basic surgical instruments professor magdy amin riad professor of otolaryngology. ain shames...
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Basic Surgical Instruments
Professor Magdy Amin RIAD
Professor of Otolaryngology. Ain shames University
Senior Lecturer in OtolaryngologyUniversity of Dundee
Principles of instruments handling
• Safety (patient and staff)
• Economy of movements
• Relaxed handling.
• Avoidance of awkward movements.
The Scalpel‘Table knife holding’
• For routine skin incisions.
• Tissue division with minimum trauma.
• Index finger guiding the blade
• Drawing the whole length of blade.
• Blade 15 is the workhorse of sharp dissection
• Do not use blunt blades
The Scalpel‘Pen holding’
• For finer work. • Blade 10 is used for finer
dissection.• Steady the arm by using
the little finger as a fulcrum.
• Pass scalpels in a kidney dish.
• Never pass it point-first across the table.
• Change blades by using a haemostat .
Sharp dissection
• Scalpels divide tissue with minimum damage.
• Tissues must be stretched to produce least trauma
• Tension must be applied at right angles to the direction of cutting
Sharp dissection with Scissors
• Although less sharp; When properly utilised , the tissue trauma is comparable to scalpel dissection.
• One blade tip is hidden from view.• Can be used for sharp and blunt
dissection.
Sharp dissection with diathermy
• Simultaneous partial tissue coagulation and haemostasis.
• Particularly useful in cutting muscles.
• Collateral tissue damage is a disadvantage.
Blunt dissection
• Splitting connective tissue close to important structures.
• Scissors, artery forceps or dissecting forceps.
• Tearing.
• wiping
Scissors
• 2 basic types of scissors; one for soft tissue and another for firmer tissues (bone, cartilage ,sutures..)
• Never use scissors that are too fine for the job.
• Blunt tip.• Edge-contact cutting.
Scissors
• Hold midway between pronation and supination.
• Distal phalanges only within the rings.
• Index finger over the joint to steady scissors.
• Steady scissors further by placing it over fingers of the other hand.
Dissecting forceps (thumb) forceps
• 2 main types:• Toothed for holding tougher
tissue with increasing force through the list; ducts, vessels, skin, fascia, cartilage and bone .
• Non-toothed for delicate tissues such as encapsulated solid organs; nodes, .
• Never crush tissues , hold structures with teeth punctures, rather than by compression between blades.
Dissecting forceps (thumb) forceps
• Ideal for a temporary and changing grip during dissection.
• Used to display structures during dissection.
• Can be used to tense loose structures before cutting.
• Used as a gentle retractor.• Round-nosed ,non-toothed
forceps make an excellent dissector.
• Learn to ‘palm’forceps while tying knots
Haemostats (Artery forceps)
• Hold in a similar manner to scissors.
• Dissectors for opening up tissue plans and tracks.
• May be used as tissue forceps, needle holders, knot-holding forceps, foreign body extractors, sinus forceps, and stitch removing forceps.
Haemostats (Artery forceps)
• Learn to release the haemostat using either hand.
• For small vessels lock with one click of the ratchet.
• For a major vessel tighten the grip further, over-tightening will cause forceps to spring.
• With minimal jerking and without springing.
Haemostats (Artery forceps)
• Pick vessels by the tip only, the grip lessens towards the joint.
Needle holder
• Grasp in a similar manner to scissors.
• Hold the needle in the tip of the jaws (maximum grip)
• Some holders have no ratchet lock e.g. Gilles for finer control
Tissue forceps
• Use when tissues cannot be separated by retractors.
• When tissues are slippery,
• Or when the direction of traction must be frequently varied.
Tissue forceps
• Rely for grip on the shape and area of blade, the roughness of opposing surface, interlocking teeth, sharp hooked blades, or a combination of these.
Tissue forceps
• Allis • Lane • Ring • Babcock• Duval• kocher
Retractors
• Hold aside tissues to explore deeper structures.
Retractors
• Hook• Malleable copper• Czerny• Deaver• Self-retaining• Gosset
Retractorsalternative methods
• Tape.• Hands• Dissecting forceps.• Retractors.• Packs.• Tissue forceps.
Handling bone
• Do not unnecessarily strip off periosteum;It provides bone vascular supply.Its deep layer is rich in osteoblasts.
• Exposure; with minimum trauma to retain intact nerve and blood supply of oerlying structures.
• Steadying; to prevent tools slipping and bone injury
Handling bone
• Cutting:
Saw
Chisel
Gouge
Osteotome
Rongeurs
Handling bone
• Rasping
• Drilling
• Screwing
• Wiring
• Stitching
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