Principles of Surgery

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Principles of Surgery
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Unit Map Follow Along in your packet

• WHAT ARE YOU LEARNING?
• Explain basic principles of surgery, laceration
  healing, and surgery considerations

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Know Understand Do!

• Know
• Basic Principles of Surgery
• Laceration types etc
• Surgical Considerations

• Understand
• Surgery principle significance
• Laceration healing
• How to determine considerations

• Do
• Outline surgery basics
• Explain healing
• Compare/Contrast Considerations

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Key Learning Surgical Considerations

• Unit EQ Why is surgery important in vet
  practices?

Concept Surgical Principles Lesson EQ What is
one basic principle of surgery? Vocab Sterilizatio
n, Autoclave, Disinfectants
Concept Laceration Healing Lesson EQ How
does a wound heal? Vocab First Intention Healing,
golden period, hemtoma
Concept Surgical Considerations Lesson EQ How
are considerations determined? Vocab GDV,
Necrotic,
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Surgical Principles

• Reminders
• Skin and mucous membranes provide barrier to
  outside world
• THEREFORE
• Surgery disturbs this barrier and allows for
  bacterial entry

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Basic Principle most important?

• Prevention of Bacterial Entry through barrier
• Environment has bacteria everywhere!
• Aseptic Technique
• General practices used to minimize the risk of
  infection
• Must be comprehensive!
• Includes
• Management of facility, patient, surgical site,
  surgeon and equipment

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Aseptic Continued

• Disinfectants
• Used to clean facility, used on inanimate objects
• Normally too harsh for direct skin contact

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Aseptic Continued

• Sterilization
• Tools are potential bacteria carriers
• Instruments are cleaned of debris (tissue etc)
• Kills all micro-organisms
• Uses pressure and steam
• Autoclave tools packed in steaming wrap, 15 to
  30mins at 275 degrees

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Aseptic in the Classroom and Lab

• Common Procedures
• Outline
• Categorize
• Explain how they work
• What safety considerations are outlined? Are they
  visible to the naked eye? Where is the safety
  information located?
• How to read an MSDS Activity

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Principles of Surgery

• Common Tools

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Common Tools and Purpose

• Scalpel
• Needle Holder
• Scissors
• Tissue forceps
• Hemostatic Foreceps
• Retractors
• Towel Foreceps/Clamps
• Spay Hook

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Scalpel

• Provides clean incision
• Typical designed for single use
• Disposal , removal off handle
• Varying Sizes and Shapes

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Needle Holder

• Holds needle for suturing
• Teeth provide strong grip
• Insert replaced as teeth wear out

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Scissors

• Various Shapes and Sizes (depends on surgery)
• Curved more maneuverable
• Straight cut through tough tissue
• Normally in packs
• Metzenbaum delicate tissue
• Mayo tough tissue

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Tissue Forceps

• Appear like tweezers
• Tip will vary depending on use
• Serrated delicate tissue holding
• Heavy teeth secure grip
• Ratchet locking grip secure hold (prolonged
  grip) Not used for delicate tissue

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Hemostatic Forceps

• Hemostats
• Have a ratchet lock
• Used to clamp blood vessels (HEMO)
• Once clamped, vessel can be ligated (tied off)

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Retractors

• Hold tissues to expose surgical area so the
  surgeon has a better view
• Self retaining or held by assistant

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Towel Forceps/Clamps

• Surgical drapes cover animal during surgery
• Only area open is surgical site
• Clamps keep towel in place during surgery and
  help prevent contamination

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Spay Hook

• Used to bring uterus through tiny incinsion

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Surgeon Prep

• Covered in bacteria naturally
• To prevent spread
• Gloves, mask, head cover, gown
• Wash hands (up to elbows) with antiseptic soap
  and scrub brush
• Scrub should last 5 minutes to properly clean
• Hold cleanest part highest (hands in the air)

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Animal Prep

• Area cleared of general debris
• Normally shaved or clipped clean
• Loose hair is vacuumed off
• Scrubbed with antiseptic soap , sometimes iodine
• Central region scrubbed first then work outward
  in a circular motion

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Types of surgery (General Terms)

• Clean
• Healthy skin is entered, healthy tissue is
  removed
• Examples
• Spay/Neuter

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Outline a typical Surgery

• Choose a typical surgery
• Spay
• Neuter
• Biopsy
• Intestinal Obstruction
• Other (explain)
• Outline prep procedure, tools typical used and
  procedure itself including suture
• Draw tools used
• JUST OUTLINE not complete sentences.

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Principles of Surgery

• Laceration Healing

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Essential Question

• How does a wound heal?

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Wound healing basics

• Understanding healing is essential to surgery and
  trauma treatment

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Wound healing Process

• Hemostasis Phase Bleeding
• Begins directly after trauma or surgery breach
• Bleeding helps to flush the wound
• Instantly the vessels constrict, blood flow slows
• Blood starts to clot
• Protects from excessive blood loss
• Clot dries scab
• Scab allows for protection and for healing
  underneth

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Wound healing process

• Inflammation Phase
• Blood vessels dilate
• Bring more white blood cells to the area
• White blood cells help destroy damaged tissue and
  bacteria
• Dilated vessels increase heat into the region and
  produce red area
• Damaged tissue releases plasma and adds to the
  swelling area
• Signs of inflammation phase
• Swelling, heat, redness, pain

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Wound healing Process

• Repair/ Proliferation Phase
• Begins simultaneously with inflammation process
• Connective tissue enter the damaged area and
  begin to form new fibrous connective tissue
• Proliferation of cells in the new connective
  fibers and matrix
• Capillaries begin to grow within the area
• Produces a granular appearance on the skin
• Tissue at this stage is called granulated tissue

