Download OR TECHNIQUE

OR TECHNIQUE
Composition of OR team
• Surgeon.
• Assistants the surgeons.
• Scrub nurse.
• Circulating nurse.
• Anesthetists.
Division of OR team
• The sterile team: includes
• Surgeon.
• Assistants to surgeons.
• Scrub nurse.
Un-sterile team: includes:
• Anesthesiologist.
• Circulate nurse.
• Others x-ray tech.
Scrub Nurse/Technician
Preoperative
• Checks the card file for surgeon's special
•
•
•
needs/requests.
Opens sterile supplies.
Scrubs, gowns, and gloves and sets up
sterile field. Obtains instruments from
flash autoclave if necessary. Checks for
proper functioning of
instruments/equipment.
Performs counts with circulator
Pre incision
• Completes the final preparation of sterile
field.
• Assists surgeon with gowning/gloving.
• Assists surgeon with draping and passes
off suction / cautery lines.
During the Procedure
• Maintains sterile field.
• Anticipates the surgeon's needs
(supplies/ equipment).
• Maintains internal count of sponges,
needles and instruments.
• Verifies tissue specimen with surgeon,
and passes off to circulator.
Closing Phase
•
•
•
•
•
•
Counts with circulator at proper intervals.
Organizes closing suture and dressings.
Begins clean-up of used instruments.
Applies sterile dressings
Prepares for terminal cleaning of instruments
and non disposable supplies.
Reports to charge nurse for next assignment.
Circulating Nurse
Preoperative
•
•
•
•
•
Assists in assembling needed supplies.
Opens sterile supplies.
Assists scrub in gowning.
Performs and records counts.
Admits patient to surgical suite.
Pre incision
• Transports patient to procedure room.
• Assists with the positioning of the
patient.
• Assists anesthesia during induction.
• Performs skin prep.
• Assists with drapes; connects suction
and cautery.
During the Procedure
• Anticipates needs of surgical team.
• Maintains record of supplies added.
• Receives specimen and labels it
correctly.
• Maintains charges and O.R. records.
• Continually monitors aseptic technique
and patients needs.
Closing Phase
•
•
•
•
•
•
•
•
Counts with scrub at proper intervals.
Finalizes records and charges.
Begins clean-up of procedure room.
Applies tape.
Assists anesthesia in preparing patient for
transfer to post anesthesia care unit [ PACU ].
Takes patient to PACU with anesthesia and
reports significant information to PACU nurse.
Disposes of specimen and records.
Reports to charge nurse for next assignment.
Circulate nurse
Duties of Circulating Nurse
• Application of the nursing process in directing
•
•
and coordinating all nursing activities and
supporting the pt.
Maintaining the safe and comfortable
environment for the pt. and the medical staff.
Assisting any members of the O.R. teams if
needed.
• Must know all supplies, instrument and
equipment.
• Identification of any environmental
dangerous or stressful situation involving
the pt. or other team members.
• Maintain a good communication link
between the O.R. team.
• The circulate nurse is the most
experienced nursing team members in
the O.R. acts as supervisor, advisor and
teacher.
Classification of surgery
• Emergency: without delay life threatening,
•
•
•
•
immediate attention.
Urgent (Imperative): prompt attention
(24-30h) acute GB stone, renal stone.
Required (planned): patient needs to have
surgery (few weeks or months) as Cataracts.
Elective: patient should be repair scars,
simple hernia.
Optimal: cosmetic surgery, individual
preference.
Scrubbing techniques
• Time Method – 5 min.
• Counting method
Basic positioning for
surgery
Supine Position and its
modifications.
Supine position.
Trendelenburg position.
Reverse Trendelenburg position.
Fowler’s and Sitting position.
Lithotomy position.
Prone position and its
modifications.
Prone position.
Kraske (jackknife) position.
Knee-chest position.
Lateral position and its
modifications.
• Lateral position.
Kidney position.
Sim’s position.
Fracture position
Preoperative Patient Routines:
• Surgical Consent
• Nail polish
• Sedation.
