Presentation on theme: "Basic Surgical Instruments"— Presentation transcript:
1Basic Surgical Instruments Professor Magdy Amin RIADProfessor of Otolaryngology.Ain shames UniversitySenior Lecturer in OtolaryngologyUniversity of Dundee
2Principles of instruments handling Safety (patient and staff)Economy of movementsRelaxed handling.Avoidance of awkward movements.
3The Scalpel ‘Table knife holding’ For routine skin incisions.Tissue division with minimum trauma.Index finger guiding the bladeDrawing the whole length of blade.Blade 15 is the workhorse of sharp dissectionDo not use blunt blades
4The 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 .
5Sharp dissection Scalpels divide tissue with minimum damage. Tissues must be stretched to produce least traumaTension must be applied at right angles to the direction of cutting
6Sharp 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.
7Sharp dissection with diathermy Simultaneous partial tissue coagulation and haemostasis.Particularly useful in cutting muscles.Collateral tissue damage is a disadvantage.
8Blunt dissectionSplitting connective tissue close to important structures.Scissors, artery forceps or dissecting forceps.Tearing.wiping
9Scissors2 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.
10Scissors 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.
11Dissecting 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.
12Dissecting 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
13Haemostats (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.
14Haemostats (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.
23Retractors alternative methods Tape.HandsDissecting forceps.Retractors.Packs.Tissue forceps.
24Handling boneDo 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