In
an article published by the British Medical Association (BMA), said
that in the UK, had minor surgery procedures are often performed by
general practitioners and are quite popular among patients and has a
fairly high cost. Based
Health Authority (1990), general practitioners have the authority to
perform minor surgery and get a payment from this action. Even
in 2004, general practitioners in the UK to improve and expand their
minor surgical competence by way of paying a commission to the manager
Addition pelayananan (Directed Enhance Service-DES). In
Indonesia, minor surgical care coverage that can be performed by a
general practitioner is quite diverse, ranging from action hecting open
wound, incision, excision, extraction, cauterization and so forth. This action is generally performed with local anesthesia with anesthetic techniques appropriate to the case at hand.
Implementation of minor surgical procedures require a general practitioner to know some basic knowledge about these actions. Basic
knowledge in the form of minor surgical instruments, materials and
sewing techniques of disinfection and tissue engineering. This
article is only bounded on the introduction of minor surgical
instrument which is the basis of the first knowledge that must be
possessed by a doctor to perform this action. For more knowledge will be explained in a different article.
Basic
instruments minor surgery is divided into four by function, ie the
function of cutting instrument (scalpel blade + handle and various types
of scissors), an instrument with grasping function (anatomical
tweezers, forceps and clamps cirrhurgis network), an instrument with a
function to stop the bleeding (arterial clamp straight and clamps
mosquito), as well as instruments to function sewing (needle holder,
suture and needle).
Figure 1: Basic Surgical Instruments Minor
All of these instruments are described in detail as follows:
A. Instruments With Cutting Function
1. Scalpel blades + Handbook
A small scalpel blade is used with the handle. This tool is useful in skin menginsisi and sharply cut tissue. In addition, it is also a useful tool to remove tissue / foreign matter from the inside of the skin. Each
blade scalpel has two different ends, one sharp-pointed as the other
parts of cutting and blunt-tipped hollow as the attachment of a scalpel
handle. Installation
means: holding area with a blunt knife needle-holder and plug holes in
the area of the tongue handle until it locks (you hear). How to release: hold the knife edge with a needle-holder and release the grip of the tongue, then dispose in the trash. The handle scalpel is often used is the size 3 that can be used with scalpel blades in a variety of sizes. While the scalpel blade that is often used is the size no.15. No.11 size used for incision of perianal abscess and hematoma. Scalpel is used like a pen grip with maximum control when cutting is done. In daily practice, scalpel handles are usually ignored that only using a scalpel blade. This
could be accepted with the knife still in a state consideration sterile
(new package) and should be used with good control so as not to cause
tissue damage when cutting.
2. Scissors
It basically combines the action of scissors slicing and shaving. Shaving requires smooth action conflicting pressures between the thumb and other fingers child. Movement is usually done by shaving the dominant hand which is not recognized and based on instinct. We recommend using the thumb and ring finger on the second hole of scissors. This will cause the index finger when cutting instruments support so that we can cut to the right. In addition, the use of the thumb and index finger on the hole is usually the controlling scissors reduced. The types of objects based on his scissors, shears the network (surgical), yarn scissors, bandages and scissors iris scissors.
a. Network scissors (surgical)
Scissors tissue (surgical) consists of two forms. First, form a blunt end and bent-shaped ends. Scissors with blunt ends be used to make up the field of tissue or soft tissue, which can also be cut sharply. Scissors with curved ends made by experts on a flat metal carefully. Cutting with scissors is done in the case of lipoma or cyst. Usually done by mengusuri borderline lesions with scissors. It must be ensured that the cuts do not cross the line because the lesions can cause damage.
b. Scissors Yarn (dressing scissors)
Scissors are designed to cut threads thread. The scissor-shaped straight and sharp-pointed. Use only for cutting threads, not to the network. This
scissor lift is also used when the wound yarn on techniques that have
been dried with a thread cutting inserts and should use the tip of the
scissors. Be careful in cutting the stitches. If the tip protruding suture scissors, cut the risk of other structures there.
