Principles of Surgery
Basic Principles of Successful Surgery
Surgery
Disrupts the skin & mucous membranes that provide a barrier to prevent potential bacteria from invading
Basics of Surgery
Aseptic Technique
Describes the general practices used to minimize the risk of infection that may occur following surgery
Aseptic Technique
Disinfectants
Disinfectants
- Used to thoroughly clean facilities within the operating room
- Used on inanimate objects - not on patients
- Too harsh to be used on skin/mucous membranes
- Will kill majority of pathogens present on equipment
Sterilization
- Procedure in which all microorganisms are destroyed
- Pressurized steam & chemicals are two means of sterilization
Sterilization
Autoclave
Autoclave
- Used to sterilize instruments with pressurized steam
- Water boils at 220F, h20 in autoclave is brought to boil, the tight seal of autoclave allows pressure to build, increasing pressure causes increasing temps to sterilize tools
- Tools are packed into special wrap that allows steam to penetrate the items
- You can then handle the packs safely on the outside
Equipment
Sterilized Equipment
- Special tape signals when proper sterilization has occurred
- Does not guarantee instruments are sterile, does ensure adequate temps have been reached on outside of pack
Surgical Instruments
Tools
- Put together for a "PACK" or surgical pack
- Stainless steel is the best option
- Good durability, minimal corrosion
- Extensive list of tools and depends on surgery, but basic instruments are commonly used
Common Instruments
Common Instruments
- Scalpel
- Needle Holder
- Scissors
- Tissue Forceps
- Hemostatic Forceps
- Retractors
- Towel Forceps or Towel Clamps
- Spay Hook
Common Instruments Used
Tool Descriptions
- Stainless stell is best to withstand the high temps of autoclave
- Heat may damage instruments that aren't stainless
- Can be sterilized by other means
- Ethyleene oxide (gas)
- Chemical Sterilization
- Remember is toxic & requires a special chamber to expose instruments to gas without contaminating environment
Scalpel
Scalpel
- Begins surgery tpically by making an incision into tissues
- Blade is designed for single use
- Disposable
- Handle portionis reused
- Diferent sizes & shapes of scapel blades are available
Needle Holder
- Holds needle for suturing
- Many have serrated tungsten carbide insert in jaws that holds the needles
- Material is hard & lasts a long time
- When insert becomes smoot it can be replaced instead of replacing whole instrument
- Most have ratchet lock, so needle can be clamped without maintaining grip pressure on tool
Needle Holder
Tissue Forceps
Tissue Forceps
- Have the appearance of a pair of tweezers
- Tip of tissue forceps varies depending on usage
- Tip may have serrated end for handling delicae tissues/interlocking teeth for secure grip
- Another type has ratchet lock for securely holding tissues
- Generally, ratchet lock type should not be used on delicate tissue
Scissors
Scissors
- Several diffeent styles available
- Curved scissors
- More maneuverable during procedure
- Straight-blade scissors
- More readily cutthrough tougher tissues
- Surgical packs commonly have:
- Metzenbaum dissecting scissors
- Used for delicate tissues
- Mayo scissors
- Heavier tissues
Hemostatic Forceps
Hemostatic Forceps
- Generally called hemostats
- Have ratchet lock
- Used to clamp blood vessels
- Once clamped, vessel can be ligated to prevfent bleeding
- Comes in different sizes depending on procedure being performed
Retractors
- Tools used to hold tissues & exose surgical area
- Helps surgeon have a better view
- Can be held by assistant or self-retaining
Retractors
Towel Forceps / Towel Clamps
Towel Forceps
- Surgical drapes cover the animal, except for area of incision
- This prevents contamination of surrounding tissues & instruments by surrounding areas on dog/surgical table
- Towel clamps are used to clamp material to animal
Spay Hook
Spay Hook
- Used to bring the uterus through a releatively small incision
- Used to move organs when looking for the uterus
Surgeon
- The surgeon is a source of bacterial contamination
- Large number of bacteria present within normal skin
- Remember - your outer skin layers are constantly shedding & may carry bacteria
- Exhaled air can even carry contamination
- You need to prep the surgeon!
Surgery Basics
What to Wear:
- Head cover
- Must cover ALL the hair
- If you have facial hair, may have to mask that as well
- Surgical Mask
- Covers nose and mouth
- Designed to block spray of saliva that could occur when talking
- Sterile surgical gown
- Done with aid of assistant
- Sterile surgical gloves
- Placed on hands, cuffs of gloves seal over sleeves of surgical gown
Surgeon Gear
The More You Know...
