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Clinical Anatomy and Operative Surgery of Areas and Organs of Head, Neck, Chest and Abdomen

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Clinical Anatomy and Operative Surgery of Areas and Organs of Head, Neck, Chest and Abdomen Ministry of Health of Ukraine Ukrainian Medical Stomatological Academy S.M. Bilash, O.M. Pronina, M.M. Koptev Clinical Anatomy and Operative Surgery of areas and organs of head, neck, chest and abdomen Manual for training of specialists for II (Master's Degree) in branch of knowledge 22 "Health Care" on speciality 222 "Medicine" Poltava – 2018 Ministry of Health of Ukraine Ukrainian Medical Stomatological Academy S.M. Bilash, O.M. Pronina, M.M. Koptev Clinical Anatomy and Operative Surgery of areas and organs of head, neck, chest and abdomen Manual for training of specialists for II (Master's Degree) in branch of knowledge 22 "Health Care" on speciality 222 "Medicine" Recommended by the Scientific Board of Ukrainian Medical Stomatological Academy as a manual for English speaking students of the higher educational establishments of the Ministry of Health of Ukraine (protocol № 3 from 5.12.18) Poltava – 2018 1 UDC [611. 9+616-089](07) Recommended by the Scientific Board of Ukrainian Medical Stomatological Academy as a manual for English speaking students of the higher educational establishments of the Ministry of Health of Ukraine (protocol № 3 from 5.12.18) Authors: S. M. Bilash, O. M. Pronina, M. M. Koptev Clinical anatomy and operative surgery of areas and organs of head, neck, chest and abdomen. Manual for training of specialists for II (Master’s Degree) in branch of knowledge 22 "Health Care" on specialty 221"Medicine".− Poltava: Publishing office “Kopir servis”, 2018. – 186 р. The manual on clinical anatomy and operative surgery for international students specializing in medicine corresponds to the syllabus and curriculum of the subject. The main issues for practical training and also recommendations on the methodology of the subject are represented sequentially. The manual includes theoretical material, assignments for self-control, situational tasks and the list of recommended literature for self-training. It provides development of learning effectiveness of the students and is directed on mastering the subject "Clinical anatomy and operative surgery", gaining practical experience and skills which is of great importance in future medical practice. Reviewers: O.M.Slobodian – Doctor of Medicine, Professor, Head of Department of Anatomy, Topographic Anatomy and Operative Surgery, Higher State Educational Establishment of Ukraine "Bukovinian State Medical University"; Yu.I.Popovych – Doctor of Medicine, Professor, Head of Department of Clinical Anatomy and Operative Surgery, Ivano-Frankivsk National Medical University; V.I.Liakhovskyi – Doctor of Medicine, Professor, Head of Department of Surgery No. 1, Ukrainian Medical Stomatological Academy; O.M. Bieliaieva – PhD, Associate Professor, Head of Department of Foreign Languages with Latin Language and Medical Terminology, Ukrainian Medical Stomatological Academy. Literary editor – I. V. Rozhenko Literature on medicine and biology UDC [611. 9+616-089](07) ІSВІ 978-966-8716-54-6 S. M. Bilash, O. M. Pronina, M. M. Koptev 2 CONTENTS Introduction. Surgical instruments and suture equipment. 3 Primary surgical technique. 13 Clinical anatomy and operative surgery of the craniocerebral area of the head. 19 Clinical anatomy and operative surgery of the cranial cavity. 27 Simulation-based training surgery "Trepanation of the skull". 39 Clinical anatomy of the lateral facial part. Operative interventions in case of purulent processes of the face. 43 Clinical anatomy of the anterior part of the face. Operative interventions in case of purulent processes of the face. 61 Clinical anatomy of the neck regions. Fascias, triangles, neck vessels. Exposure and bandaging of external and common carotid arteries. 69 Clinical anatomy of the neck organs (larynx, trachea, pharynx, esophagus, thyroid gland). Tracheotomy. Thyroid gland surgery. 81 Clinical anatomy and operative surgery of the chest walls, mammary gland. Breast 95 surgery. Access to the organs of the chest cavity. Resection of the rib. Pleura, pleural cavity. Puncture of the pleural cavity. Pneumothorax. Surgical 101 management in case of pneumothorax. Clinical anatomy and operative surgery of the lungs and organs of the anterior and posterior mediastinum. 106 Clinical anatomy and operative surgery of the heart and pericardium. 111 Clinical anatomy and operative surgery of the anterolateral wall of the abdomen. 116 Clinical anatomy of the inguinal region. Surgical anatomy and surgical treatment of inguinal hernias. 122 Surgical anatomy and operative treatment of the femoral, umbilical and linea alba hernias. 129 Clinical anatomy of the abdominal cavity. 134 Clinical anatomy of the epigastric region. 