• Diet (NPO 4-8 hr. )
• Make up
• Patient Identification
• Lab. Tests
Technique for transferring the
patient to OR table
• For mobile pt. 2 of non sterile team
• For immobile pt. 4 of non sterile team
Hypothermia
• Hypothermia------
post- operative shivering-----
increase oxygen consumption up to
700%.
Intra operative heat loss
• Radiation – loss of heat from the patients body
•
•
•
to the environment.
Convection- loss of heat into the air currents.
conduction- loss of heat from the patients
body into a cooler surface such as the operating
table.
Evaporation- loss of heat via perspiration or
respiration.
Principles of aseptic technique
• Only sterile items are used within the
sterile field.
Sterile persons are gowned and gloved
Tables are sterile only at table level
Sterile persons touch only sterile items
or areas
• unsterile persons touch only
unsterile items or areas.
• Unsterile persons avoid reaching
over sterile field
• sterile persons avoid leaning over
unsterile area.
• Edges of anything that encloses
sterile contents are considered
unsterile
• Sterile field is created as close as
possible to time of use
• Sterile areas are continuously kept in
view
• Sterile persons keep well within
sterile area
• Unsterile persons avoid sterile areas
Pathogens and infection
• Pathogens associated with surgical
site infection ( S.S.I.):
• Bacteria.
• Fungi
• Viruse
• The most commonly transmitted
pathogen in O.R is
Staphylococus
Aureus (gram + cocci).
 Mycobacterium Tuberculosis- TB
transmitted through airborne droplet
nuclei. Infects lungs, kidneys, joints
and skin.
Sources of Surgical Site
Infection ( S.S.I. ):
• Normal flora of the patient.
2.Personnel.
3. Inanimate objects
(contaminated instruments).
4.Air borne contamination.
5.Contamination during procedure (surg).
UNIVERSAL Precautions
Applied in an invasive procedure
PROTECTION
 GLOVES
MASKS
EYEWEAR or FACE SHOELDS
GOWNS or APRONS
Prevention of puncture
injuries
• E.g. needles, knifes blades and
sharp instruments present a
potential hazards for the handler
and user.
• Do not manipulate by hand
• Mouth protection- incase of emergency
• Care of specimens- should be contained
• Decontamination- all instruments must be
cleaned before sterilization or disinfection.
• Laundry- soiled linen should be handled as
little as possible.
• Waste - Blood and suctioned fluids .
• Hand washing- following every contact with
patient, blood and body fluids.
Cleaning, Disinfection and
Sterilization
Levels of disinfection
• High level disinfection – kills all
microorganisms and may kill certain
spores with sufficient contact time.
• Intermediate level disinfection – kills
most microorganisms except spores.
• Low level disinfection –kills fungi,
bacteria, and hydrophilic viruses.
Sterilization
• Destruction of all microorganisms in
or about an object as by steam,
chemical agents, ultraviolet
radiation.
Methods of Sterilization
• Thermal.
– Steam under pressure\ moist heat.
– Hot air\dry heat.
– Microwaves\ non ionizing radiation.
uv light [ ultraviolet light ].
• Chemical.
–
–
–
–
–
–
Ethylene oxide gas.
Formaldehyde gas.
Hydrogen peroxide plasma\vapor.
Ozone gas.
Glutaraldehyde activated solution.
Per acetic acid solution.
•Ionizing radiation (physical).
• Disinfectant and
disinfectant/ sterilant
agents.
High level disinfectant and
sterility compounds
• Glutaraldehyde (cidex)2% concentration with PH of 7.5- 6.5, is
a high level disinfectant.
20 minutes for disinfection and 10 hours
for sterilization.
• Hydrogen peroxide 6%.
Solution of 6% H2O2 with detergents
and 0.58% phosphoric acid have been
proven to be parricidal with 6 hours of
exposure at 20 degree.
• Peracetic Acid (steris) sterilization.
This cycle usually takes 30 minutes.
• Chlorine compounds.
- Chlorine compounds are effective
against HIV, HBV and other viruses.
• Formaldehyde.
It is bactericidal, psudomonacidal and
fungicidal in 5minutes exposure,
tuberculocidal and virucidal in 10-15
minutes, sporicidal in 12 hours.
Intermediate level
disinfectants.
• Phenolic compounds- (phenol,
carbolic acid).
