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Principle of Surgery

Principle of Surgery. 口腔顎面外科 吳崇維. 手術基本要件. 良好的視野 適當的途徑 適當的燈光 乾淨的手術區 助手 熟悉 訓練有素. 無菌技術. 減少由致病微生物所以起的傷口污染. Flap （皮瓣）. 獲得進入手術區域之途徑 或將組織由一處移至另一處. 常見口腔皮瓣種類 . Envelop flap Triangular flap Horizontal and single vertical incision Quadrangular flap Horizontal and 2 vertical incisions.

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Principle of Surgery

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  1. Principle of Surgery 口腔顎面外科 吳崇維

  2. 手術基本要件 • 良好的視野 • 適當的途徑 • 適當的燈光 • 乾淨的手術區 • 助手 • 熟悉 • 訓練有素

  3. 無菌技術 • 減少由致病微生物所以起的傷口污染

  4. Flap（皮瓣） • 獲得進入手術區域之途徑 • 或將組織由一處移至另一處

  5. 常見口腔皮瓣種類 • Envelop flap • Triangular flap • Horizontal and single vertical incision • Quadrangular flap • Horizontal and 2 vertical incisions

  6. 組織的處理 • 溫柔地 • 避免過度的拉扯或擠壓 • Toothed forceps or tissue hooks • 切骨時，需大量沖洗，以減少骨頭因熱所受的傷害 • 開放的傷口需常常加以濕潤或以濕紗布覆蓋

  7. 處進傷口止血的方法 • 自然止血的機制 • Fabric sponge or gauze or hemostat • Gelfoam, surgicel • Small vessels: 20~30 seconds • Large vessels: 5~10 minutes • 輕敷而非擦拭

  8. 用熱來封閉（Thermal coagulation） • Hold the vessels by hemostat • Removal of any blood or fluid around the vessel • 用縫線來結紮（Suture ligation） • 直接加壓（Pressure dressing） • Most bleeding from dentoalveolar surgery can be controlled by this method. • 使用血管收縮素（Vasocontrictive substance） • epinephrine • Lidocaine with epinephrine

  9. Suture ligation

  10. 去污及清創 • Normal saline irrigation • Decrease the bacterial count • Lessen the chance of wound infection • Wound debridement • Necrotic tissue • Foreign body • Severely ischemic tissue

  11. 縫線材料 • Resorbable sutures • Gut • Proteolytic enzymes by inflammatory cells • Plain gut : 5-7 days, but 2~4 days in oral cavity • Chromic gut : 9~14 days, but 3~5 days in oral cavity • Polyglycolic acid (PGA) • Hydrolysis • Dexon • Polyglactin 910 (PLGA) • Hydrolysis • Vicryl • Not used in the skin wound • Inflammatory reaction

  12. 縫線材料 • Nonresorbable sutures • Silk • Multifilamentous • Inflammatory response • Nylon • Monofilamentous: Ethilon, Dermalon • Multifilamentous • Polyester • Monofilamentous: Polysorb • Polypropylene • Monofilamentous: Prolene • Nylon is suitable for facial laceration wound

  13. Suture sizes • 7 ~ 11-0 • Most oral and maxillofacial surgical procedures require the use of a 3-0 or 4-0 suture

  14. 縫線操作 • Multifilamentous sutures handle better than monofilamentous sutures • Silk • 3 knotting throws • Polyester, gut, PGA, PLGA • 4 knotting throws • Nylon • 5 knotting throws

  15. 縫針 • Preattached vs. nonattached (French-eyed needles) • Needle points • Cutting or tapered • Degrees of needle curvature

  16. 基本縫合技術 • Needle holder • ½ to ¾ needle • Perpendicular to the surface • Following the curvature of needle • From free tissue to fixed tissue • Tie only tightly enough to gently approximate the wound edges

  17. 縫合傷口的術後照護 • Keep free of dried blood and other debris • Sutures in oral cavity • Removal of sutures in 5~7days • Sutures in face • Removal of sutures in 5 days • Adhesive strips (Steri-strips)

  18. 水腫的控制 • Degree of edema • The greater the amount of tissue injury, the greater the amount of edema • The more loose connective tissue, the more edema is presented • Attached gingiva vs. lip or mouth floor • Control method • Minimize tissue damage • Ice packing • Corticosteroid • Adminstered before tissue is damaged

  19. The End

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