c. Bandage Scissors
Bandage scissors angle is tipped scissors with a blunt tip. These scissors have a small head on a useful tip for ease in cutting bandages. This type consists of a pair of scissors knowles and lister. The base of this scissors is longer and very easy to use in cutting bandages. Blunt tip designed to prevent accidents when done remove bandages. In
addition to forming and cutting bandages just before closing the wound,
is also safe to use scissors for cutting bandages when the bandage was
placed over the wound. (Wikipedia)
d. Iris Scissors
Iris scissors are scissors with sharp edges and small about 3-4 inches. Normally used in surgery ophtalmicus especially iris. In minor surgery, iris scissors used to cut threads because the tip is small enough to slip when done remove the thread. (Online dictionary)
B. Instruments With Hold Function
3. Tweezers Anatomy
Anatomy has a blunt tip tweezers smooth. In general, tweezers used by the thumb and two or three other fingers in one hand. Spring pressure occurs when the fingers pressed together in the opposite direction and generates grasping ability. This tool can grasp small objects or tissue quickly and easily, as well as move and issued a variety of tissues with pressure. Anatomy
tweezers is also used when stitching is done, a network exploration and
form a stitch patterns without involving the fingers. (Wikipedia)
4. Tweezers Chirurgis
Tweezers Chirurgis usually has a 1x2 arrangement of teeth (two teeth on the field). This toothed tweezers used on the network; must
be the exact calculation, because it may damage tissue when compared
with anatomical tweezers (can be used with smooth grip). This
tool has the same functionality as the anatomical tweezers to form a
stitch pattern, removing sutures, and other functions. (Wikipedia)
5. Clamps Network
Tissue clamps shaped like pincers with two interconnected springs on her toes. The size and shape of these tools varies, there are long and short, and there are those that are scalloped and there is not. This tool is useful for holding tissues appropriately. Usually held by the dominant hand, while his other hand to cut, or sew. How pemegangannya: clamp held in a relaxed state such as holding a pen with a position in the middle of the hand. Many people who hold these clamps with one, which forces the arm in full pronation position and cause the hands to become tense. In use, careful tissue damage. Hold the clamp gently as possible, try to limit the depth of mobile networks should be. Clamps toothed network has small teeth on the end that is used to hold the tissue firmly and with accurate control. Be careful, clumsiness when using these tools can damage the tissue. Then,
not toothed clamps also have the risk of tissue damage if left too long
tongs, as the clamp has a strong pressure in grasping tissue.
C. Instruments With Bleeding Stop Function
6. Artery Clamps
In
principle, artery clamps useful for stopping bleeding of small blood
vessels and other tissues with a proper grip without causing unnecessary
damage. In general, artery clamps and needle-holders have the same shape. The
difference in the structure of the jaws (figure 2), which clamps the
artery, the clip structure in the form of parallel lines on the surface
and the length of the pattern of the clips to the handle slightly longer
than the needle-holder. This tool is also available in two forms namely straight and curved forms (mosquito). However, bent shape (mosquito) is more suitable for use in minor surgery.
How to use: arterial clamps have a ratchet on the handles. Ratchet is what causes the arterial clamp position in a state terututup (locked). Ratchet
generally have three degrees, which at the time of closure do not
directly use the final degree because it will bind automatically and is
difficult to remove. The release of the clamp is done by first must be pressed into the handles, then separated, opening the handles of both. We
recommend using the thumb and ring finger as this will cause the index
finger so that it can support the instruments work properly position the
grappling.
Artery clamp smooth-shaped clamps with parallel latitude lines that form a circle when the instrument channel is closed. These are relatively long tongs to grip handled that allow finer network without destruction. Grappling with the tip bent (mosquito) function to assist the binding of blood vessels. Do not use these clamps to sew, and therefore does not support the structure of the clip holding the needle.
D. Instruments With Function Tailoring
7. Needle Holder
Needle holder is useful for holding suture needle insertion is done. Overall between the needle holder and clamp the artery of the same form. Handled and ends the clip may be either straight or curved. However, the most important is the difference in the structure of the clip (Figure 2). The
structure of the needle holder jaws shaped criss-cross on its surface
and has handled a longer size of the clip, to prisoners who are strong
in holding the needle. Therefore, do not grasp tissue with a needle holder because it will cause serious tissue damage.
How
to use: how to shut down and remove the ratchet similar to the method
that has been presented on the use of artery clamps above. Needle is held at a distance of 2/3 of the end of the hollow needle, and is at the tip of the needle-holder jaws. This will facilitate network puncture at the time of stitching done. In addition, holding the needle in an area close to the needle holder hinge will cause the needle to bend. Then,
steered needle slightly toward the front of the instrument jaws as it
will be adjusted to the natural direction of the hand when insertion is
done and hands will feel more comfortable. Failure to deflect the needle will cause the needle to bend.
