Universal precautions are intended to prevent parenteral, mucous membrane, and
nonintact skin exposures of health-care workers to bloodborne pathogens. In addition,
immunization with HBV vaccine is recommended as an important adjunct to universal
precautions for health-care workers who have exposures to blood
Standard precautions
Standard Precautions are the minimum infection prevention practices that apply to all patient care,
regardless of suspected or confirmed infection status of the patient, in any setting where health care
is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading
infections among patients.
Constipation
Unsatisfactory defecation characterized by infrequent stool, difficult stool passage or both at
least for previous 3 months
◦ ROME 4 diagnostic criteria
‣ Out of the 6 - 2 or more should be there to diagnose
• At least during 25% of defection ◦ Straining during
◦ Lumpy or hard stool
◦ Sensation of incomplete evacuation
◦ Sensation of anorectal obstruction or blockage
◦ Manual maneuvers to facilitate evacuate
• Fewer than 3 defecations per week
In statistics, a confidence interval (CI) is a type of estimate computed from the statistics of the
observed data. This proposes a range of plausible values for an unknown parameter (for example,
the mean). The confidence level is designated before examining the data. Most commonly, a 95%
confidence level is used.[6] However, confidence levels of 90% and 99% are also often used in
analysis.
Factors affecting the width of the confidence interval include the size of the sample, the confidence
level, and the variability in the sample. A larger sample will tend to produce a better estimate of the
population parameter, when all other factors are equal. A higher confidence level will tend to
produce a broader confidence interval.
Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess the
results of previous research to derive conclusions about that body of research. Typically, but not
necessarily, the study is based on randomized, controlled clinical trials.
A systematic review attempts to collate empirical evidence that fits prespecified eligibility criteria to
answer a specific research question. The key characteristics of a systematic review are a clearly stated
set of objectives with predefined eligibility criteria for studies; an explicit, reproducible methodology; a
systematic search that attempts to identify all studies that meet the eligibility criteria; an assessment of
the validity of the findings of the included studies (e.g., through the assessment of risk of bias); and a
systematic presentation and synthesis of the attributes and findings from the studies used.
ACUTE LIMB ISCHAEMIA Definition • Sudden decrease in limb perfusion that threatens the viability of
the limb
Critical limb ischaemia ◦ Definition: Ischaemic rest pain more than 2 weeks or evidence of tissue loss as
in ulcers and gangrene attributed to objectively proven occlusive arterial disease ‣ In these patients
ankle pressure is 50mmhg and ABPI is 0.4
Chi-squared test
Chi-squared test for nominal (categorical) data. The c2 test is used to determine whether
an association (or relationship) between 2 categorical variables in a sample is likely to
reflect a real association between these 2 variables in the population.
Molecular target therapy
These drugs target key regulatory molecules involved in the cellular division or
metabolic pathways and modify the cellular level steps to inhibit cancer cell growth or to
stimulate cell death
The odds ratio is the measure of association for a case-control study. It tells us how
much higher the odds of exposure is among cases of a disease compared with controls
The measure of association between exposure and disease in cohort studies is the
relative risk
case control - weight lifting causes hernia or not? we take a cohort of
weight lifters and non-weight lifters and see how many already have got herniae in each
group.
‣ In cohort studies we start with exposure. The outcome is not there at the beginning!
(Eg: if we want to see whether weight lifting causes hernia or not, in a cohort study we
take weight lifters and non-weight lifters who do not have herniae at present, and then
we follow them up to see who develops herniae and who don't!)
The premise of targeted therapy in oncology is the fundamental
reliance of tumor cells on biological pathways to which drugs
inhibiting those pathways can be applied.
Traditional anticancer chemotherapy agents block cell division
and DNA replication.
Oncoprotein or oncogenes targets, which are mainly involved in
various signaling pathways.
RTK activities are mainly dependent on signaling molecule phosphorylation and activation of
transcription factors that mediate target gene expression in response to ligands
Resistance is a problem
Metastatic renal ( sunitinib ) breast (traztuzumab), colorectal (Bevacizumab), HCC (sorafenib), melanoma
BRAF 600 targeted therapy.
Phenotypic transformation can lead to resistance to RTKIs. The most frequent example is the epithelial-
mesenchymal transition (EMT) during which tumor cells lose their epithelial characteristics, such as cell-
cell adhesion and polarity, in favor of mesenchymal characteristics and of the acquisition of an invasive
phenotype.
