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Management of Specific Wounds
7 Management of Specific Wounds Bite Wounds 174 Hygroma 234 Burns 183 Snakebite 239 Inhalation Injuries 195 Brown Recluse Spider Bites 240 Chemical Burns 196 Porcupine Quills 240 Electrical Injuries 197 Lower Extremity Shearing Wounds 243 Radiation Injuries 201 Plate 10: Pipe Insulation Protective Frostbite 204 Device: Elbow 248 Projectile Injuries 205 Plate 11: Pipe Insulation to Protect Explosive Munitions: Ballistic, the Greater Trochanter 250 Blast, and Thermal Injuries 227 Plate 12: Vacuum Drain Impalement Injuries 227 Management of Elbow Pressure Ulcers 228 Hygromas 252 Atlas of Small Animal Wound Management and Reconstructive Surgery, Fourth Edition. Michael M. Pavletic. © 2018 John Wiley & Sons, Inc. Published 2018 by John Wiley & Sons, Inc. Companion website: www.wiley.com/go/pavletic/atlas 173 174 Atlas of Small Animal Wound Management and Reconstructive Surgery BITE WOUNDS to the skin. Wounds may be covered by a thick hair coat and go unrecognized. The skin and underlying Introduction issues can be lacerated, stretched, crushed, and avulsed. Circulatory compromise from the division of vessels and compromise to collateral vascular channels can result in Bite wounds are among the most serious injuries seen in massive tissue necrosis. It may take several days before small animal practice, and can account for 10–15% of all the severity of tissue loss becomes evident. All bites veterinary trauma cases. The canine teeth are designed are considered contaminated wounds: the presence of for tissue penetration, the incisors for grasping, and the bacteria in the face of vascular compromise can precipi- molars/premolars for shearing tissue. The curved canine tate massive infection. teeth of large dogs are capable of deep penetration, whereas the smaller, straighter canine teeth of domestic cats can penetrate directly into tissues, leaving a rela- tively small cutaneous hole. -
Absorbable Surgical Gut Suture
Food and Drug Administration, HHS § 878.4840 § 878.4800 Manual surgical instrument in subpart E of part 807 of this chapter, for general use. subject to the limitations in § 878.9. (a) Identification. A manual surgical [53 FR 23872, June 24, 1988, as amended at 61 instrument for general use is a non- FR 1123, Jan. 16, 1996; 66 FR 38803, July 25, powered, hand-held, or hand-manipu- 2001] lated device, either reusable or dispos- able, intended to be used in various § 878.4820 Surgical instrument motors general surgical procedures. The device and accessories/attachments. includes the applicator, clip applier, bi- (a) Identification. Surgical instrument opsy brush, manual dermabrasion motors and accessories are AC-pow- brush, scrub brush, cannula, ligature ered, battery-powered, or air-powered carrier, chisel, clamp, contractor, cu- devices intended for use during surgical rette, cutter, dissector, elevator, skin procedures to provide power to operate graft expander, file, forceps, gouge, in- various accessories or attachments to strument guide, needle guide, hammer, cut hard tissue or bone and soft tissue. hemostat, amputation hook, ligature Accessories or attachments may in- passing and knot-tying instrument, clude a bur, chisel (osteotome), knife, blood lancet, mallet, disposable dermabrasion brush, dermatome, drill or reusable aspiration and injection bit, hammerhead, pin driver, and saw needle, disposable or reusable suturing needle, osteotome, pliers, rasp, re- blade. tainer, retractor, saw, scalpel blade, (b) Classification. Class I (general con- scalpel handle, one-piece scalpel, snare, trols). The device is exempt from the spatula, stapler, disposable or reusable premarket notification procedures in stripper, stylet, suturing apparatus for subpart E of part 807 of this chapter the stomach and intestine, measuring subject to § 878.9. -
Reconstructive
