Institute of Surgical Research

Surgical Technics – A2. practical module

A1. MODULE – Asepsis and antisepsisA2. MODULE – Surgical DeontologyA3. MODULE - OperationsA4. MODULE - BleedingsA5. MODULE - WoundsA6. MODULE - Clinical aspects of shock

Surgical Technics – A2. practicalmodule

Surgical Deontology• Basic surgical instruments;• Textiles in the operating room;• Suture materials;• Tying surgical knots;• Asepsis and the patient:

preparing the operative site(skin cleansing, draping)

Holding Scissors

Holding Scalpels

„fiddle bow” „pen”

Holding Forceps

„pen” „knife”

Holding Locking Instruments

Holding Hemostatic Forceps

Grasping Instruments –Needle holders

Hegar Mathieu Holding a Hegar-typeneedle holder

Basic surgical knots

Surgeon’s knotHalf hitch Square knot Sailor’s knot

Tying Surgical Knots 1.

The ends of sutures and ligatures are joinedwith surgical knots. Requirements:

- quick- strong- safe

Incorrect knots lead to severe postoperativecomplications !

Loose knot = haemorrhage, thicker scarFully tightened knot = blocks local blood

supply, slow wound healing

Tying Surgical Knots 2.

A simple knot = the threads form a closed loop.

Two identical simple knots tied aboveeach other = granny knotbutthis slips easily, therefore it must not be used in surgery !

In surgical practice a knot consists of at least twomirror image half hitches, one placed on theother:

base half hitch + second half hitch (in theopposite direction).

Before tying a half hitch the threads should be crossed!

The number of half hitches depends on the typesof threads (synthetic threads require extra ones -up to 6 or more).

Tying Surgical Knots 3.

Methods of tying knots in surgery:

- two-hand knot: both hands take anactive part in theformation of the knot

- one hand knot: one hand is active, theother holds the thread, then the knot is tied withboth hands

- instrument tie: with needle holders, mosquitos (1. in a deep cavity; 2. with atraumatic needles; 3. with short suture materials

Tying Surgical Knots 4.

Methods of tying two hand knots:

two-handed square knotsurgeon’s knotViennese knotinstrument tie

Methods of tying one-hand knot and instrumenttie will be taught by the Suture Tutor program.

Tying Surgical Knots 5.

Tying knots: „Two-handed square knot”

Tying knots: „Surgeon’s knot”

Tying knots: „Viennese” knot

Tying knots: Instrument tie

4. Repeat disinfection with betadineon less area

3. Disinfection with betadine

Preparing the operative site 1.(cleansing)

1. Cleansing with alcohol 1.

IT IS FORBIDDEN:to return to a cleansed areawith the same sponge!

2. Cleansing with alcohol 2.

Preparing the operative site 2.(draping)

Drapes can be moved away from the sterile field

towards the sterile field….NOOOOOO!

1. Lower drape

2. Upper drape

3. Side drapes

4. Fixing the drapes with towel clips

5. Moving the Mayo stand in place

Preparing the operative site 1.Instruments for skin cleansing

Skin cleansingPreparing the operative site 2.

DrapingPreparing the operative site 3.

Have a good practice!