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(BQ) Part 1 book Surgical handicraft manual for surgical residents and surgeons presents the following contents: Local anesthetics used for minor surgery, digital nerve blocks (finger and toe blocks), minor surgical procedures of subcutaneous swellings, ingrowing toe nail, venous cutdown, resuscitation in trauma,...
Chapter 21 Digital Nerve Blocks (Finger and Toe Blocks) R Dayananda Babu Anatomy There are four digital nerves for each finger/toe including the thumb and great toe (Fig 21.1) The palmar digital nerves have the most extensive sensory distribution (Fig 21.2) They are responsible for the distal finger and Fig 21.1: Section of digit showing the dorsal and palmar digital nerves Digital Nerve Blocks (Finger and Toe Blocks) Fig 21.2: Sensory innervations of the dorsal and palmar view fingertips sensation including the nail bed Although the dorsal nerves have a lesser distribution, there is sufficient overlap with the palmar nerves All four branches on each finger/toe must be blocked to achieve complete digital anesthesia The digital nerves are immediately adjacent to the phalanges and these structures act as landmarks for locating the nerves Indications For suturing of the wounds distal to the level of the midproximal phalanx/ toe For removal of nail For paronychia drainage For pulp abscess drainage For repair of lacerations of the digits Techniques for Digital Nerve Block For the procedure, 1% lignocaine without adrenaline is recommented Usually mL of the solution is used Small needle of sizes 24 to 28 gauge are used for injection Two needle pricks are used to block the nerves on either side The needle is introduced into the dorsolateral aspect of the proximal phalanx in the web space just distal to the metacarpophalangeal joint The dorsal digital nerve is approached first followed by redirecting the needle to the palmar nerve Approximately 0.5 mL of the anesthetic is delivered to the dorsal digital now The needle is then withdrawn and redirected adjacent to the bone of the phalanx to the volar surface of the digit and mL of the solution is deposited at the site of the palmar nerve The procedure is repeated on the other side of the digit to achieve full finger/toe anesthesia (Fig 21.3) 105 106 Surgical Handicraft Fig 21.3: Performing digital nerve block in hand and toe The deposition of local anesthetic into the web space prevents excessive buildup of pressure on the digital nerves and blood vessels The needle is advanced in such a way that it touches the bone Maintaining close proximity of the needle to the bone at all times will ensure good blockade because the course of the nerve is adjacent to the bone A complete blockade is usually achieved within to minutes Chapter 22 Minor Surgical Procedures of Subcutaneous Swellings R Dayananda Babu Lymph Node Biopsy, Excision of Cystic Swellings and Lipoma under Local Anesthesia Lymph Node Biopsy In general terms, lymph nodes in the neck, supraclavicular fossa, axilla or groin should be biopsied under a general anesthesia However, if they are very easily defined and the doctor is experienced, superficial lymph nodes may be excised using local anesthetic infiltration In generalized lymphadenopathy, it is preferable to take a neck node rather than axillary or inguinal node If inguinal and axillary nodes are enlarged, it is preferable to take axillary rather than the inguinal (inguinal lymph nodes are enlarged in bare-footed persons, and therefore, may not be significant) Steps of Lymph Node Biopsy of Neck Position of the patient—small sand bag behind shoulders with a head ring for support and head tilted to contralateral side Skin antiseptic preparation and draping of the area Infiltration of local anesthetic agent/general anesthesia The incision should be made in the line of the skin crease over the swelling and should be at least twice the size of the node to be biopsied to ensure that the whole dissection is carried out under direct vision The fat and superficial fascia should be incised in the line of the wound and the lymph node or group of nodes exposed using blunt dissection If necessary, a small self-retaining retractor may be used to aid the dissection The tissue that tethers the deep surface of the node will contain small blood vessels and lymphatic channels, and therefore, an artery clip is placed across this pedicle, which is then ligated and divided, leaving the clip attached to the specimen (it may be adherent to the major vein like internal jugular vein) 108 Surgical Handicraft The capsule of the node should not be grasped, since this may