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Institute of Surgical Research A Module -
Surgical Technics
A1. MODULE Asepsis and antisepsis A2. MODULE
Surgical deontology A3. MODULE Surgical
interventions A4. MODULE Bleedings A4.
practical skin incisison, handling
surgical bleedings, wound closure
continuous suture, clips A5. MODULE - Wounds
A6. MODULE - Clinical aspects of shock
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Skin incision 1.

• - skin scalpel (20 blade, 4 handle),
• the surgeon and the assistant stretch the skin
  with sterile towels on both sides of the
  operative field.

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Skin incision 2.
Incision is - perpendicular to the skin, -
made with a single, definite cut. Direction of
the incision depends on the location of the organ
being operated - parallel to Langers lines
(better wound healing, less scar
formation), - toward oneself, from left to
right.
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Skin incision 3.
Depth must be the same in the whole length 1.
insert the tip of the scalpel perpendicularly
into the skin, 2. cut at 450 angle with the edge
(not with the tip!),3. finish the incision with
holding the scalpel perpendicularly. Discard
the scalpel into the container!
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Handling surgical bleeding 1.

• Methods
• oozing tamponade with dry or wet (warm saline)
  towels, Spongostan, Surgicel, etc.
• small vessels electrocoagulation
  (diathermy) thermal effect of high frequency
  alternating current

Must not be used to cut skin, only deeper
layers(burn injury)!
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Handling surgical bleeding 2.

• larger vessels ligature
• 1, soak up blood with sponge (assistant) 2,
  clamp with artery forceps (mosquito, Péan,
  etc. - surgeon)3, ligature with threads
  (depending on the size of vessel), - tie the
  first knot (half-hitch), - remove artery
  forceps, - tie the second knot.

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Handling surgical bleeding 3.

• diffuse, anatomical bleeding suture - with
  two stitches
• - 8 form
• preventive hemostasis - clamp with two artery
  forceps, - cut the vessel between them, -
  ligate both ends.

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Handling surgical bleeding 4. (video)
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Wound closure

• Suturing with continuous sutures
• Simple continuous suture
• Intracutaneous suture (Suture Tutor)
• Wound closure with Michel clips

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Wound closure 1. Simple continuous suture
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Wound closure 2. Simple continuous suture (video)
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Wound closure 3. Intracutaneous suture - by the
Suture Tutor program
CONTINUOUS WOUND CLOSURE Inserting the suture
(intracutan suture) Summary 1 the
subcuticular plane 2 video the 1st stitch 3
grasp the end of the thread with a forceps 4
video intracutan suturing Completing the
closure 1 video the last stitch 2 video to
close the wound pull the ends of the suture 3
video secure the suture ends.
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Wound closure 4. Michel clips
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Practical tasks

• In the teaching lab
• Half group
• 1. Practical test
• Interrupted (simple or Donati) sutures 2-3
  sutures
• Simple continuous suture with atraumatic thread
  and instrument tie.
• Intracutaneous suture by the Suture Tutor
  computer program (survey).

In the operating room Other half 1. Gloving
alone. 2. Skin incision (team work - surgeon,
assistant, scrub nurse) on tissue. 3. Handling
bleeding with ligatures. 4. Wound closure with
simple continuous suture. 5. Wound closure with
Michel clips.
35 min
35 min
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REPEAT gloving alone
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• Have a good practice!