Regurgitation should strictly refer to the
return of oesophageal contents from above a functional or
mechanical obstruction. Reflux is the passive return of gastroduodenal
contents to the mouth as part of the symptomatology
of gastro-oesophageal reflux disease (GORD)
Triage
A French verb meaning ‘to sort’.
Is a dynamic process designed to sort out the victims in a mass casualty for treatment
priority depending on the severity of their injuries, resources and the situation.
Aim is to do the best for the most rather than everything for everyone.
Disaster
A disaster is a serious disruption occurring over a short or long period of time that causes
widespread human, material, economic or environmental loss which exceeds the ability of the
affected community or society to cope using its own resources.
Triage sieve ◦ Takes undifferentiated patients at the point of injury and prioritise them in to patients
who require treatment based on physiological scoring in to five categories
‣ Immediate care (P1/T1/Red)
‣ Soon - Within 2 hours (P2/T2/Yellow) ‣ Delayed - Within 4 hours (P3/T3/Green)
‣ Expectant (P4/T4/Blue) - implies that the patient is so severely injured that even if they were the only
casualty and not in a major incident, survival would be very unlikely even with maximum resources
invested in them (eg: >90% burns, but still alive) - this category can be used only after approval by the
gold commander!
‣ Died (P0/T0/Black)
An advance healthcare directive, is a legal document in which a person specifies what
actions should be taken for their health if they are no longer able to make decisions for
themselves because of illness or incapacity.
Another form is a specific type of power of attorney or health care proxy, in which the
person authorizes someone (an agent) to make decisions on their behalf when they are
incapacitated.
DCR
Systematic approach to resuscitation in order to minimize haemorrhage and maximize tissue
oxygenation to optimize patient outcome. • Includes ◦ Permissive hypotension ◦ Haemostatic
resuscitation ◦ Damage control surgery and/or Damage control radiology (dDCRad and dDCRad
To prevent the lethal triad in trauma – coagulopathy, acidosis and hypothermia
DCS
Abbreviated form of surgery to control hemorrhage and to stop contamination where restoration of
physiology is given priority over definitive anatomical reconstruction. Main aim is to prevent the lethal
triad of trauma. Patient is send to intensive care unit resuscitsted and definitive surgery is planned once
stable.
Mechanism of action:
Aspirin (acetylsalicylic acid) irreversibly inhibits prostaglandin H synthase (cyclooxygenase-1) in
platelets and megakaryocytes, and thereby blocks the formation of thromboxane A2 (TXA2; a
potent vasoconstrictor and platelet aggregant).3 It is only the parent form, acetylsalicylic acid,
which has any significant effect on platelet function. Because platelets are unable to
regenerate cyclooxygenase, the immediate antithrombotic effect of aspirin remains for the
lifespan of the platelet (8–10 days).
(clopidogrel bisulfate) is an inhibitor of ADP-induced platelet aggregation acting by direct inhibition of
adenosine diphosphate (ADP) binding to its receptor and of the subsequent ADPmediated activation of
the glycoprotein GPIIb/IIIa complex.
Pathogenesis and pathophysiology
Urinary stone formation is a result of different mechanisms. Whereas
exceeding supersaturation (ie, free stone formation) is the cause of uric acid
or cystine calculi, infection stones result from bacterial metabolism [
32
]. The formation of the most common fraction, the calcium-containing calculi,
is more complex and, surprisingly, is not yet completely understood. Recent
evidence suggests that both free and fixed stone formation is possible [
33
]. The long accepted simple explanation of exceeding the solubility product of
lithogenic substances in the urine cannot describe these complex processes
sufficiently [
33
]. Deviating from the hypothesis that claims the initial crystal deposition takes
place in the lumens of renal tubules [
34
,
35
,
36
], new insights suggest a primary plaque formation in the interstitial space of
the renal papilla [
37
,
38
]. CaPh crystals and organic matrix initially are deposited along the basement
membranes of the thin loops of Henle and extend further into the interstitial
space to the urothelium, constituting the so-called Randall plaques, which are
regularly found during endoscopy of patients who form CaOx stones (Fig. 2).