distort the histological features It is preferable to take a lymph node intact, rather than a part of the lymph node If tuberculosis is suspected it is better to take two nodes, one for the pathology and for microbiology department The specimen for the microbiology is sent in saline bottle and for the pathology department, the specimen is sent in formalin 10 The wound is closed with subcutaneous absorbable sutures and 3/0 nylon to the skin Note: Remember most of the lymph nodes of the neck are deep to the deep fascia, and therefore, one has to open the deep fascia Lymph nodes are distributed along the veins, and therefore, it is important to avoid injury to the internal jugular vein, if it is located near to the vein While doing posterior triangular lymph node biopsy, one should take care of the spinal accessory nerve Excision of Sebaceous Cyst and Other Cystic Swellings Sebaceous cysts are of two basic histological types, although the distinction has no significant practical relevance • Those arising from hair follicle cells are more properly called pilar cyst and occur on hair-bearing areas such as the scalp • Epidermoid cyst arises from nonhair-bearing areas such as the palms and soles • Although usually simple to diagnose, nevertheless, a sebaceous cyst can sometime be mistaken for other lesions Differential Diagnosis of a Cystic Swelling Thyroglossal cyst in the midline at the front of the neck Brachial cyst anterior to the sternomastoid at the junction of its upper third and lower two-third Parotid tumor at the angle of the mandible Congenital dermoid cyst at lines of embryonic fusion Caseating lymph node Pulsating boney swelling of the skull—metastasis from follicular carcinoma thyroid (mistaken for sebaceous cyst at times) Rarely a solid subcutaneous tumor (such as secondary deposit of a malignant melanoma; thus all excised specimen should be sent for histological examination) Minor Surgical Procedures of Subcutaneous Swellings Site of the Cyst Cyst in some sites of body can cause great difficulty in their removal, unless the doctor is experienced Cyst situated in the posterior triangle of neck or behind the angle of the mandible should be done carefully because of the risk of damage to the spinal accessory and facial nerve Removal of cyst on the back of the neck may be more difficult and more bloodier than expected because the skin there is often thick and firm If possible, the cyst should be removed wholly The cyst wall is often (but not always) attached to deep layers of the overlying dermis If any remnant of the cyst wall is left behind, the cyst is likely to recur For this reason, incision and squeezing out the contents is not recommended (except when infected), although puncturing and emptying the cyst can allow the deflated cyst to be removed through a smaller incision and is an acceptable technique (Figs 22.1 to 22.3) Swellings in the Scalp When removing small cyst in the scalp, it is often enough to trim the hair immediately overlying the cyst itself and then to hold the rest of the hair out of the way with adhesive tapes Fig 22.1: Sebaceous cyst excision Fig 22.2: Excision of a small sebaceous cyst simple incision over the dome 109 110 Surgical Handicraft Fig 22.3: Excision of a sebaceous cyst avoding dead space Steps of Excision of Large Cyst Under Local Anesthesia Position—according to the site of the swelling Antiseptic skin preparation (it is preferable to clip the hair overlying the swelling and the surrounding area) and draping Local infiltration Incision: An elliptical incision is put over the swelling so that the redundant skin can be avoided during closure This will also avoid dead space The elliptical incision should be centered on the punctum with care taken not to puncture the cyst The incision is carefully deepened by sharp dissection until the plane between the cyst and the subcutaneous fat is identified Once this plane has been entered, the cyst may be easily shelled out by blunt dissection with an artery forceps or curved dissecting scissors It may be helpful to retract one end of the skin ellipse with an artery forceps Special care should be taken when dissecting the neck or face to avoid accidental damage to any underlying vessels and nerves, particularly when applying traction If the cyst is accidentally incised during the initial skin incision or during the excision, subsequent dissection may be difficult and messy In these circumstances, it may be helpful to make a fresh, slightly more lateral skin incision, allowing the dissection to proceed further away from the cyst wall and minimizing spillage of cyst content into