142 Clinical anatomy of the hypogastric region. 148 Abdominal cavity surgery. Intestinal sutures. Resection of the intestine. 154 Educational simulation operation "Intestinal resection". 161 Stomach surgery 166 Surgery of liver, gallbladder, biliary tract, pancreas. 172 Removal of appendix. Surgery of the large intestine. 177 Final module control 182 3 Academic discipline Clinical anatomy and operative surgery Module No.1 Clinical anatomy and operative surgery of the regions of head, neck, chest and abdominal cavity. Introduction to clinical anatomy and operative surgery. Clinical anatomy and operative surgery of areas and organs of head and Content module No.1 neck. Topic 1 Introductory lesson. Surgical instruments and suture equipment. Year II Faculty Foreign students training (medical) 1. The relevance of the topic Every surgical intervention, regardless of the complexity and region, is performed by surgical instruments and requires high-quality suture materials. Profound knowledge of surgical instruments and rules of their use are important in professional activities of specialists in different fields of surgery that should be combined with knowledge of rules and surgical techniques. 2. Specific objectives 1. Classify general surgical instruments. 2. Explain the technique of general surgical instruments application. 3. Classify surgical suture materials. 4. Explain the use of basic types of suture materials. 3. Tasks for independent work to prepare for the lesson 3.1. List of the main terms, parameters, characteristics that should be learnt by the student while preparing for the lesson Term Definition The science dealing with surgical operations, methods of surgical interventions, which provides mechanical effect on Operative surgery organs and tissues with diagnostic, medical or reconstructive purpose Science dealing with anatomical issues which are relevant to Clinical anatomy various fields of practical medicine. Topographic The science dealing with structure, shape and relative location of anatomy organs and tissues in various parts of the human body 4 Developmental The science that studies the age-related aspects of anatomical anatomy features of individual human development – ontogenesis. The branch of anatomy that studies structural changes of an individual from fertilization to maturity Comparative The science that studies similarities and differences in the body anatomy structure of animals and humans, the body structure itself at different stages of evolution, that clarifies the historical development of human organism − phylogenesis General surgical instruments Surgical instruments used for all types of surgery Special surgical instruments Surgical instruments used only for certain surgical interventions on the organs 3.2. Theoretic questions 1. What is the order of instruments placement on the table of scrub nurse? 2. What types of scalpels do you know? What positions for holding a scalpel do you know? 3. What is a scalpel position while performing the skin incision? 4. How should the scissors be held in the hand while dissecting tissue? 5. What is the difference between Kocher’s and Billroth’s hemostatic forceps? 6. What is the difference between Hegar’s, Troianov, and Mathieu needle holders? 7. Is it correct position of the forceps in the hand when its end is directed to the palm? 8. What types of surgical needles do you know? 9. What are the requirements for suture material? 10. What is the classification for suture materials? What are their comparative characteristics? 3.3. Practical skills acquired in class 1. Arrange the instruments on the table of scrub nurse. 2. Perform the soft tissue cutting with a scalpel. 3. Apply hemostatic forceps on the blood vessels. 4. The content of the topic At the beginning of the lesson the teacher should acquaint students with educational facilities of department, equipment, main tasks of the department in teaching and research work. 5 Description of surgical instruments Starting with surgical instruments, the teacher explains that there are general and special instruments and surgical suturing devices, proceeds to description of each instrument specifying its application in surgical practice and the way of its application. General surgical instruments can be distributed into the following groups: for tissue separation (cutting instruments), for bleeding arrest (hemostatic instruments), auxiliary (fixing) instruments and instruments for tissue connecting. Instruments for tissue separation include scalpels (bellied, sharp-pointed, straight). When dissecting tissue surgeons often use scissors: straight or curved along the plane or edge. There are scissors for special purpose: ocular, vascular and others. Hemostatic instruments include clamps, which can have straight or curved working surface. Kocher’s clamps are widespread in surgical practice (with teeth on working surface), Mikulich’s
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