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Supervised by DR Hisham Prepared by Anwariah Aris Noor Mohammad Safwan
Supervised by DR Hisham Prepared by Anwariah Aris Noor Mohammad Safwan
Supervised by DR Hisham Prepared by Anwariah Aris Noor Mohammad Safwan
DR HISHAM
Prepared by
ANWARIAH ARIS
NOOR MOHAMMAD SAFWAN
OUTLINES
Objectives
Pre-procedures
Procedures
Post-procedures
Take home messages
OBJECTIVES
To identify indications &
contraindications
To be able to perform
To be aware of complications and
how to avoid or minimalize
PRE- PROCEDURE
Informed consent:
Indications
Anatomy
Procedure ( Risks & Benefits)
PRE PROCEDURE
Aseptic technique:
Prepare equipmentMask
Apron
Gown
Hand wash
Sterile glove
Povidone
PRE PROCEDURE
Local anaesthesia:
Lidocaine/lignocaine
1% (10mg in 1ml)/2%(20mg in 1ml)
With/without epinephrine 100000u
PRE PROCEDURE
Max dose 4mg/kg
Max dose with epinephrine:7mg/kg
1% lignocaine:
Alone: 28ml in 70kg pt
With epinephrine: 49ml in 70kg pt
or
Secondary closure in dirty wound
Anatomy
Equipments:
T&S set
Scalpel
Water for irrigation
Syringe
Lignocaine injection
Suture
Needle holder
Forceps
Sutures:
Type: Non-absorbable for skin, absorbable for
deep tissue
Size
Face & Scalp - 3/0
Limb & Trunk - 3/0
Lips & Ear -4/0
Needle:
Cutting edge body for skin
Rounded body for tissue
Procedure:
Clean surrounding skin with povidone
Give adequate local anaesthesia
Wound assessment
Depth
Foreign body
Sign of infection
Active bleeding
Necrotic tissue
Any structural injury
Secure hemostasis:
Compressed with gauze
Suture with figure of 8
Continuous
interlocking
Timing of closure:
Primary closure: Immediate closure for
clean wounds <12 hours old (24 hours on
face)e.g. assault wound, clean cut
Secondary closure: Dirty wound e.g.
Complications:
Hematoma
Wound breakdown
Infection
Scar
Post T&S
Dressing with CMC
For patient to keep wound clean and dry
Suture removal:
Face: 3-5 days
Scalp: 7-10 days
Arms: 10-14 days
Legs: 10-14 days
Trunk : 10-14 days
2.INCISION AND
DRAINAGE
Indications:
ANATOMY
Equipment:
Scalpel
Povidone
Lignocaine injection
Artery forceps
Gauze/gamgee
Syringe
Swab for c+s
PROCEDURE
Clean and drape
Give adequate local anaesthesia
Make a cruciate incision at most fluctuant
area
PROCEDURE
Express pus (swab for C+S)
Break loci using artery forceps
Secure hemostasis with gauze compression
PROCEDURE
Copiously irrigate with sterile water
Wash with povidone + hydrogen peroxide
Packed the wound loosely with ribbon
Complications:
Pain
Incomplete drainage
Scar
Bleeding
discharge
Antibiotics in presence of
Localized cellulitis
Fever or chills
In immunocompromised patient
Wounds
Chronic
Wounds
Anatomy:
Proliferative
Phase
Proliferation,
Granulation
and
Contraction
ACUTE
WOUND
Remodelling
Phase
Haemostasis &
Inflammatory
Phase
Healed Wound
CHRONIC WOUND
Hemostasis
Platelet
Aggregation
Neutrophil
Immigration
Monocyte
Immigration
Granulation
Re-epithelialization
Wound Closure
Scar Formation
Remodeling
Minutes
Hours
Days
Weeks
Months
Years
Time
Procedure
Equipments:
Curettage
Dressing set
Blade
Gauze
Cotton wool
Cleansing agents
Normal Saline
Hydrogen Peroxide
Povidone iodine
Desloughing:
Wound Inspection
Daily desloughing or dressing
Antibiotic
Analgesia
Complications:
Excessive bleeding
Infection
Delay wound closure
4. CHEST TUBE
INSERTION
Indications:
Pneumothorax / hemothorax
Massive pleural effusion
Empyema
Post operative procedures Eg :
Procedure
Procedure
Equipment:
Chest tube
Child : 16-20F
Average size adult :24-32F
Large size adult : 36-40F
Underwater seal system
Accessory : Chest tube set, blade,
Insertion site:
Safety triangle
Lateral
border of
pectoralis
major
Mid
Axillary
Line
4th or 5th intercostal
space
Complications:
Bleeding
Lung injury
Infection
Abdominal organ injury if chest tube
Spo2 monitoring
Start analgesia & start antibiotic if
indicated
Encourage incentive spirometry
CXR
Watchout for complications of chest tube
insertion
CONT..
5. Puncture all loci to ensure complete drainage
Referrences
Herbert Chan, Juan E. Sola, Keith D. Lillemoe,