Institute of Surgical Research
„A” Module - Surgical Technics
A1.
A2.
A3.
A4.
A5.
MODUL – Asepsis and Antisepsis
MODUL – Surgical Deontology
MODUL – Surgical interventions
MODUL - Bleedings
MODUL – Wounds
sterile bandage replacement,
suture removal,
open wound management,
bandaging.
A6. MODUL - Shock
About wounds - revision
Classification based on:
1. morphology / origin,
2. infection
3. time elapsing from the trauma,
Ad 1a. morphology
Puncture/Stab w.
Incised wound,
Cut wound,
Bruised/crush w.
Bite wound
Lacerated wound
Shot wound
Ad 2. Intection
Clean
Spoiled
Dirty
4. depth,
5. factors affect wound healing,
6. wound closure.
Ad 3. Injury Time
Acute
Chronic
Ad 4. Depth
•Superficial
•Partial-thickness
•Full-thickness
•Deep wounds
Ad 5. Factors
affect wound
healing
Per primam
Per secundam
Per tertiam
Ad 6. Wound
closure
•Temporary
management
•Surgical closure
About wounds - in general
Basic principles:
Accidental (non surgical) wounds should be considered infected,
therefore we should remove:
- the causative agents
- the devitalized tissues
Accidental wound should be transformed to surgical one.
Phases
Management
Inspection
Under sterile circumstances (hat, mask, gloves)
Anamnesis
 Elucidation of the circumstances of injury
 Tetanus
 Rabies
Diagnostic
procedures
Exclusion of accompanying injury
• Examinations of the circulatory, sensory and motoric functions
• Exclusion of bone fractures (X-ray)
Wound
management
The accidental wound care should be based on the depth of injury and the
danger of infection with primary- or delayed wound closure (see next table).
Types of wound closure
Definite primary wound management (within 12 hrs)
Immediate wound closure
Always perform primary wound closure:
 penetrating injury of the abdomen
 chest
 dura mater
- Primary delayed suture (3-8 days)
- Early secondary wound closure (> 14 days )
- Late secondary wound closure (4 - 6 weeks )
When primary wound closure is contradicted:
 infectious signs
 severely spoiled
 foreign body
 pouched, greatly bruised wounds
 special injury forms of some
professions (e.g. surgeons, butcher,
veterinarian, pathologist, bacteriologist)
 bite, shot, deep incised wound
 hostility wound
Primary wound closure - debridement
Local anesthesia
Excision
Primary suture
Drain
Ad 1a. morphology
Puncture/Stab w.
Incised wound,
Cut wound,
Bruised/crush w.
Bite wound
Lacerated wound
Shot wound
Ad 2. Intection
Clean
Spoiled
Dirty
Ad 1a. morphology
Puncture/Stab w.
Incised wound,
Cut wound,
Bruised/crush w.
Bite wound
Lacerated wound
Shot wound
Ad 2. Intection
Clean
Spoiled
Dirty
Ad 1a. morphology
Puncture/Stab w.
Incised wound,
Cut wound,
Bruised/crush w.
Bite wound
Lacerated wound
Shot wound
Ad 2. Intection
Clean
Spoiled
Dirty
Ad 3. Injury Time
Acute
Chronic
Ad 4. Depth
•Superficial
•Partial-thickness
•Full-thickness
•Deep wounds
Ad 3. Injury Time
Acute
Chronic
Ad 4. Depth
•Superficial
•Partial-thickness
•Full-thickness
•Deep wounds
Ad 3. Injury Time
Acute
Chronic
Ad 4. Depth
•Superficial
•Partial-thickness
•Full-thickness
•Deep wounds
Ad 5. Factors affect
wound healing
Per primam
Per secundam
Per tertiam
Ad 6. Wound closure
• primary wound closure
• primary delayed wound suture
• early secondary wound closure
• late secondary wound closure
Ad 5. Factors affect
wound healing
Per primam
Per secundam
Per tertiam
Ad 6. Wound closure
• primary wound closure
• primary delayed wound suture
• early secondary wound closure
• late secondary wound closure
Ad 5. Factors affect
wound healing
Per primam
Per secundam
Per tertiam
Ad 6. Wound closure
• primary wound closure
• primary delayed wound suture
• early secondary wound closure
• late secondary wound closure
TYPES OF BANDAGES
Depending on the function:
- adherent/taped bandages: (to fix covering bandages or for the approximation of edges of
small wounds)
- covering bandages: (to protect the wound and absorb secretion. Prevention from
secondary infection and mechanical trauma)
- pressing bandages: (for temporary handling of capillary and venous bleedings under 40-
60 mmHg.)
- wedging bandage (used for temporary handling of capillary arterial and venous bleedings
until surgical management. Should be relieved in every 2 hrs)
- compressing bandages: (to prevent postoperative bleeding on the limbs, and for the
prophylaxis of thrombosis and for the reduction of chronic lymph-edema. Always placed
from distal to proximal
- fixing/retention bandage (to immobilize the injured body part or to fix the reposition).
Layers of bandages
1. Layer in direct contact with the wound (sterile, hypoallergenic, not
irritating, non-sticking)
- simple sheet (e.g. Mull sheet: good fluid absorbent, but easily sticks to
the wound)
- impregnated sheet (vazeline, paraffin: ie. “Jelonet”, non-sticking) (with
saline which melts when gets into contact with body fluids i.e. Mesalt.)
2. Absorbent layer (to absorb and store blood and excretions)
3. Fixing layer to secure the bandage (adherent tapes i.e. Centerplast,
Leukoplast or Mefix, Mepore; the latter two for bigger surfaces).
Special compression bandage: ear bandage
Special retention bandage: rucksack bandage
Special retention bandages:
Desault-bandage
Charnley-loop
TASKS
OPERATING THEATRE
COMPUTER ROOM
1. Sterile bandage removal
from surgical wound
Removal of sutures
1. Steam bandage
2. Sterile bandage removal
open wound management
2. Compression bandage:
ear bandage
3. Retention bandages
OPERATING THEATRE: WOUND MANAGEMENT
1. Surgical wounds – sterile bandage replacement, removal of sutures
STERILE EQUIPMENT
SURGEON
2. Sterile gloving
3. Desinfection (Betadine solution)
4. Removal of sutures
5. Sterile covering (sterile gauze)
NON-STERILE
ASSISTANT
1. Removal of the former bandage
(pouring fluid on the sponge)
6. Fixing
2. Spoiled wounds – open wound management
STERILE EQUIPMENT
SURGEON
2. Sterile gloving
3. Wound cleansing (H2O2)
4. Rinsing with saline
5. Desinfection (Betadine solution)
6. Sterile covering (sterile gauze)
NON-STERILE
ASSISTANT
1. Removal of the former bandage
(pouring fluid on the wound)
(pouring fluid on the wound)
(pouring fluid on the sponge)
7. Cover, fixing
COMPUTER ROOM: BANDAGING
1. Covering bandages
2. Steam bandage
Layers:
- Ointment: (Burow-ointment, aids demarcation of the necrotic area),
- Steril gauze sheet:
- Plastic layer: (for isolation of heat and steam)
- Fixing layer
3. Special compression bandage: ear bandage
4. Retention bandage: wrist and elbow
4. Special retention bandage: Desault-bandage