Principles of Surgery

1. Principles of Surgery

2. WHAT ARE YOU LEARNING? Explain basic principles of surgery, laceration healing, and surgery considerations Unit Map: Follow Along in your packet

3. Know Understand Do! Know Basic Principles of Surgery Laceration types etc Surgical Considerations Understand • Surgery principle significance • Laceration healing • How to determine considerations Do • Outline surgery basics • Explain healing • Compare/Contrast Considerations

4. Key Learning: Surgical Considerations Unit EQ: Why is surgery important in vet practices? Concept Surgical Principles Lesson EQ: What is one basic principle of surgery? Vocab Sterilization, Autoclave, Disinfectants Concept : Laceration Healing Lesson EQ: How does a wound heal? Vocab First Intention Healing, golden period, hemtoma Concept : Surgical Considerations Lesson EQ: How are considerations determined? Vocab GDV, Necrotic,

5. Reminders: • Skin and mucous membranes provide barrier to outside world • THEREFORE • Surgery disturbs this barrier and allows for bacterial entry Surgical Principles

6. Prevention of Bacterial Entry through barrier • Environment has bacteria everywhere! • Aseptic Technique • General practices used to minimize the risk of infection • Must be comprehensive! • Includes • Management of facility, patient, surgical site, surgeon and equipment Basic Principle = most important?:

7. Disinfectants: • Used to clean facility, used on inanimate objects • Normally too harsh for direct skin contact Aseptic Continued

8. Sterilization: • Tools are potential bacteria carriers • Instruments are cleaned of debris (tissue etc) • Kills all micro-organisms • Uses pressure and steam • Autoclave : tools packed in steaming wrap, 15 to 30mins at 275 degrees Aseptic Continued

9. Common Procedures Outline Categorize Explain how they work What safety considerations are outlined? Are they visible to the naked eye? Where is the safety information located? How to read an MSDS Activity Aseptic in the Classroom and Lab

10. Common Tools Principles of Surgery

11. Scalpel Needle Holder Scissors Tissue forceps Hemostatic Foreceps Retractors Towel Foreceps/Clamps Spay Hook Common Tools and Purpose

12. Provides clean incision • Typical designed for single use • Disposal , removal off handle • Varying Sizes and Shapes Scalpel

13. Holds needle for suturing Teeth provide strong grip Insert replaced as teeth wear out Needle Holder

14. Various Shapes and Sizes (depends on surgery) • Curved = more maneuverable • Straight= cut through tough tissue • Normally in packs • Metzenbaum – delicate tissue • Mayo – tough tissue Scissors

15. Appear like tweezers • Tip will vary depending on use • Serrated= delicate tissue holding • Heavy teeth= secure grip • Ratchet locking grip= secure hold (prolonged grip) Not used for delicate tissue Tissue Forceps

16. “Hemostats” • Have a ratchet lock • Used to clamp blood vessels (HEMO) • Once clamped, vessel can be ligated (tied off) Hemostatic Forceps

17. Hold tissues to expose surgical area so the surgeon has a better view Self retaining or held by assistant Retractors

18. Surgical drapes cover animal during surgery Only area open is surgical site Clamps keep towel in place during surgery and help prevent contamination Towel Forceps/Clamps

19. Used to bring uterus through tiny incinsion Spay Hook

20. Covered in bacteria naturally • To prevent spread • Gloves, mask, head cover, gown • Wash hands (up to elbows) with antiseptic soap and scrub brush • Scrub should last 5 minutes to properly clean • Hold cleanest part highest (hands in the air) Surgeon Prep

21. Area cleared of general debris • Normally shaved or clipped clean • Loose hair is vacuumed off • Scrubbed with antiseptic soap , sometimes iodine • Central region scrubbed first then work outward in a circular motion Animal Prep

22. “Clean” • Healthy skin is entered, healthy tissue is removed • Examples • Spay/Neuter Types of surgery (General Terms)

23. Choose a typical surgery • Spay • Neuter • Biopsy • Intestinal Obstruction • Other (explain) • Outline prep procedure, tools typical used and procedure itself including suture • Draw tools used • JUST OUTLINE not complete sentences. Outline a typical Surgery

24. Laceration Healing Principles of Surgery

25. How does a wound heal? Essential Question

26. Understanding healing is essential to surgery and trauma treatment Wound healing basics

27. Hemostasis Phase: Bleeding • Begins directly after trauma or surgery breach • Bleeding helps to flush the wound • Instantly the vessels constrict, blood flow slows • Blood starts to clot • Protects from excessive blood loss • Clot dries= scab • Scab allows for protection and for healing underneth Wound healing Process

28. Inflammation Phase: • Blood vessels dilate • Bring more white blood cells to the area • White blood cells help destroy damaged tissue and bacteria • Dilated vessels increase heat into the region and produce red area • Damaged tissue releases plasma and adds to the swelling area • Signs of inflammation phase • Swelling, heat, redness, pain Wound healing process

29. Repair/ Proliferation Phase • Begins simultaneously with inflammation process • Connective tissue enter the damaged area and begin to form new fibrous connective tissue • Proliferation of cells in the new connective fibers and matrix • Capillaries begin to grow within the area • Produces a granular appearance on the skin • Tissue at this stage is called granulated tissue Wound healing Process

