Become visible
Good exposure during the operation is a prerequisite for the smooth operation. There are many factors that reveal the operating field, such as the patient's position, the lighting of the operating field, and good anesthesia to ensure muscle relaxation. Therefore, the surgeon should personally check the patient's posture, lighting equipment and anesthesia before operation.
The choice of incision is an important step of surgical field exposure. Generally, the incision is directly on the surface of superficial lesions. Thoracic and abdominal organs and joints of limbs. , the choice of incision must be combined with local anatomy, namely:
A) It is best to directly expose the operation area, and it can be easily extended if necessary.
B) The damage is minimal, and important blood vessels and nerves are not cut off.
C) does not affect the function.
D) the healing is firm.
E) Simple operation and short time required.
F) does not affect the appearance. (Incisions on face, joints and hands should conform to dermatoglyphics)
The cut tissue must be neat and try to cut it at one time. The scalpel must be perpendicular to the skin and muscles to prevent unnecessary tissue damage caused by oblique cutting or multiple cutting in the same plane.
The size and location of the surgical incision should be determined according to the actual needs, and it should be considered from the aspects of facilitating postoperative healing and functional recovery.
For the exposure of deep tissue, in addition to the correct choice of incision, hook and gauze can be used to cut the tissue. The tissue must be neat and try to cut it once. The scalpel must be perpendicular to the skin and muscles to prevent unnecessary tissue damage caused by oblique cutting or multiple cutting in the same plane.
The size and location of the surgical incision should be determined according to the actual needs, and it should be considered from the aspects of facilitating postoperative healing and functional recovery.
For the exposure of deep tissue, in addition to the correct choice of incision, retractor and large gauze can also be used.
anatomize
Anatomy is an important step to expose deep tissue and remove lesions. Dissecting and separating tissues should be carried out according to the normal tissue space, which is not only simple to operate, but also less harmful. But when there are adhesions and scars in the tissue, it is often impossible to do so. It is difficult to dissect at this time, so be sure to be vigilant at any time. According to different anatomical separation methods, it can be divided into blunt separation and sharp separation. Blunt separation with knife handle, vascular clamp, stripper or finger is used to separate normal fascia, loose adhesion, benign tumor capsule, etc. Sharp separation is a careful cutting with a scalpel or surgical scissors, which must be carried out under direct vision, with accurate and precise movements, and is used for fine dissection and tight adhesion of each layer.
stop bleeding
Whether hemostasis can be perfected is not only an important measure to ensure exposure and prevent blood loss during operation, but also an important link related to postoperative patient safety, wound healing and reducing complications. Hemostasis needs to be fast and reliable. To stop bleeding in surgery, hemostatic forceps should be used to quickly and accurately clamp the bleeding point with less tissue, avoiding tongs, and then silk thread ligation or electrocoagulation should be used to stop bleeding. For large deep blood vessels, the method of separating one section, ligating both ends and then cutting off is often used.
tie
Suture should be inserted at the proximal end, and the suture site must be at the distal end of the ligation line, otherwise the blood vessel will bleed. For large-scale capillary bleeding, gauze pad can be used to stop bleeding. If necessary, hot saline gauze can be used to stop bleeding or hemostatic powder, gelatin sponge, hemostatic cotton and gauze can be used to stop bleeding. Sometimes, when the patient is in critical condition and can't stop bleeding for a while, direct finger pressing can be used for large vascular bleeding. For a large area of bleeding in the operation field, dressing with gauze pad and pressing can temporarily stop bleeding. After the patient's blood volume is corrected to a certain extent and the situation improves, the bleeding point can be found and the bleeding can be stopped reliably.
tie
Mainly used for vascular ligation and wound suture. If the knot is not tied correctly, the ligature will slip, which will cause secondary bleeding after operation, bring unnecessary pain to the patient and even endanger life.
Flat knot: one of the most commonly used in surgery, used for ligation of general blood vessels and ligation during various sutures.
Surgical knot: Because the first thread is repeatedly wound twice, the friction surface is large, and the second thread is not easy to loosen when knotting, so it is firm and reliable. Used to ligate large blood vessels.
Three knots: tie a flat knot and add a first single knot. Even if it loosens after ligation, there is no harm, but there are many ligatures left in the tissue. It is used to tie important tissues, such as arteries, or to tie catgut.
Common mistakes are false knots and slip knots.
(1) False knot: it is made of two knots with the same action, which is easy to slip off and should not be used;
(2) Slip knot: If the second-hand force is uneven when tying the knot, only one thread is tightened. Although the second-hand cross knot is used, the result is still slip knot, not flat knot, which is easy to slip. Try to avoid it.
Knotting method
Knot with one hand.
Knot your hands.
Vascular clamp knot
Pay attention to the following points when tying a knot:
(1) When knotting and tightening, it is required that the three-point two-hand force point and the ligation point are in a straight line.
(2) To tie a knot, the ear canal must be hit in the opposite direction, that is, the hands need to cross.
suture
Suture is a basic operation to restore the function of cutting tissues or organs by combining or rebuilding the channels to ensure good healing. Suture method:
Simple stitching:
(1) Simple intermittent suture: used for skin, subcutaneous tissue, fascia, critical membrane and other tissues.
(2) splayed stitches: there are inner splayed stitches and outer splayed stitches. Used for suture of abdominal white line, muscle and other tissues and as a bleeding point.
(3) Simple continuous suture: used for suture of peritoneum and other tissues.
(4) Continuous suture: used to close the broken end of gastrointestinal tract.
(5) Tension-reducing suture: used for suture when the incision tension is too high in general, so as to ensure good healing and prevent the incision from cracking, such as abdominal wall or cracked wound.
Eversion suture:
(1) Vertical mattress suture: used for loose skin.
(2) transverse mattress suture: used for blood vessels and muscles.
(3) Continuous eversion suture: used for peritoneum and posterior wall of blood vessels.
Inverted suture:
(1) Intermittent varus suture: used to suture the first layer of gastrointestinal tract.
(2) Continuous varus suture:
(3) Intermittent suture of seromuscular layer:
(4) Continuous suture of seromuscular layer:
(5) purse-string suture: used to bury appendix stump and tighten stoma. The suture only passes through the seromuscular layer.
(6) Semi-purse-string suture: used to close the two corners of the damaged gastrointestinal tract.