These CaPh crystals seem to be the origin for the development of future
CaOx stones, which form by the attachment of further matrix molecules and
CaOx from the urine to the plaque [
39
]. The driving forces, the exact pathogenetic mechanisms, and the involved
matrix molecules are still largely unknown. Completely different
pathomechanisms obviously lead to the common clinical diagnosis of “CaOx
stone former.”
Polyp with high grade dysplasia
High grade (also called carcinoma in situ/intraepithelial carcinoma → because muscular mucosa is not
penetrated by these tumors, and there is no risk of metastasis as lamina propria doesn't have
lymphatics).
Adenomatous polyps
‣ Definitions
• Adenoma: Glandular proliferation of the epithelium with any degree of dysplasia
• Advanced adenoma
◦ Size >1cm
◦ Villous component
◦ High grade dysplasia
A choristoma is a mass formed by heterotopic tissue. Thus, by definition, choristomas are
benign tumors
Teratomas are germ cell tumors commonly composed of multiple cell types
derived from one or more of the 3 germ layers.
A hamartoma (from Greek hamartia, meaning “fault, defect,” and -oma, denoting a tumor or
neoplasm) is a benign (noncancerous) tumorlike malformation made up of an abnormal mixture of
cells and tissues found in areas of the body where growth occurs.
Serrated polyps are a type of growth that stick out from the surface of the colon or rectum.
The polyps are defined by their saw-toothed appearance under the microscope.
There are 2 major classes of precancerous polyps in the colon. One class is the conventional adenomas,
all of which are dysplastic. (The dysplasia should be classified as low or high grade.) Conventional
adenomas are also classified as tubular or villous or, if there is a mixture of tubular and villous elements,
as tubulovillous. This class of polyps is the precursor of colorectal cancer in 2 of the 3 major molecular
pathways: the chromosomal instability pathway, which accounts for approximately 65% to 70% of all
colorectal cancers, and the Lynch pathway, which accounts for approximately 3% of colorectal cancers.
Sessile serrated polyps have a high prevalence of hypermethylation and mutations in the BRAF
oncogene. These features are shared with a group of colorectal cancers that are hypermethylated.
Sessile serrated polyps are common in the proximal colon, the same location where hypermethylated
cancers are more common. Traditional serrated adenomas are relatively rare and predominantly left-
sided, and their molecular profile is not well characterized. Therefore, sessile serrated polyps appear to
be the predominant precancerous lesions in the serrated class.
Sessile serrated polyps are, on average, more difficult to detect than conventional adenomas. This is
likely because the color of the lesions is nearly always similar to that of the surrounding mucosa, their
profile is always flat or sessile, and the edges of these polyps are frequently difficult to define. Patients
who develop cancer after colonoscopy are more likely to have hypermethylated cancers than are
patients whose cancers are diagnosed at an initial colonoscopy. Thus, the detection of sessile serrated
polyps is an important goal during colonoscopy.
The other class of precancerous polyps in the colon is a subset of the serrated lesions, which is currently
understood to be the precursor of the remainder of colorectal cancers. Unlike conventional adenomas,
which are uniformly dysplastic, the vast majority of serrated lesions contain no dysplasia. The serrated
class includes the hyperplastic polyps, which are not considered precancerous; sessile serrated polyps
(also called sessile serrated adenomas; Figures 1 and and2);2); and traditional serrated adenomas, which
are quite rare and often mistaken by pathologists for conventional adenomas.
Cancer cachexia:
- Cancer cachexia is a wasting syndrome characterized by weight loss, anorexia, asthenia and anemia.
The pathogenicity of this syndrome is multifactorial, due to a complex interaction of tumor and host
factors.
Delirium – acute onset fluctuating level of mental status and inattention with altered level of
consciousness.
PARALYTIC ILEUS
• Affects the whole bowel • Due to failure of transmission of peristaltic waves secondary to
neuromuscular failure
Regurgitation should strictly refer to the
return of oesophageal contents from above a functional or
mechanical obstruction. Reflux is the passive return of gastroduodenal
contents to the mouth as part of the symptomatology
of gastro-oesophageal reflux disease (GORD). Loss of
weight, anaemia, cachexia, change of voice due to refluxed
material irritating the vocal folds, and cough or dyspnoea due
to tracheal aspiration may all accompany regurgitation and/
or reflux.
