Explain the Clinical Significance of the Basic Principles of Surgery

Chapter 19 Principles of Surgery

Explain the clinical significance of the basic principles of surgery.

Surgery - The branch of medicine concerned with treatment of injuries or disorders of the body by incision or manipulation, esp. with instruments.

Such treatment, as performed by a surgeon.

Elective surgery - procedure that is planned and generally routine (spay, neuter) Non-elective surgery - procedure that is unplanned and is required for saving the animals life (hit by car, tumor removal for malignant cancer)

• surgery disrupts the barrier to invading pathogens (mucous membranes and skin) • special care must be taken to minimize the patient exposure to bacteria

Aseptic technique - general practices used to minimize the risk of infection that may occur following surgery • patient (surgical site) • surgical team • surgical equipment • operating room

Disinfectants - harsh chemicals that kill the majority of pathogens present on an object • used on inanimate objects only • are not 100% effective in killing pathogens

Sterilization - procedure in which all microorganisms are destroyed on an object • 100% effective • steam, chemicals, and radiation • Autoclave - provides high pressure steam heat to sterilize instruments

Surgical Instruments SCISSORS = used to cut tissue, blood vessels or organs. 1. Mayo Scissors- dense tissue 2. Metzenbaum Scissors- delicate tissue 3. Littauer Suture Removal Scissors - cuts/removes sutures 4. Lister Bandage Scissors - remove bandage material without cutting patient

FORCEPS = grasp tissue, blood vessels or organs Thumb Forceps - pencil grip forceps (tweezers) 1. Rat Tooth Forceps - grasps skin; large teeth 2. Adson Tissue Forceps - grasps tissue with minimal damage 3. Brown Adson Tissue Forceps - fine intermeshing teeth 4. Dressing Forceps - grasps dressing materials

Self Retaining Forceps - ratchet locking device 1. Allis Tissue Forceps - tough dense tissue 2. Babcock Intestinal Forceps - smooth intestinal tissue 3. Backhous Towel Clamps - secures drapes to skin

Hemostatic Forceps - ligates vessels and tissues 1. Halsted Mosquito Forceps - capillary bleeding 2. Kelly Forceps - arteries & veins 3. Crile Forceps - arteries & veins 4. Rochester Pean Forceps - large tissue bundles 5. Rochester Carmalt Forceps - large tissue bundles

Needle Holders - holds curved needles without damage 1. Mayo Hegar Needle Holder - needle holder only 2. Olsen Hegar Needle Holder - needle holder with scissors

MISCELLANEOUS 1. Scalpel blade - surgical steel to cut through tissue, blood vessels, organs, and cartilage 2. Scalpel handle - reusable handle to secure blades in place 3. Snook Ovariohysterectomy Hook - used to retrieve uterine horn when performing spay surgery 4. Groove Director - protects underlying tissues when making surgical incisions 5. Retractors - hold tissue and expose surgical area

LACERATION HEALING Explain the clinical significance of healing of lacerations by first and second intention.

Phases of Wound Healing 1. Inflammatory: BEGINS IMMEDIATELY HEMORRHAGE FILLS WOUND/CLEANS SURFACE BLOOD VESSELS DILATE AND LEAK FLUID WITH CLOTTING ELEMENTS CLOT DRIES, FORMS SCAB, ALLOWS HEALING UNDERNEATH SCAB PROTECTS/PREVENTS FURTHER HEMORRHAGE WBC’S LEAKED INTO WOUND

2. Debridement: 6 HOURS POST INJURY WBC’S REMOVE NECROTIC TISSUE, BACTERIA, FOREIGN MATTER NEUTROPHIL IS DOMINANT CIRCULATING WBC IN CANINE/FELINE/HUMAN NEUTROPHILS PRIMARILY MAKE UP PUS 3. Repair: 3-5 DAYS POST INJURY FIBROBLASTS ENTER & PRODUCE COLLAGEN WOUND STRENGTH INCREASES SIGNIFICANTLY GRANULATION TISSUE FORMS (HEALING TISSUE) EPITHELIALIZATION TAKES PLACE 24-48HRS AFTER SX; 4-5 DAYS AFTER ACCIDENTAL FRAGILE AT FIRST BUT THICKENS

4. Maturation: WEEKS TO YEARS WOUND STRENGTH MAXIMUM SCAR PALES WITH DECREASE OF CAPILLARIES PALING CONTINUES OVER YEARS WOUND NEVER AS STRONG

First Intention Healing • wound with edges closely apposed • well closed incision • epithelial cells can cross defect in 1-2 days • healing is rapid and successful

Second Intention Healing • granulation tissue must fill gap between skin edges • larger wounds where too much tension to allow skin edges to appose

POTENTIAL PROBLEMS Debridement - process in which damaged and contaminated tissue must be removed. Dead space - potential space that is present because of separation between tissues.

Hematoma - accumulation of blood within dead space. Abscess - accumulation of bacteria, white blood cells, and dead tissue within dead space.

Dehiscence - breaking of wound edges; too much tension, infection, licking or scratching