the wound Any spillage should be mopped up with a wet swab Inflamed Sebaceous Cyst If the cyst is red and painful but the overlying skin is not too angry or indurated, then it is often better to excise the cyst followed by primary suture rather than subjected to incision and drainage followed by later excision The local anesthetic takes longer time to work when there is inflammation Excision of the inflamed cyst will always give rise to more bleeding during the procedure (Fig 22.4) Bleeding will be minimized when local anesthetic mixed with adrenaline is used Minor Surgical Procedures of Subcutaneous Swellings Fig 22.4: Sebaceous cyst excision by secondary incision Previously Infected Sebaceous Cyst The excision of a previously infected cyst may be quite difficult and bloody because of dense fibrous tissue formed In such circumstances, it may be impossible to shell out the cyst Instead the cyst should be excised by sharp dissection in continuity with a block of subcutaneous tissue (Fig 22.5) Fig 22.5: Excision of previously infected sebaceous cyst Lipoma Small superficial lipoma or lipomata are easily diagnosed and shelled out under local anesthesia, however, larger lipomas may extend deep to the deep fascia and sometimes may be intermuscular Lipomas of the back may be deeper than expected and it is safer to it under general anesthesia (Fig 22.6) The fat lobule of a lipoma are usually larger and are easily distinguished from those of normal subcutaneous fat (Fig 22.7) The tumor is usually well-defined with a very thin capsule and can be either dissected out or removed using the squeeze technique 111 112 Surgical Handicraft Fig 22.6: Lipoma dissection Fig 22.7: Dissection of lipoma lobule Steps of Excision of Lipoma Position of the patient—according to the site of the swelling Antiseptic skin preparation and draping Local infiltration Incision is made over the swelling along the skin lines of least skin tension and deepened until the lipoma is identified The incision is needed only for two-thirds of the length of the lesion Once the plane is found between the lipoma and the subcutaneous fat, then it is shelled out by blunt dissection using scissors or a finger (Fig 22.8) Minor Surgical Procedures of Subcutaneous Swellings Fig 22.8: Lipoma finger dissection Occasionally, there are some tethering vessels on deep surface of the lipoma and these should be ligated with absorbable sutures Secure hemostasis The wound should be closed taking care to avoid any dead space In the squeeze method, a smaller incision is made and traction is applied to the lipoma, while digital pressure is applied around the lesion’s circumference to squeeze it out of the wound Since the wound is deliberately small, its cavity cannot be easily inspected Therefore, particular care should be made to ligate any vessels to ensure against any bleeding inside the wound 113 Orthopedics Complications Malunion Stiffness Inferior radioulnar dislocation Carpal tunnel syndrome Extensor pollicis longus rupture Complex regional pain syndrome Management Closed manipulative reduction may be done Using general anesthesia/Bier’s block/sedation, the assistants give traction countertraction and the surgeon reduces by disimpacting and reducing by giving a palmar flexion and ulnar deviation (Fig 33.89) Colles used to give a below elbow slab called the Colles’ Fig 33.89: Traction in Colles’ fracture to disimpact 263 264 Surgical Handicraft plaster which we follow even now, although as a fracture involving inferior radioulnar joint scientifically an above elbow slab should have been given as in Smith fracture Time has proven that a below elbow plaster is ideal This should be applied for 5–6 weeks A plaster check at day and a repeat X-ray at day 10 is ideal (Figs 33.90 and 33.91) For a malunited fracture, excision of the lower one inch of ulna retaining the ulnar styloid for ulnar collateral ligament is done commonly A definitive management is osteotomy and plate fixation of the radius with Darrach’s procedure SCAPHOID FRACTURE Scaphoid fractures are complicated by the distally based blood supply The fractures can be waist fracture, proximal and distal pole fractures and the tuberosity fracture The proximal pole fracture has a high incidence of avascular necrosis and nonunion An attempt of Closed Manipulative Reduction (CMR) and conservative management can be done and if the Fig 33.90: Palmar flexion Fig 33.91: Ulnar deviation Orthopedics fracture stays displaced, an ORIF and screw fixation can be done Nonunion can be managed by bone grafting along with Herbert screw fixation If there is coexisting arthritis, arthrodesis