- When not actively operating, hands are held in front of the surgeon
- Still being held high above the elbows
- This helps to prevent any accidental contact of hands w/ a nonsterile item
- ie. Surgical Table
Surgeon Tip
Proper Scrubbing Technique
Surgical Prep
- After applying hair net and face mask, surgeons was hands & forearms w/ surgical scrub
- Antiseptic soap is used to clean
- Scrubbing procedure:
- Removes not only dirt & oil from skin, decreases number of bacteria present
- Scrubbing needs to be thorough
- Clean all areas of hands
- Includes under fingernails
- A brush is used here
Antiseptic Contact Time
Scrub Time
- Must have a certain amount of contact time with the antiseptic for it to work effectively
- They do not kill bacteria immediately
- Must have prolonged contat with organism
- To wash:
- Skin must be scrubbed all over the hands & forearms down elbows
- Next, organized scrubbing is performed
- This allows antiseptic to be in contact w/ all areas while scrubbing continues
- Standard Rule: 5 MINUTES
Remember:
Special Technique
- When scrubbing, hands are held higher than elbows!
- Principle is to hold the cleanest part the highest.
- This means if a higher bacterial count is on "elbows," water does not run from them to contaminate hands.
- Using sterile towel, dry hands, followed by arms
- Hands continously held in air until gloved
Is this scrubbing overkill?
Overkill?
- If you are wearing gloves, why scrub so much?
- Gloves are sterile, but can tear easily with a bone fragment or accidental cut
- A small puncture in the glove doesn't result in severe contamination if the hands have been thoroughly scrubbed!
Prepping the Animal
- You need to appropriately prep the animal for surgery
- The hair must be clipped from surgical region
- clipped in a large enough area that the surgical incision can be enlarged if it becomes necessary
- Next step is scrubbing with antiseptic soap!
Animal Preparation
What To Do:
Scrubbing the Animal
- Working with antiseptic soap
- Scrubbing will remove dirt & oils
- Will help reduce bacterial population
- Contact time is equally important
- Make sure to have at least 5 minutes
- Scrub central region over anticipated incision site first
- Work in larger circles to outside of clipped area
- This will help prevent dirt & hair from peripheral region from contaminating central region
Actual Surgery
Surgery
- Following all surgical prep, actual surgery may begin.
- The prep is essential for a clean surgery
- Example:
- Spay or Castration = this is where healthy skin is entered & healthy tissue is being removed
- Not all surgeries are this clean
- Surgeries involving mouth intestines, & contaminated wounds may have various degrees of contamination
- Greater risk of infection
Consider:
Considerations
- Conditions surrounding surgeries vary dramatically
- The preparation before surgery helps to minimize risk of infection following surgery
- Sometimes surgeries are not done in the most clean areas.
- Remember large animal surgery is often done in a field or barn.
- The doctor will still use a cap, mask, & sterile gown
- They cannot have the cleanest of surroundings
- ie. wind blowing, cat jumping, etc.
Wounds
- Surgery creates a wound
- healing process is essential for both surgery & traumatic wounds
- Healing is divided into phases, steps actually overlap in time
Laceration Healing
Inflammation Phase
Inflammation
- Begins immediately following the trauma or incision
- Bleeding is beneficial to flush wound of contamination
- Instantly blood vessels constrict, slowing flow of blood
- Blood begins to clot, protects from excessive blood loss
- Clot fills wound, seals it
- Clot dries, scab formed
- Scab helps protect damaged area
- Allows healing to occur beneath it
Repair Phase
Repair Phase
- It really started at the same time as the inflammatory phase
- Here, connective tissue cells enter damaged area, begin to form fibrous connective tissue
- Addition, capillaries begin to grow into this newly forming connective tissue
- In open wound combo of capillaries & connective tissue takes on fleshy red appearance
- Healing tissue is called granulation tissue
Purpose
Granulation Tissue
- Essential for allowing healing process to continue
- Tissue obviously fills gap between wound edges & sets up barrier to infection
- Rich supply of capillaries delivers WBCs to area to engulf any invading bacteria
- Granulation tissue provides surface for epithelial cells to bridge across the wound
- As granulation tissue forms, epi cells from wound edges begin to move across wound
- Cells initially form single layer beneath scab, until two edges connect
- Cells continue to replicate, layer thickens
Next...
After that...
- Blood vessels dilate, bring more WBCs to area
- WBC's destroy damaged tissue/invading bacteria
- Damaged tissue leaks plasma into wound
- Dilated vessels increase heat in region, produces reddened appearance
- Leaking plasma adds to swelling, which puts pressure on nerve ends, results in pain
- Heat, redness, swelling, pain are classic signs of inflammation
Healing Process