Basic Surgical Principles

This post outlines few principles of general surgery as compiled from Farquharson's Textbook of Operative General Surgery.

Principles for Closure:

• Clean wound margins
• Sterile technique
• Appropriate timing of wound closure
• Prevent Ischamia at edges
• Avoid Dead space
• Adequate Haemostasis
• Avoid Tension
• Deep bites taken to evert edges
• Delayed Primary Closure for highly contaminated or unclear margins for tumour excision
• Skin Graft on weight bearing area, with well vascularized wound bed and no exposed vital structures
• For Minor degree of contamination or low energy injuries simple lavage with 14G pulsaltile irrigation is enough
• For Moderate to heavy levels of contamination or high energy injury serial sharp debridements.

Techniques of Primary Skin Closure:

• Layered closure i.e., scarpas followed by intradermal and adhesive tape
• Layered closure and simple interrupted skin stitches
• Subcuticular stitches
• Horizontal or vertical mattress
• Running skin sutures

Split Skin Graft:

Prepare donor and recipient area. Dermatome is used to cut only the epidermis with the thickness of 13/1000 to 18/1000 inches. Either meshed to 1.5-1.3 to 1 or Pie-crusted i.e., small holes cut for drainage. Then the graft is fixed. If motion suspected then use tie-over bolus dressing and remove after 3-5 days.

Full Thickness Graft:

Donor area is marked followed by removal of epidermis and dermis with scalpel and trimming any fat attached to it followed by donor area primarily closed and recipient area dressed with tie-over dressing.

Rotation Flap:

Rhomboid Flap:

Irregular shaped defect converted to rhomboid and a straight line drawn from the obtuse corner and than angled to parallel the side of rhomboid defect.

Bilobed Flap:

Larger defect than for rotation flap, 1st eclipse larger and 2nd eclipse smaller.

V-Y Advancement Flap:

Rotation Advancement Flap:

Flap is undermined and a triangle is removed to prevent redundancy, called as burrows triangle.