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Removal of metals and other foreign bodies Removal of piercings and rings from the surgical site is import - ant as they often act as a nidus for infection; metallic objects could also potentially lead to thermal injury when diathermy - is used. In addition, ...

Removal of skin staples or sutures The timing of removal of non-absorbable sutures depends on the anatomic location, tension with which the wound was closed and the operation performed. It is customary for the operating surgeon to specify the time of suture ...

SURGICAL EXPOSURE AND WOUND APPROXIMATION SURGICAL EXPOSURE AND WOUND APPROXIMATION SURGICAL EXPOSURE AND WOUND APPROXIMATION

Skin antisepsis Skin antisepsis removes transient organisms and dirt, thereby preventing SSI. The principles involved in skin antisepsis are as follows. /uni25CF The use of alcohol-based antiseptic solution is recom mended. The World Health Organization recom...

Skin incisions Skin incisions ( Figure 7.6 ) are made using a scalpel with the blade pressed firmly down at right angles to the skin and then drawn gently across the skin in the desired direction to create a clean incision. It is important not to incise the sk...

Specialist use of drains Nasogastric drainage The role of nasogastric tube placement in the surgical patient has been steeped in dogma. There is no doubt that selective use of nasogastric tubes have a vital place in the perioperative management of patients;...

Supine position This is the most common position for general surgical proce - dures. The patient’s arms may be placed by their side or extended to a ff ord access to intravenous and arterial cannulae. This is a versatile position and can be modified as follows: ...

Surgical access to the abdomen in general surgery Access to the abdominal cavity can be achieved in many ways and the exposure required will depend on the surgical pathology anticipated, procedure performed and expertise of the surgeon ( Summary box 7.4 ). Sum...

Suture characteristics There are five characteristics of any suture material that need to be considered: 1 Physical structure : monofilament or multifilament. /uni25CF Monofilament sutures are smooth and tend to slide through tissues easily , but are more di ffi cul...

Suture techniques There are four frequently used suture techniques. 1 Interrupted sutures . Interrupted sutures require the needle to be inserted at right angles to the incision and then to pass through both aspects of the suture line and exit again at right ...

T-tube drains A T-tube ( Figure 7.21 ) may be inserted after exploration of the common bile duct and stone retrieval or following repair of a damaged common bile duct. The principle is to allo w bile to Indications for placement of the nasogastric tube /uni25...

TECHNIQUE The suturing of an incision or wound needs to take into consid - eration the site and tissues involved. There is no ideal wound closure technique that would be appropriate for all situations, and the ideal suture has yet to be produced, although many...

TOPICAL HAEMOSTATIC AGENTS Physical or biological topical haemostatic agents are considered adjuncts to traditional mechanical and electrosurgical tech - niques. The physical agents commonly used are absorbable gelatin, absorbable collagen and oxidised cellu...

The effects of diathermy Diathermy ( Figure 7.19 ) can be used for two basic purposes ( Table 7.4 ): 1 coagulation: to achieve haemostasis; 2 cutting: incision and dissection of tissues during surgery . Several ‘blend’ options are also available, combining va...

The principles of electrosurgery Electric current is defined as the flow of charged particles through a circuit. Alternating current (AC), a type of current wherein current periodically changes direction, is solely employed in electrosurgery . The time taken t...

The role of drains in modern surgery The routine use of surgical drains has generated much contro - versy . Protagonists suggest that the use of drains may: /uni25CF help remove the collection of purulent material, blood, serous fluid, bile, chyle, pancreati...

principles of electrosurgery Bleeding encountered during an operation can be arterial, venous or capillary . Surgical haemorrhage is categorised as primary (during the operation), reactionary (24–48 hours postoperatively) or secondary (days to weeks postoperat...

Anatomy The weight of the normal adult spleen is 75–250 /uni00A0 g and it measures up to 10 /uni00A0×/uni00A0 7 /uni00A0×/uni00A0 3 /uni00A0 cm. It lies in the left hypochondrium between the gastric fundus and the left hemidiaphragm, with its long axis lying a...