RECONSTRUCTIVE Muscle versus Nonmuscle Flaps in the Reconstruction of Chronic Osteomyelitis Defects Christopher J. Salgado, Background: Surgical treatment of chronic osteomyelitis requires aggressive M.D. debridement followed by wound coverage and obliteration of dead space with Samir Mardini, M.D. vascularized tissue. Controversy remains as to the effectiveness of different tissue Amir A. Jamali, M.D. types in achieving these goals and in the eradication of disease. Juan Ortiz, M.D. Methods: Chronic osteomyelitis was induced in 26 goat tibias using Staphylo- Raoul Gonzales, D.V.M., coccus aureus as an infecting inoculum. In a single stage, debridement followed Ph.D. by reconstruction using either a muscle flap (n ϭ 13) or a fasciocutaneous flap Hung-Chi Chen, M.D. (n ϭ 13) was performed. Flap donor sites were closed primarily and antibiotics El Paso, Texas; Kaohsiung, Taiwan; were given for 5 days postoperatively. Daily clinical evaluation for 1 year was and Sacramento, Calif. performed and monthly radiographs were obtained for 9 months and 1 year after the reconstruction. Results: Twenty-five flaps survived completely, and one nonmuscle flap under- went partial flap loss following a period of venous congestion. There were no postoperative complications in the muscle flap group. Two goats (15 percent) in the nonmuscle group developed superficial wounds in the immediate post- operative period that resolved with conservative management. No limbs had recurrent osteomyelitis wounds at 1 year of clinical follow-up examination. Radiographic evidence of osteomyelitis was present in two goats (15 percent) in the muscle group and one goat (8 percent) in the nonmuscle group. -
(TECA) Surgery
Audit of Total Ear Canal Ablation-Lateral Bulla Osteotomy Procedures Performed by One Surgeon Audit project lead: D G Bentley Subject/area of practice: Surgery/Dermatology Date: January 2nd 2018 Reasons for Audit: To determine how complication rate of this procedure, both short and long term, compare with that in recently published literature and to be sure this procedure should be still be offered in-house rather than being referred to a surgical specialist. Background Total Ear Canal Ablation-Lateral Bulla Osteotomy (TECA-LBO) procedures on dogs (and cats) have been performed by this surgeon since 1991 and since that time over 260 procedures have been performed. The surgeon also runs a dermatology service with special interest in ear disease and wishes to provide a complete service whereby cases that are beyond medical treatment can go to surgery without being referred to a specialist surgeon. Indications for TECA-LBO are “end stage otitis”, where there is chronic irreversible change to the ear canal, intractable ear infections particularly as a result of middle ear infection and changes in the vicinity of the tympanic membrane/lower horizontal ear canal, and tumours in the ear canal which cannot be dealt with either by Lateral Wall Resection or Vertical Canal Ablation. Also sometimes, due to financial reasons, a client may prefer surgery to lengthy courses of treatment, requiring several anaesthetics and ear flushings, with no guarantee of success at the outset. The surgeon first learnt the technique that was published in video format in the “In Practice” series around 1991. This involved the use of an osteotome to separate the ear canal from the bulla and also looking for the facial nerve and pulling it out of the way using penrose drain material. -
Oral and Maxillofacial Surgery
ORAL AND MAXILLOFACIAL SURGERY 3rd EDITION 2/2012 US Chapter Pages 1 BASIC SETS OMFS-SET 1-36 TELESCOPES AND INSTRUMENTS FOR FRAKT 37-54 2 ENDOSCOPIC FRACTURE TREATMENT TELESCOPES AND INSTRUMENTS FOR TMJ 55-60 3 ARTHROSCOPY OF TEMPOROMANDIBULAR JOINT TELESCOPES AND INSTRUMENTS FOR DENT 61-80 4 MAXILLARY ENDOSCOPY TELESCOPES AND INSTRUMENTS DENT-K 81-120 5 FOR DENTAL SURGERY TELESCOPES AND INSTRUMENTS SIAL 121-134 6 FOR SIALENDOSCOPY 7 FLEXIBLE ENDOSCOPES FL-E 135-142 8 HOSPITAL SUPPLIES HS 143-240 9 INSTRUMENTS FOR RHINOLOGY AND RHINOPLASTY N 241-298 10 BIPOLAR AND UNIPOLAR COAGULATION COA 299-312 11 HEADMIRRORS – HEADLIGHTS OMFS-J 313-324 12 AUTOFLUORESCENCE AF-INTRO, AF 325-342 13 HOLDING SYSTEMS HT 343-356 VISUALIZATION SYSTEMS OMFS-MICRO, OMFS-VITOM 357-378 14 FOR MICROSURGERY OMFS-UNITS-INTRO, UNITS AND ACCESSORIES U 1-54 15 OMFS-UNITS COMPONENTS OMFS-SP SP 1-58 16 SPARE PARTS KARL STORZ OR1 NEO™, TELEPRESENCE 17 HYGIENE, ENDOPROTECT1 ORAL AND MAXILLOFACIAL SURGERY 3rd EDITION 2/2012 US Important information for U.S. customers Note: Certain devices and references made herein to specific indications of use may have not received clearance or ap- proval by the United States Food and Drug Administration. Practitioners in the United States should first consult with their local KARL STORZ representative in order to ascertain product availability and specific labeling claims. Federal (USA) law restricts certain devices referenced herein to sale, distribution, and use by, or on the order of a physician, dentist, veterinarian, or other practitioner licensed by the law of the State in which she/he practices to use or order the use of the device. -