• Iodophors- (iodine, Polidine, Povidine)
• Alcohol 50-90%
Methods of monitoring the
sterilization process
• Mechanical: Monitoring of parameters
(time, temp, and pressure).
• Chemical: Internal and external
indicator for steam and E.O.
• Biological: Is a device that contains a
known number and specific type of
microorganisms that are killed when
exposed to the sterilizing conditions.
Homeostasis and Blood
Replacement
Methods of controlling
bleeding during surgery:
• Mechanical methods.
1- clamping or ligation or clipping the cut
vessels.
2-Sponges-Patties (cottonoids)
3- Pledgets-Teflon.
4- Bone wax- Bee’s wax.
5- Suction, Drains.
6- Tourniquet, Pressure devices .
• Pharmacological Agents.
- Absorbable gelatin (gel foam).
- Collagen
- Oxidized cellulose (surgicel).
- Silver Nitrate (nasal bleeding).
- Epinephrine (vasoconstriction).
- Thrombin (enzyme).
• Thermal Hemostasis.
- Elctrosurgery and Laser.
Blood Loss and Blood
Replacement:
• Blood replacement can be:
- Homologous- patient’s own blood.
- Autologus- from the same species.
Blood types and groups.
- A, B, O, AB.
Methods of wound closure include
•
•
•
•
•
Sutures.
Staples.
Clips.
Tapes.
Glues
Suture - means ligation or approximating
tissue together.
Methods of suturing
• Everting sutures- skin edges.
1. Simple continuous.
2. Simple interrupted.
3. Continuous locking.
4. Horizontal mattress.
5. Vertical mattress.
• Inverting sutures- used for two
layers
- Purse String Suture
.Tentions sutures
.Traction sutures
- umbilical tape and
vessel loop
.Endoscopic suturing-
Kinds of sutures
• Absorbable suture
-Natural
1. Plain surgical gut
2. Chromic surgical gutsalt solution.
Is treated in a chromium
3. Collagen suture
• Absorbable suture
- Synthetic
1. Polydioxanone suture (PDS)
2. Poligleceprone( monocryl )
3. Polyglyconate (MAXON)
4. Polyglactin 910 (Vicryl)
5. Polyglycolic acid (Dexon)
6. Copolymer(Panacryl)
• Non absorbable Suture
- Natural
1. Surgical silk
2. Surgical stainless steel
• Non absorbable Suture
- Synthetic
1. Ethilon, Dermalon ( monofilament )
2. Nurolon ( multifilament uncoated )
3. srugilon ( multifilament coated )
4. NovafiL
5. Prolene
6. Ethibond
Kinds of Surgical staples
1. Skin stapler
2. Intra luminal circular stapler
(CEEA) Circular End to End Anastomosis .
3. Ligating and dividing stapler
( GIA ) Gastro Intestinal Anastomosis.
Roticulator.
4. Endo scopic stapler.
Tissue Adhesives
• Biologic adhesives
- Fibrin glue.
- Autologous or homologous- plasma and
clotting factors.
- Pooled donor plasma- multiple donors.
Synthetic adhesives- Cyanoacrylate glue- dries after 2 ½ minutes.
- Methyl methacrylate- used for fixation (bone
cement).
Kinds of skin graft
– Auto graft- skin is grafted from one part
of the patient's body to another part.
– Allograft -Human tissue is grafted to
another person (from cadaver).
– Xenograft- Skin obtained from a
dissimilar species .
– Artificial skin- synthetic skin
Terms Associated With Wound
Healing
• Adhesion - Band of scar tissue that holds
or unites surfaces or structures together
that are normally separated.
Contracture-Formation of extensive scar
tissue over a joint
Dead space - Space caused by separation
of wound edges or by air trapped between
layers of tissue.
Debridement - Removal of damaged
tissue and cellular or other debris from a
wound to promote healing and to prevent
infection.
Dehiscence - Partial or total splitting open
or separation of the layers of a wound.
• Edema - Abnormal accumulation of fluid
in interstitial spaces of tissues
• Evisceration -Protrusion of viscera
through an abdominal incision.
• Extravasations- Passage of blood,
serum, or lymph into tissues.
