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A1. MODUL – Asepsis and Antisepsis A2. MODUL – Surgical Deontology A3. MODUL – Surgical interventions A4. MODUL - Bleedings A5. MODUL – Wounds sterile bandage replacement, suture removal, open wound management, bandaging. A6. MODUL - Shock Institute of Surgical Research „A” Module - Surgical Technics

A1. MODUL – Asepsis and Antisepsis A2. MODUL – Surgical Deontology A3. MODUL – Surgical interventions A4. MODUL - Bleedings A5. MODUL – Wounds sterile

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A1. MODUL – Asepsis and Antisepsis A2. MODUL – Surgical DeontologyA3. MODUL – Surgical interventions A4. MODUL - Bleedings A5. MODUL – Wounds

sterile bandage replacement,suture removal,open wound management,bandaging.

A6. MODUL - Shock

Institute of Surgical Research

„A” Module - Surgical Technics

Classification based on:1. morphology / origin, 4. depth,2. infection 5. factors affect wound healing,3. time elapsing from the trauma, 6. wound closure.

About wounds - revision

Ad 1a. morphologyPuncture/Stab w.Incised wound,Cut wound,Bruised/crush w.Bite woundLacerated wound Shot wound

Ad 2. IntectionCleanSpoiledDirty

Ad 3. Injury TimeAcuteChronic

Ad 4. Depth•Superficial•Partial-thickness•Full-thickness•Deep wounds

Ad 5. Factors affect wound healingPer primamPer secundamPer tertiam

Ad 6. Wound closure•Temporary management•Surgical closure

Basic principles: Accidental (non surgical) wounds should be considered infected,therefore we should remove:

- the causative agents - the devitalized tissues

Accidental wound should be transformed to surgical one.

Phases Management

Inspection Under sterile circumstances (hat, mask, gloves)

Anamnesis Elucidation of the circumstances of injury Tetanus Rabies

Diagnostic procedures

Exclusion of accompanying injury• Examinations of the circulatory, sensory and motoric functions• Exclusion of bone fractures (X-ray)

Wound management

The accidental wound care should be based on the depth of injury and the danger of infection with primary- or delayed wound closure (see next table).

About wounds - in general

Types of wound closure

Definite primary wound management (within 12 hrs)

Immediate wound closureAlways perform primary wound closure: penetrating injury of the abdomen chest dura mater

- Primary delayed suture (3-8 days)- Early secondary wound closure (> 14 days )- Late secondary wound closure (4 - 6 weeks )

When primary wound closure is contradicted: infectious signs severely spoiled foreign body pouched, greatly bruised wounds special injury forms of some professions (e.g. surgeons, butcher, veterinarian, pathologist, bacteriologist) bite, shot, deep incised wound hostility wound

Local anesthesiaExcisionPrimary sutureDrain

Primary wound closure - debridement

Ad 1a. morphologyPuncture/Stab w.Incised wound,Cut wound,Bruised/crush w.Bite woundLacerated wound Shot wound

Ad 2. IntectionCleanSpoiledDirty

Ad 3. Injury TimeAcuteChronic

Ad 4. Depth•Superficial•Partial-thickness•Full-thickness•Deep wounds

Ad 5. Factors affect wound healingPer primamPer secundamPer tertiam

Ad 6. Wound closure• primary wound closure• primary delayed wound suture• early secondary wound closure • late secondary wound closure

Ad 1a. morphologyPuncture/Stab w.Incised wound,Cut wound,Bruised/crush w.Bite woundLacerated wound Shot wound

Ad 2. IntectionCleanSpoiledDirty

Ad 3. Injury TimeAcuteChronic

Ad 4. Depth•Superficial•Partial-thickness•Full-thickness•Deep wounds

Ad 5. Factors affect wound healingPer primamPer secundamPer tertiam

Ad 6. Wound closure• primary wound closure• primary delayed wound suture• early secondary wound closure • late secondary wound closure

Ad 1a. morphologyPuncture/Stab w.Incised wound,Cut wound,Bruised/crush w.Bite woundLacerated wound Shot wound

Ad 2. IntectionCleanSpoiledDirty

Ad 3. Injury TimeAcuteChronic

Ad 4. Depth•Superficial•Partial-thickness•Full-thickness•Deep wounds

Ad 5. Factors affect wound healingPer primamPer secundamPer tertiam

Ad 6. Wound closure• primary wound closure• primary delayed wound suture• early secondary wound closure • late secondary wound closure

Depending on the function:- adherent/taped bandages: (to fix covering bandages or for the approximation of edges of small wounds)

- covering bandages: (to protect the wound and absorb secretion. Prevention from secondary infection and mechanical trauma)

- pressing bandages: (for temporary handling of capillary and venous bleedings under 40-60 mmHg.)

- wedging bandage (used for temporary handling of capillary arterial and venous bleedings until surgical management. Should be relieved in every 2 hrs)

- compressing bandages: (to prevent postoperative bleeding on the limbs, and for the prophylaxis of thrombosis and for the reduction of chronic lymph-edema. Always placed from distal to proximal

- fixing/retention bandage (to immobilize the injured body part or to fix the reposition).

TYPES OF BANDAGES

1. Layer in direct contact with the wound (sterile, hypoallergenic, not irritating, non-sticking)- simple sheet (e.g. Mull sheet: good fluid absorbent, but easily sticks to the wound)- impregnated sheet (vazeline, paraffin: ie. “Jelonet”, non-sticking) (with saline which melts when gets into contact with body fluids i.e. Mesalt.)

2. Absorbent layer (to absorb and store blood and excretions)3. Fixing layer to secure the bandage (adherent tapes i.e. Centerplast,

Leukoplast or Mefix, Mepore; the latter two for bigger surfaces).

Layers of bandages

Special compression bandage: ear bandage

Special retention bandage: rucksack bandage

Special retention bandages:

Desault-bandage Charnley-loop

TASKS

OPERATING THEATRE

1. Sterile bandage removalfrom surgical woundRemoval of sutures

2. Sterile bandage removal open wound management

COMPUTER ROOM

1. Steam bandage

2. Compression bandage: ear bandage

3. Retention bandages

1. Surgical wounds – sterile bandage replacement, removal of sutures

NON-STERILEASSISTANT1. Removal of the former bandage

(pouring fluid on the sponge)

6. Fixing

STERILE EQUIPMENTSURGEON

2. Sterile gloving 3. Desinfection (Betadine solution)4. Removal of sutures5. Sterile covering (sterile gauze)

2. Spoiled wounds – open wound management

STERILE EQUIPMENTSURGEON

2. Sterile gloving 3. Wound cleansing (H2O2)4. Rinsing with saline 5. Desinfection (Betadine solution)6. Sterile covering (sterile gauze)

NON-STERILEASSISTANT1. Removal of the former bandage

(pouring fluid on the wound)(pouring fluid on the wound)(pouring fluid on the sponge)

7. Cover, fixing

OPERATING THEATRE: WOUND MANAGEMENT

3. Special compression bandage: ear bandage

4. Retention bandage: wrist and elbow

Layers:- Ointment: (Burow-ointment, aids demarcation of the necrotic area), - Steril gauze sheet: - Plastic layer: (for isolation of heat and steam)- Fixing layer

2. Steam bandage

COMPUTER ROOM: BANDAGING

1. Covering bandages

4. Special retention bandage: Desault-bandage