228 April 2003 Category 1
Laparoscopica cantireflux Edward T Chory, MD Tracey A Ross, CST, MEd surgery astroesophageal Reflux The number of undiagnosed cases Disease (GERD) is a com- promises to be much higher based mon condition with a on the millions of heartburn suf- heavy economic impact. In ferers who take over-the- G a study published in the counter medications to treat May 2002 issue of Gastroenterol- their symptoms. GERD is also the ogy, researchers calculated that most expensive of the digestive GERD is one of the most preva- conditions with annual direct lent digestive diseases in America costs at $9.3 billion.1 with 19 million diagnosed cases.1 APRIL 2003 The Surgical Technologist 13 228 APRIL 2003 CATEGORY 1 Indirect costs, such as missed work and lower (painful swallowing), esophageal spasm, and productivity, would be almost impossible to more rarely GI bleeding (hematemesis or mele- measure accurately. However, companies and na). Tertiary symptoms are unrelated to the individuals are likely to feel the financial impact esophagus, such as reflux-induced asthma, in increased insurance premiums. For example, hoarseness and pharyngitis. Tertiary symptoms in 2002, the Wall Street Journal reported that the have increasingly been considered indications cost of proton pump inhibitors (PPIs) increased for antireflux surgery, and recent reports have General Motors’ health care budget for employ- documented excellent results, particularly for ees and retirees more than $55 million.2 reflux-induced asthma.11 With increasing experience in laparoscopic Traditionally, antireflux surgery was reserved antireflux surgery over the last 10 years, mor- for patients who did not respond to medical bidity has decreased, outcomes have improved therapy. -
CPT Code Description Charge Amount 83498 17-Alpha
CPT Code Description Charge Amount 83498 17-alpha-Hydroxyprogester 308.41 83497 5-HIAA, SO 125.99 83516 A MYELOPEROX (MPO) AB QL 74.1 86021 AB ID LEUKOCYTE AB/SO 610.25 86022 AB ID, PLATELET ABS;SRA U 1318 86720 AB LEPTOSPIRA/SO 166.12 86850 AB SCREEN (IDC) 207.83 86850 AB SCREEN RBC EA SRM TECH 195.25 86793 AB, YERSINIA/SO 149 74018 ABDOMEN 1 VIEW 348.75 74018 ABDOMEN 1 VIEW PORTABLE 321.36 74022 ABDOMEN ACUTE COMP WSGL V 398.36 74019 ABDOMEN COMPLETE 398.36 74018 ABDOMEN SGL ANTEROPOSTERI 475.8 49083 ABDOMINAL PARACENTESIS W/ 1216.89 86870 ABID,WNJ 294.85 ABLATOR APOLLORF XL90 ASP 877.8 86900 ABO BLOOD TYPE 370 86900 ABO,BBSO 176.5 73050 AC JOINTS W/WO WEIGHTS BI 297.94 ACCUGRID RADIOGRAPH BREAS 121.36 82164 ACE, CSF SO 144.38 83519 ACHR BIND AB QT,RIA/SO MA 258 83519 ACHR BIND QNT MGP/SO 181.37 83519 ACHR BLOC QNT MGP/SO 181.37 83519 ACHR GANGL NEUR AB,RIA/SO 258 83519 ACHR MOD QNT MGP/SO 201.16 87116 ACID FAST CULTURE SO 227.33 83519 ACR BLOCKING QNT SO 181.37 83519 ACR RECEPTOR QNT SO 108.61 82024 ACTH,SO 459.3 86602 ACTINOMYCES AB/SO 64 85347 ACTIVATED CLOTTING TIME 126.93 85307 Activated Protein C Resis 216.04 97535GO ACTIVITY DAILY LIVING 15 265.91 78278 ACUTE GI BLOOD LOSS IMAGI 1326.15 82017 ACYLCARNITINES; QUANT, EA 574 85397 ADAMSTS 13 ACTIVITY/SO 796.62 ADAPTER CATH LUER 8.69 ADAPTER CONFIDENCE CEMENT 743.66 ADAPTER DLP PERFUS Y W/6 47.54 ADAPTER FIBEROPTIC SWIVEL 73.16 ADAPTER LUER LOC SHORT 3/ 2.2 ADAPTER LUER TO COLDER 15.29 ADAPTER MALE-MALE 4.57 C1776 ADAPTER PFC SIGMA FEMORAL 8474.76 ADAPTER PLUG MALE CLAVE 5.02 ADAPTER PRODIGY EXTENSION 2340 ADAPTER UROSTOMY DRAIN TU 9.09 ADAPTER VERSO AIRWAY ADUL 33.51 82952 ADDL GLUCOSE > 3 SPEC 136.24 87260 ADENOV/ RSPFAC / SO 141.75 ADHESIVE DEMABOND .07 PEN 193.48 ADHESIVE DEMABOND .07 PEN 193.48 ADHESIVE DERMABOND PEN 0. -
Hospitals for War-Wounded
