Surgical Techniques, chirurgia
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Surgical Techniques
Textbook for medical students
Edited by Mihály Boros
University of Szeged
Faculty of Medicine
Institute of Surgical Research
Szeged, 2006
Supported by ROP–3.3.1–2005–02–0001/34. project
Readership:
Dr. Erzsébet Rőth
Dr. György Lázár
Dr. Csaba Gaál
Publisher:
Dr. Mihály Boros
Cover design:
Attila Pálfi
Press:
Innovariant Ltd.
3 Textilgyári Rd., H-6725 Szeged
Volume: 7.5 (A/4) printed sheets, 120 pages, 285 figures.
ISBN 963 482 785 3
© Prof. Dr. Mihály Boros, 2006
Introduction
“Surgical techniques” is a subject relating to the principles of surgery. Traditionally it discusses instrumentation, tools
and sterile techniques used to perform safe operations by generations of surgeons. A relatively new, but continuously
expanding element is linked to the development of clinical surgery. his part involves surgical research on the patho-
physiology of the perioperative period, and scientific studies on the consequences of invasive procedures on the body
functions and on the relationship of surgery and patient care in general. hese aspects are of utmost importance for
the achievement of good surgical results. In brief, “surgical techniques” is concerned with the methodology of classi-
cal surgery, and may also be regarded as the deontology of modern surgery (
deontology
= theory of obligations).
his handbook is based on the topics presented on the graduate courses at the Institute of Surgical Research at the
University of Szeged. hese courses do not cover all aspects of clinical surgery; the intention is rather to give a general
overview of basic techniques which could be used in practice in all major fields and subspecialties. here are a number
of conventional surgical techniques that have been in use for some time and the scalpel is the symbolic instrument of
these fields. However, it is being replaced by new and more effective surgical tools, sophisticated computer technology
and techniques such as laser, robotic or minimally invasive surgery. If we wish to be at the forefront of these advances,
the new methods should also be discussed.
he volumes have been compiled by the staff and PhD students of the Institute (Dr. Ágnes Adamicza, Dr. Mihály
Boros, Dr. Tamás Jánossy, Dr. József Kaszaki, Dr. Andrea Szabó, Dr. Csilla Torday, Gabriella Varga, Dr. Gábor Erős
and Dr. Miklós Czóbel), together with Dr. László Szalay (Department of Ophthalmology), Dr. Zsolt Bella (Depart-
ment of Oto-Rhino-Laryngology) and Dr. Zoltán Bajory (Department of Urology). he editor wishes to acknowledge
the creative illustrations by Drs Miklós Czóbel and László Szalay and Mrs. Kálmánné Csíkszentimrei. he activities of
Dr. Miklós Czóbel have made it possible to maintain a highly effective website (
)
where the main parts of this book can be found.
he ROP-3.3.1-2005-02-0001/34 project has led to an infrastructure for skills training where specific invasive tech-
niques can be safely practised and mastered. We hope that the new skills laboratory at the Institute of Surgical Re-
time, and that many medical students will benefit from them.
Mihály Boros
November 2006, Szeged
SURGICAL TECHNIQUES
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Table of contents
Introduction ....................................................................................................................................3
Table of contents ..............................................................................................................................4
I. Asepsis and antisepsis .................................................................................................................9
1. Historical overview ................................................................................................................................................... 9
2. Asepsis and antisepsis in surgical practice ......................................................................................................... 10
3. Surgical infections, sources of wound contamination, interventions ............................................................ 11
4. Types of surgical wound contaminations and their classification .................................................................. 12
5. Prevention of wound contamination ................................................................................................................... 12
6. Risk factors of wound contamination ................................................................................................................. 13
7. Postoperative wound management ...................................................................................................................... 13
8. Sterilization, elimination and inactivation of pathogens ................................................................................. 14
9. Disinfection.............................................................................................................................................................. 14
10. Asepsis .................................................................................................................................................................... 14
10.1. Preparation of the skin before the operation .................................................................................... 14
10.2. Disinfection and scrubbing of the skin before the operation......................................................... 15
10.3. Isolation of the operating area (draping) ........................................................................................... 15
11. Basic rules of asepsis in the operating theater .................................................................................................. 16
11.1. Personnel attire in the operating room .............................................................................................. 16
12. Scrubbing, disinfection and gowning in general ............................................................................................. 16
13. Personnel attire and movement in the operating room .................................................................................. 20
14. Basic rules of asepsis in the operating room ..................................................................................................... 21
15. Further important items to ensure asepsis and to avoid wound contamination ........................................ 21
16. Duties related to asepsis in the postoperative period ...................................................................................... 21
17. Surgical antisepsis ................................................................................................................................................. 21
II. he operating room .................................................................................................................22
1. Furniture, basic technical background ................................................................................................................ 22
2. Standard equipment ............................................................................................................................................... 22
3. he operating room personnel .............................................................................................................................. 23
3.1. Organization of the operating room personnel and their duties ..................................................... 23
4. Positioning of the surgical patient ....................................................................................................................... 23
III. Surgical instrumentation. Basic surgical instruments and their use ...................................25
1. Cutting and dissecting instruments .................................................................................................................... 25
2. Grasping instruments ............................................................................................................................................ 26
3. Retracting instruments .......................................................................................................................................... 28
4. Wound-closing instruments and materials ........................................................................................................ 28
IV. Basic wound-closing methods: sutures and clips ..................................................................32
1. Types of sutures ....................................................................................................................................................... 32
2. Rules of wound closure .......................................................................................................................................... 32
3. Correct position of the needle holder .................................................................................................................. 32
4. Interrupted sutures ................................................................................................................................................. 33
4.1. Simple interrupted suture
(sutura nodosa)
.......................................................................................... 33
4.2. Vertical mattress suture
(sec. Donati)
.................................................................................................. 33
4.3. Vertical mattress suture
sec. Allgöwer
.................................................................................................. 33
4.4. Horizontal mattress suture .................................................................................................................... 33
5. Continuous sutures................................................................................................................................................. 33
5.1. Simple continuous suture (furrier suture,
sutura pellionum
) ........................................................... 33
5.2. Locked continuous suture ...................................................................................................................... 34
5.3. Subcuticular continuous suture ............................................................................................................ 34
5.4. Purse-string suture ................................................................................................................................. 34
6. Methods of wound closure .................................................................................................................................... 34
6.1. Suturing with simple interrupted knotted stitches (skin and subcutis closure) ........................... 34
6.2. Suturing with
Donati
stitches (skin closure) ...................................................................................... 35
6.3. Wound closure with metal clips
(agrafe)
............................................................................................. 35
6.4. Other wound-closing methods ............................................................................................................. 36
7. Sutures in different tissues ..................................................................................................................................... 36
7.1. Failures of suturing technique ............................................................................................................... 36
7.2. Removing sutures .................................................................................................................................... 36
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SURGICAL TECHNIQUES
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