Download Chapter 19 Principles of Surgery

Chapter 19
Principles of Surgery
Explain the clinical significance of the basic principles of surgery.
Surgery - The branch of medicine concerned with treatment of injuries or disorders of
the body by incision or manipulation, esp. with instruments.
Such treatment, as performed by a surgeon.
Elective surgery - procedure that is planned and generally routine (spay, neuter)
Non-elective surgery - procedure that is unplanned and is required for saving the
animals life (hit by car, tumor removal for malignant cancer)
• surgery disrupts the barrier to invading pathogens (mucous membranes and skin)
• special care must be taken to minimize the patient exposure to bacteria
Aseptic technique - general practices used to minimize the risk of infection that may
occur following surgery
• patient (surgical site)
• surgical team
• surgical equipment
• operating room
Disinfectants - harsh chemicals that kill the majority of pathogens present on an object
• used on inanimate objects only
• are not 100% effective in killing pathogens
Sterilization - procedure in which all microorganisms are destroyed on an object
• 100% effective
• steam, chemicals, and radiation
• Autoclave - provides high pressure steam heat to sterilize instruments
Surgical Instruments
SCISSORS = used to cut tissue, blood vessels or organs.
1. Mayo Scissors- dense tissue
2. Metzenbaum Scissors- delicate tissue
3. Littauer Suture Removal Scissors - cuts/removes sutures
4. Lister Bandage Scissors - remove bandage material without cutting patient
FORCEPS = grasp tissue, blood vessels or organs
Thumb Forceps - pencil grip forceps (tweezers)
1. Rat Tooth Forceps - grasps skin; large teeth
2. Adson Tissue Forceps - grasps tissue with minimal damage
3. Brown Adson Tissue Forceps - fine intermeshing teeth
4. Dressing Forceps - grasps dressing materials
Self Retaining Forceps - ratchet locking device
1. Allis Tissue Forceps - tough dense tissue
2. Babcock Intestinal Forceps - smooth intestinal tissue
3. Backhous Towel Clamps - secures drapes to skin
Hemostatic Forceps - ligates vessels and tissues
1. Halsted Mosquito Forceps - capillary bleeding
2. Kelly Forceps - arteries & veins
3. Crile Forceps - arteries & veins
4. Rochester Pean Forceps - large tissue bundles
5. Rochester Carmalt Forceps - large tissue bundles
Needle Holders - holds curved needles without damage
1. Mayo Hegar Needle Holder - needle holder only
2. Olsen Hegar Needle Holder - needle holder with scissors
MISCELLANEOUS
1. Scalpel blade - surgical steel to cut through tissue, blood vessels, organs, and
cartilage
2. Scalpel handle - reusable handle to secure blades in place
3. Snook Ovariohysterectomy Hook - used to retrieve uterine horn when performing
spay surgery
4. Groove Director - protects underlying tissues when making surgical incisions
5. Retractors - hold tissue and expose surgical area
LACERATION HEALING
Explain the clinical significance of healing of lacerations by first and second intention.
Phases of Wound Healing
1. Inflammatory: BEGINS IMMEDIATELY
HEMORRHAGE FILLS WOUND/CLEANS SURFACE
BLOOD VESSELS DILATE AND LEAK FLUID WITH CLOTTING ELEMENTS
CLOT DRIES, FORMS SCAB, ALLOWS HEALING UNDERNEATH
SCAB PROTECTS/PREVENTS FURTHER HEMORRHAGE
WBC’S LEAKED INTO WOUND
2. Debridement: 6 HOURS POST INJURY
WBC’S REMOVE NECROTIC TISSUE, BACTERIA, FOREIGN MATTER
NEUTROPHIL IS DOMINANT CIRCULATING WBC IN CANINE/FELINE/HUMAN
NEUTROPHILS PRIMARILY MAKE UP PUS
3. Repair: 3-5 DAYS POST INJURY
FIBROBLASTS ENTER & PRODUCE COLLAGEN
WOUND STRENGTH INCREASES SIGNIFICANTLY
GRANULATION TISSUE FORMS (HEALING TISSUE)
EPITHELIALIZATION TAKES PLACE
24-48HRS AFTER SX; 4-5 DAYS AFTER ACCIDENTAL
FRAGILE AT FIRST BUT THICKENS
4. Maturation: WEEKS TO YEARS
WOUND STRENGTH MAXIMUM
SCAR PALES WITH DECREASE OF CAPILLARIES
PALING CONTINUES OVER YEARS
WOUND NEVER AS STRONG
First Intention Healing
• wound with edges closely apposed
• well closed incision
• epithelial cells can cross defect in 1-2 days
• healing is rapid and successful
Second Intention Healing
• granulation tissue must fill gap between skin edges
• larger wounds where too much tension to allow skin edges to appose
POTENTIAL PROBLEMS
Debridement - process in which damaged and contaminated tissue must be removed.
Dead space - potential space that is present because of separation between tissues.
Hematoma - accumulation of blood within dead space.
Abscess - accumulation of bacteria, white blood cells, and dead tissue within dead
space.
Dehiscence - breaking of wound edges; too much tension, infection, licking or
scratching