hospitals_war_cover_april2003 9.6.2005 13:47 Page 1 ICRC HOSPITALS FOR WAR-WOUNDED HOSPITALS FORHOSPITALS WAR-WOUNDED This book is intended for anyone who is faced A practical guide for setting up with the task of setting up or running a hospital and running a surgical hospital which admits war-wounded. It is a practical guide in an area of armed conflict based on the experience of four nurses who have managed independent hospitals set up by the International Committee of the Red Cross. It addresses specific problems associated with setting up a hospital in a difficult and potentially dangerous environment. It provides a framework for the administration of such a hospital. It also describes a system for managing the patients from admission to discharge and includes guidelines on how to manage an influx of wounded. These guidelines represent a realistic and achievable standard of care whatever the circumstances. A practical guide 0714/002 05/2005 1000 HOSPITALS FOR WAR-WOUNDED International Committee of the Red Cross 19 Avenue de la Paix 1202 Geneva, Switzerland T +41 22 734 6001 F +41 22 733 2057 E-mail: [email protected] www.icrc.org # ICRC, April 2005, revised and updated edition This book is dedicated to the memory of Jo´n Karlsson (died in Afghanistan, 22 April 1992) Fernanda Calado Hans Elkerbout Ingebjørg Foss Nancy Malloy Gunnhild Myklebust Sheryl Thayer (died in Chechnya, 17 December 1996) HOSPITALS FOR WAR-WOUNDED A practical guide for setting up and running a surgical hospital in an area of armed conflict Jenny Hayward-Karlsson Sue Jeffery Ann Kerr Holger Schmidt INTERNATIONAL COMMITTEE OF THE RED CROSS ISBN 2-88145-094-6 # International Committee of the Red Cross, Geneva, 1998 WEB address: http://www.icrc.org CONTENTS vii CONTENTS FOREWORD ............................................ -
Surgical Instruments Ă
SURGICAL INSTRUMENTS Claudia Gherman, ăCiocan, Ovidiu Fabian Learning objectives What you should know The main types of surgical instruments The main instruments used for cutting tissues The main instruments used for tissue manipulation The main instruments used for exposure (retractors) The main instruments used for suturing The functioning principle of electrocautery devices The main laparoscopic instruments What you should do Recognize the main surgical instruments Attach a scalpel blade to a handle/remove it from the handle Hand a scalpel to another person correctly Perform an incision Handle scissors (hold them correctly, cut under visual control, hand scissors to another person) Handle a self-retaining forceps (hold it correctly, grip the tissue, close and open the forceps, hand it to another person) Hold a retractor correctly Hold, close/open and hand over a needle holder correctly Recognize a suturing needle; recognize a sharp needle and an intestinal needle; find on the needle and suture package the main information about the needle Classification In order to perform surgery, the surgical team needs a number of surgical instruments. Each of the thousands of instruments used is designed for a specific function. They can be classified depending on use as follows: Cutting instruments Instruments for tissue grasping and manipulation Instruments for tissue exposure Suturing instruments Hybrid instruments Endoscopic instruments Cutting instruments Scalpels: consist of a handle and a blade; the handle is made of metal (reusable) or plastic (disposable); blades are disposable, of various shapes and sizes. The top of the scalpel handle has a special part, with a groove that allows its sliding into the blade slot and securing of the blade in position. -
Answer Key Chapter 1
Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 1 of 101 Answer Key Chapter 1 Introduction to Clinical Coding 1.1: Self-Assessment Exercise 1. The patient is seen as an outpatient for a bilateral mammogram. CPT Code: 77055-50 Note that the description for code 77055 is for a unilateral (one side) mammogram. 77056 is the correct code for a bilateral mammogram. Use of modifier -50 for bilateral is not appropriate when CPT code descriptions differentiate between unilateral and bilateral. 