of the involved joint can be done BENNETT’S FRACTURE Bennett’s fracture is fracture dislocation of the base of the first metacarpal The deforming force is the tendon of abductor pollicis longus The differential diagnosis is a ‘T’-shaped fracture of the base of the first metacarpal called Rolando fracture Closed manipulative reduction and casting can be attempted If the displacement persists, a K-wire fixation can be done 265 Index Page numbers followed by f refer to figure and t refer to table A Abdominal binders 172, 172f Abscess in different parts, drainage of 118f Abscess, deep 117 Abscess, drainage of 117 Accidental damage 41 Acid-base imbalance 34 Acromioclavicular dislocations 247 Acromion scapula 247 Adult bradycardia, management of (with pulse) 60 cardiac arrest, management of 59 CPR/AED 57 tachycardia, management of (with pulse) 61 Airway compromised 127f control 126 patency, advanced techniques for 58 Albumin 30 Alkaline phosphatase 76 Ambu bag 128f Ametrop gel 39 Ampicillin 83 Amputation stump 170 bandage 171f Anesthesia, infiltration of local 122f Analgesia 192 Anemia 191 Anesthesia induction of 19 professional 20 Anesthetic infiltration, local 102f Anesthetics used for minor surgery, local 101 Anesthetics, local 101 Anisocoria 181 Ankle foot 240 ligament strains 240 Ankle fractures 241 Antegrade intramedullary interlocking nail, method of closed 236f Antibacterial ointments 176 neosporin 176 Antibiotic prophylaxis, concept of 82 Antidiuretic hormone 28 Antiseptics and ointments for wound management, use of 174 Anti-shock trouser contraindications, medical 130 disability, medical 130 glasgow coma scale, medical 130 indications, medical 130 medical 130 Antithyroid drugs 73 Apley’s grinding test 237 Arrhythmias and cognitive deficits 74 valvular heart disease 68 Artery forceps enlarging incision 137f inserting 138f ASA classification of anesthesia 79 Asthma 67 Austin moore’s prosthetic replacement 234f Autologous blood 133 Automated external defibrillation 56 Autotransfusion 133 Avascular necrosis 232f 268 Surgical Handicraft Axila, level of 17 Axillary veins, anatomy of 50f B B vaccination Bag polyurimeter, collecting 151f Bag, collecting 150f Balloon, inflating 154f Bandage circular 163 for head, recurrent 164f recurrent 163 triangular 166, 169f Bandaging technique 162, 168f Bandaging, representation of 168f Barbiturate coma 195 Baron guillaume dupuytren 241f Barrel bandage 168, 170f Basic airway techniques 126 Basic life support (BLS) 55 Basilic vein 43 Battered baby 205f Battle’s sign or mastoid ecchymosis 182 Biliary stents 77 Bilirubin 76 Blades generally used, types of 91 surgical 91 Blairs method 119f Blockage, causes for 161 Blocked tube 161 management of 161 Blood loss, surgical 30 products resuscitation with whole 133 sugar 71 supply of femoral head, distally based 231f transfusion 71, 133 vessel 145 Bloody vicious cycle 134 Bohler’s angle 244 Bones forearm 209 Bosworth screws 247 Bovine cartilage 33 Bowel operations, large 77 Brain herniation in raised intracranial pressure 181 injury, traumatic 178 trauma foundation (BTF) 178 Breast abscess 119 bandage 169, 170f incisions 95, 95f Breathing and ventilation 128 Bryant sign 248 Bucket handle tear 239 Bupivacaine 102 Butterfly strapping 172 of abdomen 173f C Calcaneum 243 Callaway sign 248 Callaway’s test 249f Cannula choice of 38 insertion after wound sutured 122f into vein, advance rest of 40f specifications for 39t Cannulation complications, intravenous 41 Cannulation contraindications, intravenous 37 Cannulation, intravenous 37 Cannulation, site selection for 37 Capeline bandage 166f Caprini scoring system 88 Cardiac arrest 54 causes of 54 types of 54 Cardiac arrhythmias 35 Cardiopulmonary resuscitation 54, 56 Cardiovascular diseases 67 Cardiovascular life support, advanced 55 Carica papaya 177 Carotid artery puncture 50 Catheter along guidewire in vein, inserting 47f flow 44 fully 153f Index in market, types of 146 management of 155 materials 43, 146 removal of 156 retained 156 sizes of 43, 149 tip position, complication of 52 types of 146, 146f withdrawing 155f Catheterization, problems during 154 CDC classification 23 Center for disease control (CDC) 23 Central fracture dislocation fixed with plate and screws 227f Central vein cannulation 48 Central venous access devices (CVADs) 43, 120 catheter 43, 44 pressure 49 Cerebral microdialysis 191 Cervical spine injury 225 vertebrae, different 224 Chaputs tubercle 241 Chest compressions, performing infant 56 tube connected to underwater seal 139f in position 140f wounds, open 128 Chin lift 127f Chlorhexidine 45, 174 Cholangitis, acute 