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El Arte Y La Ciencia De Los Nudos Quirúrgicos

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El Arte Y La Ciencia De Los Nudos Quirúrgicos El arte y la ciencia de los nudos quirúrgicos Elsa Ossiris Gil Narváez Universidad Nacional de Colombia Facultad de Medicina Departamento de Cirugía Unidad de Cirugía Pediátrica Bogotá, Colombia 2018 El arte y la ciencia de los nudos quirúrgicos Elsa Ossiris Gil Narváez Trabajo de grado presentado como requisito parcial para optar al título de: Especialista en Cirugía Pediátrica Director (a): Doctor Fernando Fierro Ávila Universidad Nacional de Colombia Facultad de Medicina, Departamento de cirugía Unidad de cirugía pediátrica Bogotá, Colombia 2018 A mi familia, amigos y docentes que hicieron parte de este sueño A mi esposo por su apoyo y ayuda incondicional durante todo este proceso. A mi mamá y mis tías por su amor y comprensión siempre animándome. “Los nudos son más numerosos que las estrellas e igualmente de misteriosos y bellos” John Turner (1988). Agradecimientos Un agradecimiento al Dr. Fernando Fierro Ávila por su enseñanza de nudos quirúrgicos en mi formación, y por su colaboración y el aporte en la realización de este proyecto de tabla de nudos. A Jorge Alejandro Martínez y Sonia Andrea Martínez, por la ayuda, el tiempo y edición del trabajo. A Mauricio Escrucería, por el tiempo y las fotografías de este trabajo. Resumen y Abstract IX Resumen En la educación en especialidades quirúrgicas, uno de los conocimientos y habilidades básicas que debe adquirir el personal en formación, es acerca de los nudos quirúrgicos, ya que el éxito de la mayoría de las cirugías dependerá de unos nudos quirúrgicos seguros. Este trabajo es un material pedagógico que contiene revisión de literatura de historia, conceptos básicos, seguridad en nudos y la metodología implementada para la enseñanza de la ejecución de nudos, así como instrucciones paso a paso con fotografías de la realización de 19 tipos de nudos, que se usan de cirugía tanto abierta como laparoscópica. Palabras clave: (Nudos, cirugía, seguridad, educación). X El arte y la ciencia de los nudos quirúrgicos Abstract In the education of surgical specialties, one of the basic knowledge and skills that trainees should acquire is about surgical knots, since the success of most surgeries will depend on safe surgical knots. This work is a pedagogical material that contains review of history literature, basic concepts, security in knots and the methodology implemented for teaching the execution of knots, as well as step-by-step instructions with photographs of the realization of 19 types of knots, which are used in both open and laparoscopic surgery. Keywords: (Knots, Surgery, Knot Safety, Education) Contenido XI Contenido Pág. Resumen .............................................................................................................. IX Abstract ................................................................................................................. X Lista de figuras ................................................................................................. XIV Lista de tablas ................................................................................................ XVIII Justificación ......................................................................................................... 1 Objetivo Principal ................................................................................................. 3 Objetivos Específicos .......................................................................................... 5 Metodología .......................................................................................................... 7 Introducción.......................................................................................................... 9 1. Historia ......................................................................................................... 11 2. Conceptos básicos ...................................................................................... 22 2.1 Unión de las cuerdas............................................................................... 22 2.1.1 Amarre (hitch): ..................................................................................... 22 2.1.2 Liga, unión (Bend): ............................................................................... 22 2.1.3 Nudo (Knot): ......................................................................................... 23 • De empalme o ayustes ........................................................................ 23 • Nudos de acortamiento ........................................................................ 23 • Nudos deslizantes o corredizo ............................................................. 23 • Binding (Nudos de enlace) ................................................................... 24 2.2 Propiedades de los nudos ....................................................................... 24 2.2.1 Resistencia: ......................................................................................... 24 2.2.2 Seguridad:............................................................................................ 24 2.2.3 Azocamiento: ....................................................................................... 24 2.3 Fuerzas en los nudos22 ........................................................................... 24 2.3.1 Fuerza de resistencia: .......................................................................... 24 2.3.2 Fuerza de Potencia: ............................................................................. 25 2.3.3 Fuerza de fricción, de rozamiento o de deslizamiento: ........................ 25 XII El arte y la ciencia de los nudos quirúrgicos 2.3.4 Coeficiente de fricción: ......................................................................... 25 2.4 Partes de la cuerda ................................................................................. 26 2.4.1 Extremo pasivo, poste ó firme:............................................................. 26 2.4.2 Extremo activo, chicote ó asa: ............................................................. 26 2.4.3 Seno o gaza (Bright): ........................................................................... 26 2.4.4 Bucle o asa: ......................................................................................... 26 2.4.5 Codo .................................................................................................... 27 2.4.6 Vueltas ................................................................................................. 27 2.5 Conceptos adicionales de los nudos ....................................................... 27 2.5.1 Dogging: .............................................................................................. 27 2.5.2 Punto de contacto: ............................................................................... 27 2.5.3 Bloqueo (Locking tuck): ....................................................................... 27 2.5.4 Lazada por encima (Overhand loop): ................................................... 27 2.5.5 Lazada por debajo (Underhand loop): ................................................. 28 3. Suturas o Material ........................................................................................ 29 3.1 Clasificación de las suturas ..................................................................... 29 3.1.1 Según su absorción: ............................................................................ 29 3.1.2 Según su conformación: ...................................................................... 29 3.1.3 Según su composición 23–26 ................................................................. 30 3.2 PROPIEDADES DE LAS SUTURAS ...................................................... 30 3.2.1 Fuerza tensil: ....................................................................................... 31 3.2.2 Capilaridad: .......................................................................................... 31 3.2.3 Memoria: .............................................................................................. 31 3.2.4 Elasticidad: .......................................................................................... 31 3.2.5 Flexibilidad: .......................................................................................... 31 3.2.6 Reacción tisular: .................................................................................. 31 3.2.7 Coeficiente de fricción: ......................................................................... 32 4. Herramientas ................................................................................................ 33 4.1 Agujas ..................................................................................................... 33 4.1.1 Clasificación de las agujas ................................................................... 33 4.1.2 Propiedades de las agujas5,27 .............................................................. 34 4.2 Porta – Agujas o Pinzas27: ...................................................................... 35 5. Seguridad ..................................................................................................... 37 5.1 Configuración de los nudos: .................................................................... 37 5.2 Número de vueltas .................................................................................. 39 5.3 Tipo de sutura: ........................................................................................ 42 5.4 Técnica de anudado ...............................................................................
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