• Exudate - Fluid, cells, or other
substances that have been discharged
from vessels or tissues.
• Granulation tissue - Formation of
fibrous collagen to fill the gap between
the edges of a wound healing by
contraction “second intention “.
• Hematoma - Collection of extravasated
blood in tissue.
• Granuloma- Inflammatory lesion that
forms around a foreign substance, such as
glove powder or a suture Knot.
• Homeostasis- Arrest of blood flow or
hemorrhage, the mechanism is by
coagulation (formation of a blood clot).
• Incision- Intentional cut through intact
tissue (synonym: surgical incision).
• Ischemia- Decrease of blood supply to
tissues.
• Necrosis- Death of tissue cells.
• Scar- Deposition of fibrous connective
tissue to bridge separated wound edges &
to restore continuity of tissues
• Seroma- Collection of extravasated
serum from interstitial tissue or a resolving
hematoma in tissue.
• Tensile strength- Ability of tissues to
resist rupture.
• Tissue reaction- Immune response of
the body to tissue injury or foreign
substances.
• Wound disruption- Separation of wound
edges.
Kinds of Drains
• Passive drains- T- Tube, Foley catheter,
enlarged bulbous ends (mushroom,
malecot, pezzer catheters), pen rose.
Active drains – Hemovac drain, sump drain,
chest drain.
Complications of wound
healing
• Hematoma/ Seroma
• Scar/ Surgical
• Adhesions
• Postoperative wound disruption
Classification of Occupational
hazards
• Physical- back injury, fall, noise, pollution,
•
•
irradiation, electricity and fire.
Chemical- including anesthetic gases, toxic
fumes from gases and liquids, cytotoxic drugs,
and cleaning agents.
Biologic- including the patient( as a host for
or source of pathogenic microorganisms),
infectious waste. Cuts, or needle stick injuries,
surgical plume and latex sensitivity.
Ionizing Radiation
• Radiation has cumulative effects
• Sterile team members and others who
can not leave room should stand 2
meters or more.
• Staff members may request relief from
exposure during pregnancy.
• Lateral X-Ray more dangerous than
Anterior Posterior ( AP ) X-Ray
SURGICAL SPECIALITIES
• Endescopy: Examination of a body part
or cavity with an optical system in a
tubular structure.
• Insufflation: Act of filling with gas.
Laparoscopy is performed with carbon
dioxide.
• Laparoscopy: Endoscope examination of
the peritoneal body
Hazards of endoscopy:
• Perforation- Major organ or vessel.
• Bleeding- from biopsy site,
• Hypothermia- CO2 is colder than body
temp.
• Infection- by microorganism
Breast procedures
• Incision and drainage- surgical opening
of an inflamed area because of infections
in lactating breast.
Breast biopsy
• Fine needle aspiration- 22-25 gauge
needle attached to a syringe is inserted
into the tumor mass.
• Core biopsy-
Incisional biopsy- The mass is incised and a
portion is removed for histologic examination.
Excisional biopsy - The entire mass is
removed for pathologic study.
Sentinel node biopsy-In OR the tumor is
injected with a dye containing iso-sulfan blue
that is taken up by the lymph nodes of the
breast.
Fiber optic ductoscopyA flexiable 0.9mm scope with a 0.2 mm working
channel is used in the ductal lumens of the breast.
Lumpectomy
• Partial mastectomy, consists of removal of
the entire tumor mass along with at least
1 to 2 cm of surrounding non diseased
tissue.
• Done for tumor that measure less than
5 cm.
Segmental mastectomy
• a wedge of breast tissue is removed.
• Simple mastectomy ( total mastectomy )The entire breast is removed without lymph
node dissection.
Modified radical mastectomy-
Removal of the entire breast along with all
axillary lymph nodes.
Radical mastectomy-
Removal of entire breast along with the
axillary lymph nodes, the pectoral muscles
and all adjacent tissues.
Extended radical mastectomy-
The entire breast is removed with the
underlying pectoral muscles, axillary
contents, and upper internal mammary
lymph node chain.
Characteristics of the incision
• Ease and speed of entry into the
abdominal cavity.
• Maximum exposure.
• Least post operative discomfort.
• Maximum post operative wound strength.