2. Physician performs a closed manipulation of a medial malleolus fracture—left ankle. CPT Code: 27766-LT The code represents an open treatment of the fracture, but the physician performed a closed manipulation. Correct code: 27762-LT 3. Surgeon performs a cystourethroscopy with dilation of a urethral stricture. CPT Code: 52341 The documentation states that it was a urethral stricture, but the CPT code identifies treatment of ureteral stricture. Correct code: 52281 4. The operative report states that the physician performed Strabismus surgery, requiring resection of the medial rectus muscle. CPT Code: 67314 The CPT code selection is for resection of one vertical muscle, but the medial rectus muscle is horizontal. Correct code: 67311 5. The chiropractor documents that he performed osteopathic manipulation on the neck and back (lumbar/thoracic). CPT Code: 98925 Note in the paragraph before code 98925, the body regions are identified. The neck would be the cervical region; the thoracic and lumbar regions are identified separately. Therefore, three body regions are identified. Correct code: 98926 Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 2 of 101 6. -
Images Paediatr Cardiol
RK Kumar and AC Nair. Coil Occlusion of the Large Patent Ductus Arteriosus. Images Paediatr Cardiol. 2008 Jan-Mar; 10(1): 8–26. in PAEDIATRIC CARDIOLOGY IMAGES Images Paediatr Cardiol. 2008 Jan-Mar; 10(1): 8–26. PMCID: PMC3232586 Coil Occlusion of the Large Patent Ductus Arteriosus RK Kumar and AC Nair Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India Contact information: R. K. Kumar, Amrita Institute of Medical Sciences and Research Centre, Elamakkara PO, Kochi 682026, Kerala, India Phone: 91- 484-280-4001599 Fax: 91-484-2802020 ; Email: [email protected] Copyright : © Images in Paediatric Cardiology This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract While coil occlusion is well accepted for the small patent ductus arteriosus (PDA), occlusive devices are preferred for the larger (> 3 mm) ducts by most institutions. Because of costs concerns, occlusive devices are not always realistic in many countries. The technique of simultaneous delivery of multiple coils with bioptome assistance works well for relatively larger ducts. This technique requires careful case selection through echocardiography. The duct anatomy plays a crucial part in determining the suitability for coil occlusion. Coil occlusion has a specific advantage for relatively larger ducts in selected small children and in preterm infants because it is possible to accomplish delivery of multiple coils through relatively small introducer sheaths. In addition, aortic narrowing is less likely because coils compact in the ampulla. -
Surgery Instrumnts Khaled Khalilia Group 7
Surgery Instrumnts khaled khalilia Group 7 Scalpel handle blade +blade scalpel blade disposable fixed blade knife (Péan - Hand-grip : This grip is best for initial incisions and larger cuts. - Pen-grip : used for more precise cuts with smaller blades. - Changing Blade with Hemostat Liston Charrière Saw AmputationAmputati knife on knife Gigli Saw . a flexible wire saw used by surgeons for bone cutting .A gigli saw is used mainly for amputation surgeries. is the removal of a body extremity by trauma, prolonged constriction, or surgery. Scissors: here are two types of scissors used in surgeries.( zirconia/ ceramic,/ nitinol /titanium) . Ring scissors look much like standard utility scissors with two finger loops. Spring scissors are small scissors used mostly in eye surgery or microsurgery . Bandage scissors: Bandage scissors are angled tip scissors. helps in cutting bandages without gouging the skin. To size bandages and dressings. To cut through medical gauze. To cut through bandages already in place. Tenotomy Scissors: used to perform delicate surgery. used to cut small tissues They can be straight or curved, and blunt or sharp, depending upon necessity. operations in ophthalmic surgery or in neurosurgery. 10 c”m Metzenbaum scissors: designed for cutting delicate tissue come in variable lengths and have a relatively long shank-to-blade ratio blades can be curved or straight. the most commonly used scissors for cutting tissue. Use: ental, obstetrical, gynecological, dermatological, ophthalmological. Metzenbaum scissors Bandage scissors Tenotomy scissors Surgical scissors Forceps: Without teeth With teeth Dissecting forceps (Anatomical) With teeth: for tougher(hart) tissue: Fascia,Skin Without teeth: (atraumatic): for delicate tissues (empfindlich): Bowel Vessels.