Surgical Methods (Easy notes )

Before starting any exam, always proceed to the following points:

· Introduction & Greetings

· Take consent

· Ask for privacy / female attendant in case of male examiners

· Positioning of the patient

· Proper exposure

Don’t forget to thank the patient after completion of the exam.

Surgical Drains

A surgical drain is a tube used to decompress or drain either fluid or air from the area of surgery. Drains are often made from inert silastic material. They induce minimal tissue reaction. 

Indication 

• To prevent accumulation of fluid (blood, pus and infected fluids)
• To prevent accumulation of air (dead space)
• To characterise fluid (early identification of anastomotic leakage) 

Types of Surgical Drains

• Open drains : include corrugated rubber or plastic sheets. Drain fluid collects in gauze pad or into stoma bag. Risk of infection increased

• Closed drains : consist of tubes draining into bag or bottle. They include chest, abdominal and orthopaedic drains. Risk of infection is reduced. 
• Active drains : they are maintained under suction and can be under high and low pressure. 
• Passive drains : no suction. function by differntial pressure between body cavities and the exterior. 

Removal 

• Generally drain should be removed once drainage has stopped or becomes less than 30 ml / day

Surgical Dressings

• Debriding Agents : Benoxyl-benzoic acid ( used in necrotic sloughing ulcer)

• Enzymatic Agents : Varidase-streptokinase/streptodornase (activate fibrinolysis and liquefy pus on chronic skin ulcer )

• Polymaric films : Opsite (primary adhesive transparent dressing for sutured wounds or donor site)

• Hydrogels : Intrasite (semi permeable, allow gas exchange, used for deep cavity wounds)

• Hydrocolloids : Comfeel (complete occlusion, promote epithelialistaion and granulation tissue)

• Fibrous Polymers : Kaltostat (absorptive alginate dressing they can be used to pack deep wounds)

• Biological Membranes : Porcine skin, amnion (used for superficial chronic skin ulcers)

• Miscellaneous : Gauzes (viscose/cotton with simple absorptive dressings only used as secondary dressings to absorb non adherent coating exudate)

Ideal Wound Dressing 

• Maintain a moist environment at wound interface

• Remove excess exudate 

• Provide thermal insulation and mechanical protection 

• Acts as a barrier to micro-organisms

• Allow gaseous exchange 

• Non adherent and easily removed without trauma

• Leaves no foreign particles in wound 

• Non toxic, non allergic and non sensitising 

• Sterile

• Easy to use 

• Conforms to wound contours 

• High absorption and retension under compression