77 Chopart’s joint 244 Chromic catgut 62 suture 63f Cirrhosis 77 Clavicle 246 Clean hands save lives (WHO) 10 Clostridium difficile 83 Code of conduct Cohort nursing 22 Collagen-based dressing, uses of 177 products 177 Colles’ fracture 206, 207, 210, 262 complications 263 management 263 six displacements 262 to disimpact, traction in 263f Colloids 33, 34, 35 controversy 33 Compartment syndrome 217f Compensation neurosis 223 Complete blood count 76 Condom catheter 149f Condyle fractures displacement of lateral 258f lateral 257 of humerus, lateral 257f Consensus, final 82 Consent for colostomy 78 Consent, informed 70 Coronary artery disease 68 Cotton’s fractures 242 Coudé catheter 147 Cough 67 CPR on child, performing 56 CPR revised guidelines 57f Cruciate incision 119 Crush injuries of foot 245 Cryogesic spray 39 Crystalloid 33-35 and colloids advantages 34t disadvantages of 34t maintenance fluids 31 normal saline 33 vs colloid debate 132 CSF otorrhea 182 CSF rhinorrhea 131, 196 CT head in mild TBI, indications for 183 Cushing’s reflex of hypertension 180 CVC, parts of 45f Cyst and other cystic swellings, excision of sebaceous 108 avoding dead space, excision of sebaceous 110f simple incision over dome, excision of small sebaceous 109f site of 109 under local anesthesia 110 Cystic swellings, excision of 107 269 270 Surgical Handicraft D Danis-Weber classification 241 on level of fibular fracture 244f Dentiginous imperfect, brothers with 204f Dextranes solution 32 Dextrans 30 Diabetes mellitus 74 investigations 74 preoperative evaluation 74 Diabetes on insulin, type I 75 oral hypoglycemic agents, type II 74 Diabetic patient 69 Diastatic fractures 187 Diclofenac sodium 142 Diffuse axonal injury (DAI) 196 Digoxin 54 Dislocations 198, 248 Dislodged nasogastric tube 161 Dislodgement, causes for 161 Doctor-patient relationship Dorsolumbar spine fracture 226f Drawers test 248 Dressing pad application 140f Drugs, prescribing Dugas test 248 Dupuytrens fracture 242 DVT prophylaxis 194 goals of 87 types of 87 DVT, diagnosis of 87 Dynamic hip screws 233, 234f Dyspnea 67 E Ear or mastoid bandage 168, 169f Ebers papyrus 62 Elbow closed manipulative reduction of 60f dislocations 257 posterior dislocation of 258f pulled 259 rich vascular anastomosis around 255f Elective surgery 79 Emergency surgery 79 Emla cream 39 Endocrinology 73 Endogenous 26 Endotracheal tube 58, 128f, 192 Epicondyle fractures 258 Essex-Lopresti fracture 262 Eusol and dakin solution 175 Euthyroid before surgery 73 External pressure treatment 214 Extracapsular FNOF 233 Extradural hematomas 188 acute 178 with shift of midline to right, large left parietal 188f Eye bandage 166 opening 131 response 179 F Face mask 58 Fat embolism 219f syndrome, diagnosis of 216 Female catheterization 153 Femoral fractures, displacements in different shaft of 236f Figure of eight 170 bandage 163, 164f Finger sweep method of clearing oral cavity 127f First aid management of flail chest 129 Fixation devices, internal 211 Fixing tube 140f Flashback of blood in hub of cannula 40f Fluid and electrolyte replacement, adequacy of 29 Fluid balance 27 Fluid management, postoperative 27 Fluids and plasma, composition of replacement 35t Focal neurological deficits 182, 183 Foley’s catheter 119, 131, 147, 147f parts of 149f Foot 245 Four tailed bandage 165f Index Fracture 198 and split fracture of tibial condyle, depressed 200f avulsion 200 Bennett’s 265 both bone forearm 260 of leg 240 clavicular 168 comminuted 199, 199f compound 199 compression 201 dislocation elbow 257 Galeazzi 261f hip 227, 230, 230f complications 230 of cervical spine 225f shoulder 251, 252f fixed 220f Galeazzi 210, 261, 262 Giovanni Battista Monteggia 260 green stick 201, 201f depressed 201 pathological 201 stellate 201 intra-articular 210 knee tibia 240 malunited 220f management, open 253 monteggia 210 neck of femur 230 Garden’s staging of 232f neck of humerus 251 oblique 198 of calcaneum, depressed 246f of clavicle, forces acting on 246f of proximal femur, types of 232f of spine 224 treatment 226 olecranon 259 on thomas splint, open 199f open 252 depressed 182 pathological lymphoma 202f unicameral bone cyst 201f pelvis 226 reduced 220f Rolando 265 segmental 200, 200f shaft of femur 234 humerus 252 management 252 simple 198, 199f skull 187 spine 224 transverse 198 trochanteric 206 types of 198, 201 Galeazzi 262 union 201 French osteotomy 256, 256f G Gangrene of left upper limb to rule out gas gangrene 215f Garden spade deformity 205f Gartland classification of supracondylar fracture humerus in children 254f Gastrointestinal tract 28 GCS, limitations of 