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Importance of Granulated Tissue

• This tissue fills the gap between the wound edges
  and sets barrier from infection
• (Reminder)Rich supply of capillaries increases
  amount of white blood cells
• As the G tissue forms E tissue form across the
  edges
• Cells continue to layer and thicken

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Wound healing process

• Remodeling Phase
• Gap is closed (Second Intention Healing)
• Occurs within several weeks of wound, but can
  last for years! (scar tissue)
• Connective tissue w/in the wound becomes more
  organized and shrinks (scars shrink)
• Strength of wound increases over time

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Problems in Wound healing

• Proud Flesh
• Common in lower leg wounds in horses
• Over growth of granulated tissue prevents
  epithelial tissue from covering the wound

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Activity

• Illustrate the wound healing process
• Graphic organizer Cause Effect Chain

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Minimizing healing time

• Aseptic Techniques decrease bacteria
• Gentle handling during surgery- decreases
  inflammation response
• Appropriate incisions- less disruption of blood
  supply faster healing

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Bleeding in wounds and during healing

• Dead space important to consider
• Present because of tissue separation
• Tumor removal leaves a pocket
• Types of Accumulation
• Hematoma accumulation of blood in the dead open
  space
• Seroma- more puss like
• Abscess- contains bacteria, white blood cells,
  dead tissues
• Fluid build up increases tension _at_ wound site

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Reducing tension from Fluid

• Two main methods
• Decrease size of pocket during surgery
• Sew together tissues manually
• Latex tubing
• Penrose drain (passive)
• Active Drain

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Suture Activity

• Outline the steps for suturing a wound.
• What are the TYPES of sutures
• What do they look like?
• How are they sewn? (only do a general outline for
  sewing a wound closed)
• What are important items to consider when
  suturing a trauma or surgical wound?

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Principles of Surgery

• Surgical Considerations

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Basic Concepts

• More than one method to a surgery
• Possible Differences
• Approach
• Order of Steps
• Tech methods / Tools etc

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Take A Common Surgery Spay

• Aka Ovariohysterectomy
• Steps
• Animal anesthetized and secured to table
• Scrubbed
• Start surgery

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Spay

• Most common
• Ventral Midline incision
• Middle of the stomach
• Why the midline?
• Abdominal muscles naturally have a gap (Linea
  Alba)
• Little bleeding , easy access to organs
• Locate Uterus (near the spine)
• Deep in cavity
• Use spay hook to contact and begin uterine horn
  removal

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Spay Continued

• Control blood flow
• All arteries are ligated by the three-clamp
  method
• Vessels are sutured
• Clamps releases
• Check for leaking
• Ligaments cut
• Ligaments located
• Ligaments holding the uterus are ligated
• Uterus is free

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Spaying Wrap up

• Organ removal
• Ovaries, uterine horns, uterine body all removed
• Cavity Check
• No bleeding in dead space
• Suture
• Sub Q tissue tightened to close dead space
• Absorbable using a tapered point needle
• Close Linea Alba
• Close epithelial label with NON absorbable suture
  (stitches removed later)

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Exploratory Horse

• Same incision Ventral Midline
• Possible findings?
• Looped intestine
• Blood supply cut off from segment
• Intestine become necrotic (dead)
• Reposition If severe, section must be removed
  attaching only healthy portions together (
  intestinal anastomosis)

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Intestinal/ Gastric torsion in dogs

• AKA gastric dilation- volvulus syndrome (GDV)
• Occurs in deep chested breeds ( Boxer)
• Circulation to the stomach is disrupted
• Vomiting common symptom (food cannot move
  forward, build up of gases)
• Diagnosis through radiographs / Xrays
• Treatment
• IV fluids to reduce shock
• Tube down esophagus to relieve gas pressure
• If stomach is twisted surgery is needed

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Example 3 Bladder stones

• Ventral midline incision along linea alba
• Bladder brought the surface through incision
• Gauze surrounding surgical area to prevent urine
  entering abdomen
• Incision of bladder
• Stones removed
• Continuous mattress suture
• Suture abdomen

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Activity Reading

• Surgical Considerations
• What procedures are cited? Outline their process
• What are common complications that occur after
  surgeries?
• What is the common approach used? (Common
  incision used). What is the location and why is
  this location used?
• What characteristic of tumors makes for difficult
  removal? How do vets combat this problem?
• What are the challenges present when working in
  the chest cavity? How do vets combat these
  problems?
• What is orthopedic surgery? What are common ways
  to perform repairs during orthopedic surgery?
• Summarizing In 10 sentences or less summarize
  surgery in veterinary practice. What might make
  is more difficult in animals than human surgery?
  What are basic principles? How does one generally
  perform surgery based off these principles? How
  does one perform a surgery correctly?

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Test Review

• Define Aseptic, Disinfectant, Sterilization,
  Proud Flesh, First Intention Healing, Second
  Intention Healing, Penrose Drain, Suture, GVD,
  Ovariohysterectomy
• What is the 1st and more important principle of
  surgery?
• What is the most common aseptic technique? (We
  use it in class, and before surgery) How long
  should this technique be performed?
• List the common tools and what they are used for
• How is the surgeon prepped ?
• How is the animal prepped? Explain how they are
  washed and why it is done in this manner
• What are the phases of wound healing?
• What ways can wound healing time be minimized?
• What is a common problem in wound healing in
  horses?
• What are the two kinds of drains and how does
  each drain work?
• What are the types of sutures (draw them)
• What are the steps in spaying an animal