30. This tissue fills the gap between the wound edges and sets barrier from infection • (Reminder)Rich supply of capillaries increases amount of white blood cells • As the G tissue forms E tissue form across the edges • Cells continue to layer and thicken Importance of Granulated Tissue

31. Remodeling Phase • Gap is closed (Second Intention Healing) • Occurs within several weeks of wound, but can last for years! (scar tissue) • Connective tissue w/in the wound becomes more organized and shrinks (scars shrink) • Strength of wound increases over time Wound healing process

32. Proud Flesh: • Common in lower leg wounds in horses • Over growth of granulated tissue prevents epithelial tissue from covering the wound Problems in Wound healing

33. Illustrate the wound healing process Graphic organizer : Cause Effect Chain Activity

34. Aseptic Techniques – decrease bacteria Gentle handling during surgery- decreases inflammation response Appropriate incisions- less disruption of blood supply = faster healing Minimizing healing time

35. Dead space: important to consider • Present because of tissue separation • Tumor removal leaves a pocket • Types of Accumulation • Hematoma – accumulation of blood in the dead open space • Seroma- more puss like • Abscess- contains bacteria, white blood cells, dead tissues • Fluid build up= increases tension @ wound site Bleeding in wounds and during healing

36. Two main methods • Decrease size of pocket during surgery • Sew together tissues manually • Latex tubing • Penrose drain (passive) • Active Drain Reducing tension from Fluid

37. Outline the steps for suturing a wound. • What are the TYPES of sutures • What do they look like? • How are they sewn? (only do a general outline for sewing a wound closed) • What are important items to consider when suturing a trauma or surgical wound? Suture Activity

38. Surgical Considerations Principles of Surgery

39. More than one method to a surgery • Possible Differences • Approach • Order of Steps • Tech methods / Tools etc Basic Concepts

40. Aka Ovariohysterectomy • Steps: • Animal anesthetized and secured to table • Scrubbed • Start surgery Take A Common Surgery : Spay

41. Most common • Ventral Midline incision • Middle of the stomach • Why the midline? • Abdominal muscles naturally have a gap (Linea Alba) • Little bleeding , easy access to organs • Locate Uterus (near the spine) • Deep in cavity • Use spay hook to contact and begin uterine horn removal Spay

42. Control blood flow • All arteries are ligated by the three-clamp method • Vessels are sutured • Clamps releases • Check for leaking • Ligaments cut • Ligaments located • Ligaments holding the uterus are ligated • Uterus is free Spay Continued…

43. Organ removal • Ovaries, uterine horns, uterine body all removed • Cavity Check • No bleeding in dead space • Suture • Sub Q tissue tightened to close dead space • Absorbable using a tapered point needle • Close Linea Alba • Close epithelial label with NON absorbable suture (stitches removed later) Spaying Wrap up

44. Same incision : Ventral Midline • Possible findings? • Looped intestine • Blood supply cut off from segment • Intestine become necrotic (dead) • Reposition : If severe, section must be removed attaching only healthy portions together ( intestinal anastomosis) Exploratory : Horse

45. AKA gastric dilation- volvulus syndrome (GDV) • Occurs in deep chested breeds ( Boxer) • Circulation to the stomach is disrupted • Vomiting common symptom (food cannot move forward, build up of gases) • Diagnosis through radiographs / Xrays • Treatment: • IV fluids to reduce shock • Tube down esophagus to relieve gas pressure • If stomach is twisted surgery is needed Intestinal/ Gastric torsion in dogs

46. Ventral midline incision along linea alba Bladder brought the surface through incision Gauze surrounding surgical area to prevent urine entering abdomen Incision of bladder Stones removed Continuous mattress suture Suture abdomen Example 3: Bladder stones

47. Surgical Considerations • What procedures are cited? Outline their process • What are common complications that occur after surgeries? • What is the common approach used? (Common incision used). What is the location and why is this location used? • What characteristic of tumors makes for difficult removal? How do vets combat this problem? • What are the challenges present when working in the chest cavity? How do vets combat these problems? • What is orthopedic surgery? What are common ways to perform repairs during orthopedic surgery? • Summarizing: In 10 sentences or less summarize surgery in veterinary practice. What might make is more difficult in animals than human surgery? What are basic principles? How does one generally perform surgery based off these principles? How does one perform a surgery correctly? Activity : Reading

48. Define: Aseptic, Disinfectant, Sterilization, Proud Flesh, First Intention Healing, Second Intention Healing, Penrose Drain, Suture, GVD, Ovariohysterectomy What is the 1st and more important principle of surgery? What is the most common aseptic technique? (We use it in class, and before surgery) How long should this technique be performed? List the common tools and what they are used for How is the surgeon prepped ? How is the animal prepped? Explain how they are “washed” and why it is done in this manner What are the phases of wound healing? What ways can wound healing time be minimized? What is a common problem in wound healing in horses? What are the two kinds of drains and how does each drain work? What are the types of sutures (draw them) What are the steps in spaying an animal Test Review