179 Gelatins solution 30, 32 Genitalia, cleaning the 151f Germinal matrix after total nail bed excision, removal of 116f Gibbon catheter 148f Gissane’s crucial angle 244 Glasgow coma scale 179 eye opening response 179 verbal response 179 Gloved finger separating adhesions of pleura 138f Gloving techniques Gloving, closed method of 6, 15f Gloving, open method of 15, 16f Gloving, steps of closed method of 15f Glucose required 29 Glycemic control 195 Gunstock deformity 256 Gypsum plaster 210 H Hamilton’s ruler test 249f Hand hygiene five moments for 10 policy 39 271 272 Surgical Handicraft Handwashing 10 practice 10 steps 13f Hartmann’s solution 34 Haversian system 198 Hawkins classifications of talar neck fractures 245f Head bandage 165 types of 167f Barton’s bandage 165 capeline bandage 165 four tailed bandage 165 injured patient, management of 183 injury 178 transport of 184 recurrent bandaging 165 trauma 180 Healthcare associated infections 10 environment 10 worker 10 Hemaccel, gelofusine 33 Hematologic syndromes 87 Hematoma 42 intracerebral 190 Hemodialysis catheters 48 Hemoglobin-based oxygen carriers 133 Hemorrhagic shock 30, 129 Hilton’s method 119 Hip dislocation, close manipulatory reduction of 229f Hippocratic method 249 Holstein-Lewis syndrome 252 Horner’s syndrome 182 Hospital surgical surveillance program 26 House surgency House surgeons/residents, model conduct for Hutchinson’s pupil 181 Hybrid fixation 211 Hydrogen peroxide 175 Hydroxyethyl starch 32, 33 solution 30 Hypercapnia 191 Hypercoagulable states 87 Hyperglycemia 191 Hypernatremia, causes for 193 Hypertension 191 Hypertonic saline 132 solution (HSS) 194 Hypervascular nonunions, types of 221f Hypocapnia 191 Hypochloremic alkalosis 76 Hypoglycemia 191 risk of 74 Hypokalemia 35 exists 35 Hyponatremia 191 Hypoosmolality 191 Hypotension 191 Hypothermia, avoid 71, 133 Hypothyroidism 74 Hypovascular nonunions, types of 222f Hypovolemia 30 Hypoxemia 191 I IJV cannulation 47f Iliac crest bone grafting 222f Incentive spirometer 142f Incision 117, 118f, 137f and drainage, dangerous areas for 117 Infected wounds, management of 175 Infection treatment, deep incisional surgical site 24 Ingrowing toe nail 114 Injury in pulled elbow, mechanism of 259f Intercostal drainage tube 135 Intracranial air 187 Intravenous cannula, parts of 38f Intravenous cannulation indications 37 Intravenous fluids 27 Intravenous replacement fluid 31 colloids 32 crystalloids 31 properties of 33 Intravenous replacement therapy 31 Index Intraventricular hemorrhage 189 predominantly in right lateral ventricle 190f Ischemia from vascular damage 214 Ischemia of limb 209 J Jaw thrust maneuver 127f Jefferson’s fractures 226 Jehovah witness Jugular vein anterior approach, internal 50 Jugular vein, internal 50 K Kitgut 62 Knee dislocation 239 menisci of 237 Knife for incision, method of holding 92f Kocher’s method 249 Kuntscher nailing 236 K-wire fixation 265 of supracondylar fractures 255f L Lachman test’s 237, 237f Laparoscopic surgery 77 Laryngeal mask airway 58 Lauge-Hansen classification 241, 242f Lefort-Wagstaffe fracture 242 Legs together, bandaging both 208 Life-threatening chest injuries 129 Ligaments 237 Lignocaine 101 jelly 152f Lipoma 111 dissection 112f finger dissection 113f lobule, dissection of 112f steps of excision of 112 under local anesthesia 107 Lisfranc 244 Lisfranc joint 244 Liver 76 function tests 76 Local anesthetic, infiltration of 102 Log book Looser’s zone 202f, 204f Lucid interval 180 Lumen, medial 45f Lumen, proximal 45f Luxatio erecta dislocation 247 Lymph node biopsy 107 of neck, steps of 107 M Mafenide acetate 176 Magill’s endotracheal tube 160 Male catheterization 150f procedure 151 Mallampati test 69 Malunited femur fracture, reduction of 220f Mattress suture, vertical 97, 97f McMurray test 237 Meniscal injuries 238, 239f different 239f Meniscus, zones of 238f Metformin increases 75 Methicillin-resistant Staphylococcus aureus 21 Metronidazole 83 Mild head injury 184 Minocycline 45 Monteggia fracture 260, 261f joints in 207 Morel-Lavallée lesion 207 Mount Fuji sign to large pneumocephalus 197f MRSA infection hand hygiene, prevention of 22 manifestations of 21 MRSA prophylaxis 22 MRSA, antibiotics for 22 N Nail bed, excision of 115, 116f Nail segment, removing 115f Nail, avulsion of 114 Nasogastric intubation 157 Nasogastric tube 76, 158, 160 contraindications for 131 insertion, equipment required for 159f 273 274 Surgical Handicraft parts of 157, 157f problems of 160 removal of 161 Nasopharyngeal airway 58 Neck bandage 169 veins, anatomy of 50f Needle from cap, removal of 40f Needle into vein, inserting 