Types of abdominal incisions
• Paramedian incision
• Longitudinal midline incision
• Subcostal upper quadrant oblique incision
( Kocher )
• Chevorn incision –bilateral subcostal
incision
• McBurney incision
• Thoracoabdominal incision
• Mid abdominal Transverse incision
• Pfannestiel incision
• Inguinal incision
Biliary Tract
• Biliary Tract Procedures
• Cholecysectomy – is the removal of gallbladder
Choledochoscopy -Intra operative biliary endoscopy provides
image, transmission and illumination.
CholelithotripsyNon invasive procedure in which high energy shock
waves are used to fragment cholesterol gall stones.
Choledochostomy-
A T-Tube is used to drain the common bile duct through the
abdominal wall.
Choledochotomy –
bile duct.
Is an incision of the common
CholecystoduodenostomyCholecystojejnostomy –
- Both performed to relieve an obstruction in the distal end
of the common duct. Anastomosis between the gall bladder
and duodenum or jejunum.
CholedochoduodenostomyCholedochojejunostomyAre side to side anastomosis between duodenum or
jejunum and the common duct.
Splenic Procedures
• Splenectomy
• Splenorrhaphy
Pancreatic Procedures
• Pancreaticojejunostomy
• Pancreaticodudenectomy
Esophageal Procedures
• Esophageal hiatal heniorrhaphy
Nissen fundoplication -360 degree
Toupet fundoplication – 180-200
Gastrointestinal Surgery
• Gastroscopy
• Gatrostomy
• Total Gastrectomy
• Vagatomy
• Pylroplasty
• Gastrojejunostomy
• Gastroplasty
• Gastric Bypass
Intestinal Procedures
• colectomy
• Ileostomy
• Cecostomy
• Colostomy
• Appendectomy
Colorectal Procedures
• Sigmoidscopy
• Colonoscopy
• Polypectomy
Complications of abdominal
surgery
•
•
•
•
•
•
Pulmonary complications.
Fluid and electrolyte imbalance
Peritonitis and wound infection
Wound infection can cause wound disruption
Incisional hernia
Adhesions are the most common cause of
post operative intestinal obstruction.
Anorectal procedures
• Hemorrhoidectomy
• Anal abscess
• Fistulotomy and fistulectomy
• Fissuerectomy
• Pilonidal cyst and sinuses
Kinds of hernia
• Inguinal hernia
• Femoral hernia
• Umbilical hernia
• Ventral ( incisional ) hernia
• Hiatal hernia
Amputation of extremities
• Reasons for amputation:
• Massive trauma.
• Malignant tumor.
• Extensive infection.
• Vascular insufficiency.
• Phantom limb pain- Is the sensation that
the amputated part is still present.
Gynecologic and Obstetric
Surgery
• Colposcopy- Done for identification of
abnormal epithelium to target for biopsy
of the lower part of cervical canal and
vaginal wall.
• Culdocentesis- Blood, fluids and pus in
the culdesac is aspirated by needle via
the posterior vaginal fornix for suspected
of intra peritoneal bleeding, ectopic
pregnancy, trauma, and tumor.
• Colpotomy- Transverse incision is made
through the posterior vaginal fornix to
facilitate diagnosis by intra peritoneal
palpation, inspection of the pelvic organs
or determination of fluids.
Fallopian tube diagnostic
procedures
• Hystosalpingography
• Hysteroscopy and Laparscopy
Vaginal procedures
•
•
•
•
•
•
•
•
Vaginal lesion
Vaginectomy
Vaginoplasty
Vesicovaginal fistula
Rectovaginal fistula
Vaginal hysterectomy
Dilation and Evacuation (D & E)
Dilation and Curettage ( D & C )
Abdominal Procedures
•
•
•
•
•
•
•
•
Total Abdominal hysterectomy
Salpingo-Oophorectomy
Myomectomy
Ovarian cystectomy
Shirodkar and Cerclage procedures
Ectopic Pregnancy
Cesarean Section (CS)
In Vitro Fertilization (IVF)
Urologic Surgery
• Surgical Procedures
• Nephrectomy
• Pyeloplasty- Revesion of the renal pelvis
• Percutaneous Nephrolithotomy,
Nephrolithotripsy PCNL
• Ultrasonic lithotripsy
• Electrohydrolic lithotripsy
• Nephrolithotomy or pyelolithotomy
• Extracorporeal shock wave lithotripsy
•
•
•
•
•
•
•
(ESWL)
Ureteroscopy
Percutaneous Uretrolithotomy
Ureterolithotomy- An open procedure for the
removal of stones from the ureter.
