1. 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

2. 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.

3. 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 Langer’s lines (better wound healing, less scar formation), - toward oneself, from left to right.

4. 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!

5. 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)!

6. 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.

7. 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.

8. Handling surgical bleeding 4. (video)

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

10. Wound closure 1. Simple continuous suture

11. Wound closure 2. Simple continuous suture (video)

12. 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.

13. Wound closure 4. Michel clips

14. Practical tasks In the teaching lab: In the operating room: 35 min
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

15. REPEAT: gloving alone

16. Have a good practice!