Built • Nourishment • Vitals
- 22. Proper nutrition isessential for • Ability to resist infection • Essential nutrients for anabolism • Nutrients for cell repair
- 23. Medical impairing woundhealing Catabolic states DIABETES MELLITUS END STAGE RENAL DISEASE DECOMPENSATED LIVER DISEASE MALIGNANCY INTERFERENCE IN DELIVERY OF OXYGEN AND NUTRIENTS TO WOUND COPD CONGESTIVE HEART DISEASE ADDICTIONS(SMOKING,ALCOHOL) DRUGS, AGENTS, IMMUNOLOGICAL STATES AUTO IMMUNE DISEASES CHRONIC STEROID INTAKE MALIGNANCY RADIATION
- 24. • SURGEON’S ROLE •Diagnosis and evaluation, • Swift Decision making, • Education and preparation of patient, • Management of complex challenging situations with skill and knowledge
- 25. Surgeon’s Role • Increasingchances of normal healing of surgical wound by evaluating and optimizing patients general health status before surgery For malnourished patients • Improving nutritional status to maintain positive nitrogen balance and anabolic metabolism
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- 28. THANK YOU FORPATIENT LISTENING