Cystolithotomy and cystolitholapaxyRemoval of bladder stone, crushing a
urinary stone in the bladder.
Cystoscopy
Cystotomy or Cystoplasty
Cystectomy
• Urethrotomy-cut into a urethral
stricture
• Urethroplasty
• Orchiectomy
• Testicular Torsion
• Hydrocelectomy
• Varcocelectomy
• Vasectomy
• Transurethral Resection of Prostate
(TURP)
• Suprapubic Prostatectomy
Sings of TUR syndrome
•
•
•
•
•
•
•
•
Mental confusion.
Nausea and vomiting.
Hypertension followed by hypotension.
Symptoms of fluid over load and pulmonary
edema.
Bradycardia and dysrhthmia.
Visual disturbances.
Seizures and twitching.
Coma.
Treatment of TUR
syndrome
• Administration of IV hyper tonic saline
• Monitoring of serum sodium levels
• Diuretics
Orthopedic Surgery
• Steps of bone healing
– Hematoma formation.
– Callus formation, 1-2 weeks.
– Calcification process, completed by 6 weeks.
- Remodeling phase, 6 months to 1 year.
Indications for orthopedic
surgery
• Fracture of bones.
• Reconstruction of joints.
• Repair of tendons and ligaments
Kinds of fractures
– Traumatic fracture- may be closed
or open fracture.
– Pathologic fracture- due to
demineralization of bone (osteoporosis
or the aging process).
Methods of treating fractures
• Closed reduction with immbolization
• Skeletal traction
• External fixation
• Internal fixation
• Electrostimulation
Arthrodesis
• Fusion of a joint may be achieved by
removing the articular surface and
securing bony implant that inhibits motion.
Arthroplasty
•
•
•
•
It is done to :
Restore or improve range of motion
Provide stability
Relieve pain.
• Arthroscopy
• Arthrotomy
• Bunionectomy: Hallux valgus It is
done to remove a painful exotosis or to
functionally or cosmetically correct the
deformity.
• Neurolysis:
• Meniscectomy
Neurosurgery
• Craniotomy
• Cranioplasty
• Epidural hematoma Bleeding caused by
•
rupture or tear of the middle meningeal artery
or its branches forms a hematoma between the
skull and the dura
Subdural hematoma Bleeding between the
dura matar and arachnoid is caused by
laceration of viens that cross the subdural space.
• Laminectomy
• Diskectomy - discectomy
• Spinal fixation
Ophthalmic Surgery
• Ophthalmic drugs
• Mydriatic drugs used to dilate the pupil.
• Miotic drugs used to constrict the pupil.
Ocular surgical procedures
• Extra ocular procedures•
•
•
•
are conditions
affecting the exterior surface of the eye.
Chalazion: an extremely common but benign tumor of
the lid, it can be malignant.
Correction of pitosis: is a drooping of the upper lid
Ectropin: is a condition in which either the upper or
the lower lid is everted ( turned out).
Entropin: is a condition in which either the upper or
the lower lid is enverted (turned in).
Lacrimal apparatus
• Lacrimal duct dilation –Probing
• Dacryocystectomy: removal of the lacrimal
sac due to chronic inflammation.
• Dacryocystorhinostomy (DCR):
construction of a new opening into the
nasal cavity from the lacrimal sac
Extra ocular muscle
• squint –
Procedure on the oculomotor muscles
which control eye movement, are done to
correct misalignment that interferes with
the ability of the two eyes to remain in
simultaneous focus on a viewed object.
ORBIT
• Enculation:
is the complete removal of the eyeball,
severing of its muscular attachments. The
muscle stumps are preserved. Over lying
fascia and conjunctiva are closed to hold
the prosthesis in the socket.
• Evisceration:
is the removal of the contents of the
eyeball only, the outer sclera and muscles
are left intact.