47f Needle, method of holding 96f Needles 66 reverse cutting 66 round bodied 66 Neglected disease 124 Nerve axillary 251 block anatomy of digital 104 digital 104 in hand and toe 106f techniques for digital 105 dorsal and palmar digital 104f Neuromuscular blocking agents, use of 192 Neurosurgical referral, indications for 184 Nine tips for house surgeons/residents NNIS risk index 25 Nonabsorbable sutures 64 natural 64 cotton 64 linen 64 silk 64 synthetic 64 polyamide 64 polypropylene 64 Nontouch technique 153f Nonunion of fracture neck of femur, causes of 233f Nonunion, causes of 233 Nonunions hypervascular, types of 221 Nutritional support 195 O Optic neuropathy, traumatic 182 Oral contraceptives 70 Oral hypoglycemic agents 69 Organ space SSI masquerading incisional 25 treatment 25 surgical site infection 24 Organisms for surgical site infection 82 Oropharyngeal airway 58, 127f Orthopedic fraternity 209 Orthopedic injuries, common 240 Orthopedics closed reduction 210 Orthopedics complication 212 immediate 212 neurovascular injury 213 Orthopedics early complications 214 Orthopedics external fixation 210 Orthopedics first aid 208 Orthopedics general complication 215 Orthopedics late complication 218 causes of nonunion 221 nonunion 218 types of nonunions 221 Orthopedics local complication 214 infection 215 loss of position of fracture 215 pressure sore 214 Orthopedics management 208 Orthopedics, ABCDEF of 208 Osteomalacia 202f, 203f Osteones system 198 Osteosynthesis 234f Oxygen, administration of 71, 129 P Packed red cells (PRC) 133 Palmar flexion 264f Pancreatic operations 76 Papain-based products 177 Papaya, fruit of 177 Paralysis 192 Paralytic ileus 35 Paraplegia, traumatic 226 Parrot beak tear 239 Patella 237 acute dislocation of 236 dislocation 236 tendon 237 Patient-related factors 26 Pauwel’s classification 231f Index Pediatric CPR/AED 56 Percivall pott 241f Perianal abscess 119 Periorbital ecchymosis 183 Peripheral IV lines central line 131 Peripherally inserted central catheters 46 Phlebitis 42 Pilonidal abscess, acute 119 Plain catgut 62 Plasma-derived colloids 34 Plaster of Paris 210 Plaster to cannula to fix it in place 41f Plastic catheter 148f Pneumatic anti-shock garment 130 Pneumocephalus 187, 196 Pneumothorax, complication of 52 Poliglecaprone 63 Polyamide sutures 65f Polydioxanone 64 Polydioxanone sutures 64f Polyester suture 65f Polyethylene sutures 65f Polyglactin 63 sutures 63f Polyglycolic acid 63 sutures 63f Polytrauma, case of 212 Polyurethane 43 Port needles 66 Post-cardiac arrest care 59 Post-compartment syndrome sequelae 216f Potassium required 29 Potts’s fractures 242 Povidone iodine 175 Practice evidence-based medicine Predictive index 25 Prilocaine 102 Primum non-nocere Pronation external rotation injury 243f Prophylactic antibiotic 81 in surgery 81 Prophylaxis of deep vein thrombosis 86 Prophylaxis, indications for 82 Prophylaxis, prolongation of 83 Proximal femoral nail fixation for trochanteric fractures 234f Pseudofracture 201 Pulmonary artery catheters 49 coronary 54 embolism 86 diagnosis of 88 prophylaxis of 88 treatment of 90 Pulp space abscess 119 Pupillary asymmetry 181 Q Q mechanism 237 Quadriceps mechanism 200f Quinolone 83 R Raccoon eyes 183 Radial head fracture 259 Red rubber catheters 147f Resuscitation, damage control 132 Retraction of prepuce, cleaning after 152f Rhinorrhea 182 Rifampin 45 Right frontal hemorrhagic contusion 190f Right frontoparietal intracerebral hematoma 191f Ringer’s lactate 34 Room environment, operating 71 Rotator cuff tear dislocation 247 Ryle’s tube 157 inserting 159 S Safe surgery essential objectives for 20 saves lives 18 Safety marked for tube insertion, triangle of 137f Saline required 29 Saline, normal 176 Sanitization of hands 40f Saphenous vein, anatomy of great 120 Scalp layers of 186f suturing 186 swellings in 109 275 276 Surgical Handicraft Scaphoid fracture 264 Screw fixation 234f Sebaceous cyst excision 109f by secondary incision 111f of previously infected 111f Sebaceous cyst inflamed 110 previously infected 111 Sedation 192 Seizure prophylaxis 194 Senic score 25 Sensory innervations of dorsal and palmar view 105f Serum albumin 76 electrolyte 193 Severe systemic disease 80 Severe TBI 190 Shoulder 247 anterior dislocation of 247f chronic dislocation of 248f dislocated 198f dislocation types 247 methods of reduction of 248 posterior dislocation of 251f Silicone 43 Silk suture 65f Silver nitrate 176 sulfadiazine 45, 176 disadvantages 176 Simple interrupted suture 96 Simple suture knots pulled to one side 97f SKI needles 66 Skin and soft tissue necrosis 214, 215f incisions 92 