Ischemia assessment tool scoring systems
University of Texas classification
PEDIS
WIFI classification
Diabetic infected wound debridement
Incision should start from the distal point of the infection and proximally extended along the medial
aspect (along the flexor tendon path) until healthy tissue is observed (Loeffler Ballard incision)
• Can extend posteriorly in to the medial malleolus and in to the calf if necessary
‣ Goal • Wound thoroughly explored and all necrotic and infected debris removed
• All sinuses should be opened to see if other compartments are affected
‣ A tourniquet is not recommended because it can prevent identification of viable tissue through
bleeding and lead to over-debridement
Charcot's foot ‣ It is a non-inflammatory form of neuropathic arthropathy of the foot causing
progressive destruction of bone and soft tissue at weight bearing joints characterized by joint
dislocations, pathologic fractures and debilitating deformities
‣ In diabetic Charcot arthropathy - collapse of arch of mid foot occurs and it gets replaced by a bony
prominence (Rockerbottom foot)
Port site bleeding Figure 1 (g-i)
Incidence of port site bleeding was found to be 0.7%. Our results are comparable with other
studies.[23] All were associated with the placement of secondary trocars. There was no
associated bleeding with port site dilatation for specimen removal. Injury to epigastric vessels
can be related to carelessness during the operative procedure usually during the placement of
secondary trocars which should be placed under direct vision and with prior illumination of the
abdominal wall. Bleeding from the abdominal wall may not become apparent until after the port
is removed because the port may tamponade muscular or subcutaneous bleeding. In addition to
visually inspecting the access site upon its creation, the site should also be inspected during and
following removal of the port. Bleeding points can usually be identified and managed with
electrocautery. On occasion, the skin incision may need to be enlarged to control the bleeding. If
persistent bleeding continues, a Foley catheter can also be inserted, inflated, and gentle traction
applied to tamponade the site. Also, U-stitches can be placed into the abdominal wall under
direct laparoscopic visualization using a suture passer with absorbable braided sutures. A number
of specialized instruments have been devised for fascial closure at the port site and these may
also be useful for managing abdominal wall bleeding
How to do a research? • (1) Research proposal
◦ Title ◦ Introduction justification and objectives ◦ Literature review
◦ Method ‣ (a) Study design ‣ (b) Study period ‣ (c) Study setting ‣ (d) Study population ‣ (e) Sample
size ‣ (f) Sampling method ‣ (g) Data collection tool ‣ (h) Plan of analysis ◦ References •
(2) Take ethical clearance from an ethics committee
(3) Administrator permissions
• For non-interventional research above 3 should be done! • For interventional research (ie. clinical trial)
- in addition to the above 3, following should be done ◦
(A) Register in the SLCTR (Sri Lanka Clinical Trial Registry) after taking the ethical clearance ‣ It is in the
SLMA building
(B) Take permission from NMRA (National Medicines Regulatory Authority of Sri Lanka) ‣ This was
called Cosmetic Devices and Drugs Act of Sri Lanka (CDDA)
Contralateral exploration - Unilateral hernia has a high chance of a contralateral PPV. But it may
not be a hernia (not all PPVs become inguinal hernia! might be doing unnecessary surgery).
There's a 0.5% risk of damaging the vessels leading to atrophic testis. Give contrast into the
abdomen and check whether contrast is coming in to the opposite scrotum or put the
laparoscope and insufflate air and check whether gas comes into the other scrotum. Put the
laparoscope into the sac a have a look. All these tests are done to detect a PPV, not hernia.
Therefore, selective contralateral exploration is done. Especially newborn and pre-term because
they have a high chance of incarceration, contralateral hernia, having another anesthesia is
difficult. Females - can explore the other side as there is no important structure as the gonadal
vessels. If child is having high anaesthesia risk, better to do both sides. Social reasons - child
coming from far-away - fix both sides.
the systematic, methodical investigation into and study of materials and sources in order to
create new knowledge and/or the use existing knowledge in a new and creative way so as to generate new concepts,
methodologies and understandings.
Interventional radiology (IR) is a medical subspecialty that performs various minimally-invasive
procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic
resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very
small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or
guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging
contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR
procedures provide direct treatment—they include catheter-based medicine delivery, medical device
placement (e.g., stents), and angioplasty of narrowed structures.
Immunonutrition (aimed at reducing infectious complications by enhancing immune response by
supplementing glutamine, arginine, RNA, omega-3 FA, and antioxidants)
- Prehabilitation (aims to increase functional capacity through short-term, home based, intensified
exercise programs supervised by physiotherapists)
GORD
the Montreal consensus panel reached very strong agreement in defining
GERD as “a condition which develops when the reflux of stomach contents
causes troublesome symptoms and/or complications.