Sewing
techniques: keep the ring finger and the thumb hole settled on the
handle while sewing done that restrict the movement of the hand and arm. Hold the needle holder with the palm of the hand will give good control. Constantly, do not remove the finger from the hole handled because it can damage the sewing rhythm. Consider
use your thumb on the hole which settled handled, but the manipulation
of the other hole with the ring finger and little finger.
Figure 2. Clamps Difference Between Network Structure clamp, clamp the artery and Needle Holder
8. Suture
Can be absorbable suture and non-absorbable. Absorbable thread that is usually used for the network layer, binding to blood vessels and sometimes used in minor surgery. Non-absorbable thread is usually used for a particular network and should diremove. In addition, there is also the suture are natural and synthetic. The thread can be monofilament (Ethilon or prolene) or braid (black silk). Generally, minor surgical wound on closed using non-absorbable thread. However, stitching subkutikuler should use this type of absorbable threads.
Black silk yarns are braided non-absorbable nature of the most widely used. Even so, this thread can cause tissue reaction, and produces a rather large wound. This type of thread should be avoided, because today has many alternative synthetic yarn that gives better results. Sores on the scalp is bounded is an exception, because of the use of this type of thread is more satisfying.
Abosrbable non-synthetic yarn consists of prolene and ethilon (trade name). This form of monofilament yarn which is best thread. This type of yarn is quite smooth and flexible and produces little tissue reaction. However, it is more difficult types of yarn tied on silk so often leads to open seams. This problem can be solved by using special techniques like the thread while stitching is done by adding or tying yarn winding. Prolene
(polypropylene monofilament) sutures can improve security and easier
diremove compared with Ethilon (polyamide monofilament).
Catgut is the best example of a natural absorbable threads in the group. Type of monofilament yarn is made from the gut biology sheep and cattle. There are two kinds of catgut, plain catgut and chromic catgut. Plain catgut has the power for 7-10 days. While chromic catgut have power for 28 days. However, both types of yarns can produce tissue reaction.
Absorbable synthetic yarn consisting of vicryl (polygactin) and Dexon (polyclycalic acid) which is a multifilament yarn. This thread is longer than catgut and have little tissue reaction. Its primary use is to stitch diremove subkutikuler unnecessary. In addition, it can also be used to suture the wound closure and binding on blood vessel (hemostasis).
There are two systems in regulating thickening of the thread, which is the metric system and the traditional system. The numbering system in accordance with the metric thread diameter in tenths of a millimeter. For example, a thread with a size of 2 means has a diameter of 0.2 mm. Traditional system is not rational, but many are using it. The thickness of the thread mentioned using a zero value for example 3/0, 4/0, 6/0 and so on. Most of its value, the smaller the thickness. 6/0 is most delicate numbers diameter thick as hair, are used on the face and the kids. 3/0 is the measure most commonly used in thick mostly minor surgery. Particularly harsh for the skin (skin shoulder). 4/0 is the middle value is also frequently used.
In a suture package, there is all the information about the threads and the full needlenya in the cover package. Each package has two outer seam, the first made of stronger paper that bind to the transparent cover. The suture package secured in a sterile state until the cover is open. Therefore, when opening the package, save it into a sterile container. The second part of the envelope is made of paper soaked in silver on one side. This facilitates suture package Basahan separated from the paper. Then by using a needle-holder, lift the needle of the windings and align carefully. Then, use for sewing action.
Recommendations that can be used suture material is monofilament prolene or Ethilon 1.5 metric (4/0) for interrupted sutures on all parts. Monofilament prolene or ethilon 2 metric (3/0) to a non-absorbable sutures subkutikuler. It can also be used for interrupted sutures on the skin, for example on the hard shoulder. Vicryl 2 metric (3/0) used in the absorbable sutures and suture subkutikuler in hemostasis. Vicryl 1.5 metric (4/0) is used for soft tissue or sutures subkutikuler stitches in. prolene or Ethilon 0.7 (6/0) for smooth stitching on the face and in children.
9. Surgical Needle
When
this form of surgical needle used by most people is the kind of
atraumatic consisting of a hole in the end which is where the thread
insertion. Thread will follow the path of the needle without causing tissue damage (trauma). In the old model has eye needle and thread loop on that can cause trauma. Needle has the same basic parts, despite these varied shapes. Each section has a tip, which is part of the body and the insertion hole threads. Most of needle-shaped curve with a size of ¼, 5/8, ½ and 3/8 circle. This causes the needle has to meet with a range of other needed stitches. There are also forms a straight needle, but rarely used in minor surgery. Needle flat semicircular used to facilitate its use with the needle holder.
Post a Comment