• Exenteration:
is the removal of entire eye and orbital
contents including tendon, fatty and
fibrous tissue. It is done incase of
malignant tumor of the lid or eyeball.
Intra Ocular procedures
• Pterygium: it is benign growth of the
conjunctival tissue over the corneal
surface.
• Corneal transplantation (Keratoplasty)
• Cataract: Is an opacification of the
crystalline lens, its capsule or both
• Extra capsular cataract Extraction (ECCE)
• Implantation of intraocular lens (IOL)
• Vitrectomy It is the removal of a portion
of the vitrous humor (vitrous body) that
fills the space between the lens and the
retina
Vascular Surgery
– The vein has valve and carry deoxygenated blood.
– The artery has no valve and carry oxygenated blood.
– Thrombectomy and embolectomy: A fogarty
catheter is inserted proximally and advanced into a
vessel distally beyond the obstruction.The balloon on
the tip is then inflated. As the catheter is withdrawn,
thrombotic or embolic material is removed to restore
blood flow to an extremity.
Vascular surgical procedures
• Femoropopliteal bypass
• Aneurysmectomy
-Kinds of aneurysm:
1.Fusiform aneurysm
2.Saccular aneurysm
• The most common affected vessels in an
aneurysm:
1.
2.
3.
4.
Abdominal aorta.
Thoracic aorta.
Aortic arch.
Popliteal arteries.
Venous stasis disease
• When the valves of the veins fail to
function normally, increased backpressure
of blood causes the veins to become
dilated----- Varicose Vein.
• Rx-Ligation and stripping of varicose veins
• Fasciotomy:
is the treatment of choice for the
prevention of compartment
syndromes after acute ischemia in
the upper or lower extremity.
• Vascular shunts:
• Arterio venous shunts and fistulas:
1. Anastomosis at the wrist between the radial
artery and cephalic vein.
2. Loop fistula may be created with a graft
from the brachial artery to the cephalic or
basilica vein.
Plastic and Reconstructive
Surgery
• Aesthetic procedures:



Blepharoplasty- correct deformities of
the upper or lower eyelids of one or both
eyes
Otoplasty- repair of deformity of one or
both external ears of an adult
Rhinoplasty- reshaping of the nose.
• Mentoplasty- the shape and size of the
chin can be altered for aesthetic and
functional bite disorders.
• Rhytidoplasty- face lift.
• Liposuction- localized areas of fat
deposits are removed by suction assisted
lipectomy.
• Abdominoplasty- includes excising excess
lax abdominal wall skin and adipose
tissue and tightening abdominal wall
musculature.
ENT, HEAD, and NECK
SURGERY
The ear consists of three parts:
1. External ear: consists of auricle (pinna),
2.
external auditory canal, tympanic membrane
(eardrum).
Middle ear: consists of Tympanic cavity , a
closed chamber that lies between the tympanic
membrane and the inner ear inside the cavity
there is a three small bones, the ossicular
chain ( malleus, incus, stapes) they resemble
the hammer, anvil, and stirrups.
3. Inner ear: The two main sections are the
cochlear and vestibular
• Potential complications of ear infection:
1. Facial paralysis.
2. Meningitis.
3. Intracranial infection (brain abscess).
Surgical procedures of the ear
• External ear procedure:
1. Removal of a foreign body from the outer
canal usually in children
2. drainage of hematoma due to injury
3. Excision of tumor- pinnectomy
• Middle ear procedures
1. Mastoidectomy- the eradication of mastoid
air cells done to relieve complications of
acute or chronic complications.
2. Tympanoplasty: it refers to any procedure
performed to repair defects in the eardrum
or middle air structures for the purpose of
reconstructing sound conduction paths.
3. Stapedectomy: Partial or total removal of
the stapes.
• Inner ear procedure
-Implantation of cochlear prosthesis:
A cochlear implant can restore perception
of sound to patients who have
performed sesorineural deafness not
responsive to external amplification of
hearing aids.
Nose
•
•
•
•
Turbinectomy- removal of turbinate.
PolypectomySeptoplastyRhinoplasty- correction of deformity of
the nose.
• FESS- functional endoscopic sinus
surgery