Life style modifications
(1) avoidance of foods that may precipitate reflux (coffee, alcohol, chocolate,
fatty foods),
(2) avoidance of acidic foods that may precipitate heartburn (citrus,
carbonated drinks, spicy foods), and
(3) adoption of behaviors that may reduce esophageal acid exposure (weight
loss, smoking cessation, raising the head of the bed, and avoiding
recumbency for 2–3 hours after meals).
Important alternative diagnoses include coronary artery disease, gallbladder
disease, gastric or esophageal malignancy, peptic ulcer disease, and
eosinophilic, infectious, or caustic esophagitis.
Proposed alarm features include vomiting, evidence of gastrointestinal blood
loss, involuntary weight loss, dysphagia, anemia, chest pain, or epigastric
mass.
Shock is a life-threatening condition of circulatory failure, causing inadequate oxygen delivery to
meet cellular metabolic needs and oxygen consumption requirements, producing cellular and
tissue hypoxia. The effects of shock are initially reversible, but rapidly become irreversible,
resulting in multiorgan failure (MOF) and death. When a patient presents with undifferentiated
shock, it is important that the clinician immediately initiate therapy while rapidly identifying the
etiology so that definitive therapy can be administered to reverse shock and prevent MOF and
death.
Screening
Presumptive identification of unrecognized disease in an apparently healthy asymptomatic population
by means of tests, examinations and other procedures that can be applied rapidly and easily to the
target population.
( A screening programme must include all the core components in the screening process
from inviting the target population to accessing effective treatment for individuals
diagnosed with disease.
Screening is a process – one that begins with invitation to participate and ends with
treatment for appropriately identified individuals. An effective screening programme
should meet the following criteria:
Mechanisms for systematic invitation and follow-up for individuals identified by the
screening test as having an abnormal finding (call and recall mechanisms);
Participation of over 70% of the target population to be screened;
Necessary infrastructure and resources to offer the test periodically and to adequately
diagnose and treat those found to have cancer or a precancerous lesion, and;
Robust monitoring and evaluation framework to assure quality.
In advocating screening programmes, it is important to avoid imposing models from high-
resource settings with advanced health systems on countries that lack the infrastructure
and resources to achieve adequate coverage of the population).
Screening in AAA
One of the few benign conditions where screening is done
USS at the age of 60yrs
According to UK SAT (Small aneurysm trial) - no mortality or morbidity benefit by operating
aneurysms of
‣ Fit patient (risk of rupture is higher than risk of dying because of surgery) → do intervention (open
or EVAR) • Risk of dying because of elective surgery in an infrarenal AAA - 5-10%
Risk of rupture of AAA is 5-15% if its 5-6cm
Screening for breast
Population screening
Screening of high risk people
Screening of patients with increased genetic risk (brca)
Population screening not there in SL
CBE in WWC
Symptomatic patients referred
Population screening in UK, > 40 yrs invited fro a mammo , if normal repeated every 3 yrs, if found
further investigated
Risk assessment models
Then if high risk – life style modification, chemoprevention and surgery as risk reduction stratergies
Sensitivity - Proportion of subjects with cancer who test positive (True positive rate)
Specificity - Proportion of subjects without cancer who test negative (True negative rate)
Positive predictive value - Proportion of subjects who test positive that have cancer
Negative predictive value - Proportion of subjects who test negative that do not have cancer
What is MRI
MRI is a radiological technique that uses magnetism, radio waves and a computer to produce
detailed images of body structures. • MRI is based on the principles of NMR - Nuclear magnetic
resonance
What is an antibiotic
What is SSI
What is antibiotic prophylaxsis
What are the important microrganisms in surgery
Listen to BTK screening podcast
Whast an abscess
Whats a phlegmon
What is GORD
What is Hiatal hernia
What is achalasia cardia
What is barrettes esopahgus
What is triage
What is a disaster
What is a major event
What is a diverticulum
What is a stricture
Whats a scar
What are the principles of wound healing
What is adenoma carcinoma sequence
What is histology
What is biopsy
What is radiotherapy
What is neoadjuvant therapy
What is DCS
Biofilm
A biofilm is an assemblage of microbial cells that is irreversibly associated (not removed by gentle
rinsing) with a surface and enclosed in a matrix of primarily polysaccharide material
Biofilm-associated cells can be differentiated from their suspended counterparts by generation of an
extracellular polymeric substance (EPS) matrix, reduced growth rates, and the up- and down-
regulation of specific genes. Attachment is a complex process regulated by diverse characteristics of
the growth medium, substratum, and cell surface. An established biofilm structure comprises
microbial cells and EPS, has a defined architecture, and provides an optimal environment for the
exchange of genetic material between cells. Cells may also communicate via quorum sensing, which
may in turn affect biofilm processes such as detachment.