loss or damage 213 necrosis 213f preparation, preoperative 71 tension in limbs, lines of least 94f lines, identifying 95 of trunk, lines of least 94f on back, lines of least 93f on face, lines of least 93f Sodium chloride 33 Spatulate needles 66 Spinal injury, emergency management of suspected 224 Spine dislocations of 224 injury, management of 224 Spiral bandage 163, 163f reverse 163, 164f Spiral fracture 198 Staph epidermidis 83 Sterilization 66 Steroids 195 Stimson’s method 248 Streptococcus pyogenes 117 Subacute subdural hematoma 189f Subarachnoid hemorrhage in cisterns around brainstem 189f Subclavian vein 51 femoral vein 51 infraclavicular approach 51 supraclavicular approach 51 Subcutaneous swellings, minor surgical procedures of 107 Subcuticular suture, running 98 Subdural hematoma over right cerebral convexity, acute 188f Subdural hematomas 188 Sucking wounds 128 Sudeck’s osteodystrophy 223 Sulbactam 83 Sulcus sign 248 Superficial abscesses 117 Superficial lipoma, small 111 Superficial surgical site infection 24 Superior radioulnar joint 260 Supination adduction injury 242f Supination external rotation injury 243f Supracondylar fracture close manipulative reduction of 254f complications of 256 humerus 252 Surgery, scheduled 79 Surgery, urgent 79 Surgical blades, types of 91f Surgical cases, classification of 79 Surgical site infection 23 Surgical site infections, types of 23f Index Suture 62 absorbable 62 alternatives to 99 antibacterial 83 blanket 98f continuous 97, 98f locking running 98f materials 62 natural absorbable catgut 62 kangaroo tendon 63 natural, absorbable 62 properties of 62 removal 99, 100f remove 99 simple running 98f skin adhesive strips 99 clips 99 synthetic, absorbable 63 techniques 95 tissue glue 99 Syncope, history of 67 Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) 193 Synthetic absorbable sutures 66 Tibial tuberosity 237 Tiemann catheter 148f neoplex 147 Tillaux-Chaput fractures 242 Toes 246 Tongue fracture of calcaneum 245f Total nail bed excision f 115f Tourniquet, applying 40f Tourniquet, release of 41f Trabecular pattern of proximal femur 231 Tramadol 142 Transesophageal echocardiography 52 Trauma center, resuscitation area in 125 Trauma life support, advanced (ATLS) 126 Trauma team in trauma centers 125 Trauma, resuscitation in 124 Traumatic subarachnoid hemorrhage (SAH) 189 Trimodal distribution of death 126 Tube removal 143 Tube with artery forceps, holding tip of 139f TV cannulation, steps of 40 T U Talar fractures 242 Talus 242 treatment 242 T-bandage 171f TBI classification of 178 mild 183 Tennis score classification of hemorrhage 130t Tension pneumothorax 129 Theodor Kocher’s method of reduction of anterior dislocation shoulder 250f Therapeutic antibiotic 81 Thoracostomy tube, complications of 140 Thrombosis prophylaxis 90 Thyroidectomy 73 Tibia fracture upper 240 Ulcer prophylaxis, stress 195 Ulnar deviation 264f Unfractionated heparin 90 Upper GI endoscopy 75-77 Upper limb medial cubital vein, venous anatomy of 121f Urethral catheterization 145 requirements for 150 technique of 150 Urine outflow in drainage tube 154f V Vascular anastamosis 254 Vasogenic edema 190 Vasovagal faint/syncope 42 Vein femoral 52f thrombosis, treatment of deep 90 tip of cannula, pressure to 40f 277 278 Surgical Handicraft Venous air embolism, complication of 51, 52 Venous cutdown 120 complications of 123 Ventilation, indications for mechanical 129 Verbal response 131 Vessel lumen pythagorous theorem 49f Visual infusion phlebitis score 42t Volkman’s ischemia 254 Volkman’s ischemic contracture (VIC) 214 Volkman’s sign 218f Volkmann’s triangle 241 Volkmans ischemic contracture 217f W Wash hand 10 Wear gloves, preferably to 40f Wearing sterile gown and gloves 17 Wedge excision of nail bed 115f Wheeze 67 WHO surgical safety 8, 18 Wound breakdown 215 care antiseptics 174 care of 174 closure 95 infection, risk of 25 X Xylocaine 102 Z Zadik’s excision 115 Zadik’s operation 114 anesthesia 114 indication 114 procedure 114 Zollinger-Ellison syndrome 158 ... or 8) A B Contd 121 122 Surgical Handicraft Contd C D E F G H Figs 25 .3A to H: Infiltration of local anaesthesia A B Figs 22 .4A and B: Cannula insertion after the procedure and the wound sutured... maneuver Fig 26 .4: Chin lift Fig 26 .5: Oropharyngeal airway 127 128 Surgical Handicraft The Advanced Airway Techniques Consists of: Oral/nasal intubation (Fig 26 .6 and 26 .7) Surgical/ needle... with adhesive tapes Fig 22 .1: Sebaceous cyst excision Fig 22 .2: Excision of a small sebaceous cyst simple incision over the dome 109 110 Surgical Handicraft Fig 22 .3: Excision of a sebaceous