Occur in the body, prosthesis, medical equipments.
Wound
breakdown in the protective function of the skin; the loss of continuity of epithelium, with or
without loss of underlying connective tissue (i.e. muscle, bone, nerves)2 following injury to the
skin or underlying tissues/ organs caused by surgery, a blow, a cut, chemicals, heat/ cold,
friction/ shear force, pressure.
Ulcer
According to Robins's pathology, "ulcer is the breach of the continuity of skin, epithelium or
mucous membrane caused by sloughing out of inflamed necrotic tissue."
What is the difference between a wound and an
ulcer?
A wound is caused by an external force whereas an ulcer is caused by an
internal problem.
That was the short answer. The more extended explanation is the following:
In an ulcer, the primary tissue breakdown is internal, i.e. the lesion is caused
by an underlying disease or other internal reason. This disturbance of the
tissue will typically be gradual.
In a wound, the primary tissue breakdown is caused by a force originating
from the external world and the disturbance of the tissue will typically be
acute.
Negative pressure wound therapy ◦ Controlled sub atmospheric pressure is applied to a wound
covered with a foam dressing.
Negative pressure wound therapy
Contraindications for NPWT use include:[21]
1. Malignancy in the wound
2. Untreated osteomyelitis
3. Non enteric and unexplored fistulas
4. Necrotic tissue with eschar present
5. Exposed blood vessels, anastomotic sites, organs and nerves in the periwound area
6. PVD
7. Pseudomas positive culture as it is an facultative anaerobe
Antibiotic prophylaxis ( AUA definition)
Surgical antimicrobial prophylaxis is the periprocedural systemic
administration of an antimicrobial agent intended to reduce the risk of
postprocedural local and systemic infections.
Whats an antibiotic
Any substance that inhibits the growth and replication of a bacterium or kills it outright can be
called an antibiotic
are made from bacteria
Whats an antimicrobial agent can be synthetic also
Immunotherapy
Usage of bodies innate and adoptive immunity to target cancer or diseased
cells
Molecular targeted therapy ( same buut targets molecules than immune
ceels it self , so more specific and less side effects related to unwanted
activation of immunesystem
Mainly in RCC
TMT
Targets the hypoxic response pathway
1. Tyrosine kinase inhibitors
Sorafenib and Sunitinib
2. m TOR ( mammalian target of Rapamycin)
3. VEGF
Bevacizumab
Tyrosine kinases are enzymes responsible for the activation of many proteins by signal
transduction cascades. The proteins are activated by adding a phosphate group to the
protein (phosphorylation), a step that TKIs inhibit. TKIs are typically used as anticancer
drugs.
WOUND DEBRIDEMENT • Definition and aims ◦ Removal of devitalised tissue, contaminated
tissue, infected tissue and FB from a wound to make the wound bed healthy for healing
process to continue, and/or for surgical closure
Basic Principles of Skin Incision Every surgical incision must be planned and performed by the
surgeon, considering precisely the therapeutic aims, practicability and the functional and
aesthetic results of scar formation.
Surgical incisions
Introduction
- Proper placemen is vital for
o Intra op – access, extension
o Post op – pain, healing, dehiscence and incisional hernia and scar
Factors to consider,
- Accessibility
o Direct access to the anatomy
o Enough space for operation
- Extensibility
- Security
Planning of the incision
- Consider pre operative diagnosis
- Speed than operation should be performed
o Trauma
o Hemorrhage
- Body habitus – paed RHC incision
- Previous abdominal incision
- Potential stoma sites
- Incision made along the lines of cleavage
- Avoid tramline or acute angle to avoid devascularized segments
- Mark possible stoma sites preoperatively
Cosmesis
Special incisions
Bruners, flaps