What Is a Surgical Wound?

Surgery (shu shù) refers to the treatment of the patient's body with medical equipment, such as resection and suture. The operation of the knife, scissors, needle and other instruments on the human body to maintain the health of the patient. Is the main treatment method of surgery, commonly known as "surgery." The purpose is to treat or diagnose diseases, such as removing diseased tissues, repairing injuries, transplanting organs, and improving the function and shape of the body. Early surgery is limited to simple manual methods, such as cutting, cutting, and sutures on the body surface, such as abscess drainage, mass removal, trauma and suture. Therefore, surgery is an operation that destroys tissue integrity (incision), or restores (stitches) tissues whose integrity has been damaged. With the development of surgery, the field of surgery continues to expand and can already be performed on any part of the human body. The applied instruments are also constantly updated, such as scalpels including electric knife, microwave knife, ultrasonic knife and laser knife. Therefore, surgery also has a wider meaning.

[shu shù]

Surgery (shu shù) refers to the removal and suture of a patient's body with medical equipment

Early

Overview

Surgery preparation is a chemical-based disinfection process designed to prevent bacterial infection of the surgical incision. The scope of skin disinfection in the surgical area generally includes a 15 cm area around the incision, which varies depending on the specific surgery. After shaving excessively long hair and washing it, rub the skin with 2.5% iodine tincture. After drying and exhibiting bactericidal effect, wipe iodine tincture twice with 70% alcohol to avoid damaging the skin. In infants, the face and external genitalia and the areas involving the mucous membrane, it can be rubbed with 70% alcohol only 3 times; it can also be rubbed twice with 0.1% chlorhexidine or 0.1% cedar, instead of iodine, because the irritation . After detoxification in the operating area, according to the size of the operation, a sterile cloth sheet is laid, which is a sterile area. For larger surgery, more than two layers must be laid. Due to the long operation time, the pores of the skin in the disinfection area will have bacteria hiding in the deep.

Preparation of the surgeon

Aseptic

Pre-surgery is mainly prepared for the following:

Changing

Before entering the operating room, wear clean shoes, brushing clothes, and a mask and hat.

Brush hand

Two methods are commonly used: brushing with soapy water and soaking with alcohol. Shorten your nails, remove the dirt under the nail edge, and wash your hands with soapy water. Wash your hands and arms with a sterile brush dipped in boiling soapy water, 10cm from your fingertips to your elbow, bottom to top, and your arms alternate. Brush three times. Rinse with water after each brushing for 10 minutes. Dry with a sterile towel, place the water and forearm 6cm above the elbow, and soak in 70% alcohol for 5 minutes. Iodine brushing technique. Iodine is a compound of iodine and a carrier. After washing your hands with soap, use a sterile bristle brush to dip 0.75% iodophor, and wash your hands and forearms once for a total of 5 minutes. The range is the same as the alcohol immersion method. When the iodophors are naturally dry, iodine can be gradually released, the irritation is small, and the effect can last for 2 to 4 hours. The method is simple and has been gradually promoted. Others still use 0.1% Xinjieer antifoaming hands, ammonia water washing and so on.

Wear surgical gown

The method for wearing a sterile surgical gown is to shake the surgical gown gently, lift both sides of the collar, insert your hands into the sleeves, and extend your arms forward. After assisted by the circuit nurse, lift the belt across the arms and send it to the back. The nurse fastened behind him.

Use high-pressure steam to sterilize dry gloves. The method of wearing is to use the left hand to pinch the fold of the glove cover, insert the right hand into the right hand glove first, and then insert the right hand of the glove into the fold part of the left hand glove to help the left hand insert into the glove.

At the grassroots level, the gloves are sometimes sterilized by the boiling disinfection method, which is convenient for disinfection and can prolong the use of rubber gloves. When wearing wet gloves, put a small amount of sterile water in the gloves to make the gloves open and easy to put on. After putting on your gloves, lift your wrists up to let the water run down your elbows. When using wet gloves, wear gloves first and then surgical gowns;

The main places for surgical operations have different equipment conditions and similar basic requirements, that is, the status is moderate, the lighting and ventilation are good, and it is easy to clean and disinfect. It is best to build the operating room near the end of the surgical ward or the upper floor of the building to facilitate patient transfer and management; try to arrange it on the north side so as to maintain constant and soft light; according to the purpose of the area, it is generally 30m Left and right; with magnetic brick wall and terrazzo floor. If paint is used, light blue or light green is appropriate; screens are required. Advanced operating rooms have adopted ultrafiltration laminar flow devices; near the entrance, it is best to have a resuscitation or postoperative recovery room.

Summary

As surgery can cause injuries and bleeding, various complications can occur after surgery. E.g

With the expansion of the scope of surgery, surgical instruments have been continuously increased, improved and updated, but they are commonly used in several categories such as knives, scissors, needles, forceps, forceps, hooks and so on.

Incision

There are many types and methods of surgery, but the most basic operations are incision, hemostasis, ligation and suture. The choice of incision should pay attention to two issues. One is to be located near the lesion so that the affected area can be exposed through the most appropriate way; the other is to preserve the physiological function of the incision site without damaging important anatomical structures. At the same time, we should pay attention to the appearance as much as possible, and leave less scars. Therefore, the incisions on the face, joints, and hands should be related to the skin lines (

After each operation, the operator should write the operation record. First of all, the basic items such as the date of surgery, preoperative diagnosis, postoperative diagnosis, name of the operator, name of the operator, anesthesiologist, and method of anesthesia should be noted. The record itself should include the following: the patient's position, skin preparation, and incision. Explore related organs, tissues and main pathological findings. If it does not meet the clinical diagnosis, it should be recorded in detail. Decide the reason for the surgical method. The important steps of the operation include suture method, sutures used, and whether drainage or fixation is performed. It's best to illustrate. The patient's condition during and at the end of the operation, the intraoperative medications, blood transfusion, infusion and other treatment items, and whether the anesthesia effect is good. Whether the lesion specimen is visible to the naked eye, whether it is sent to the pathology department for examination.

Summary

Different wounds have different treatments. The types of wounds are as follows: Clean wounds refer to wounds that are not infected by bacteria. Most of them are sterile surgical incisions. After proper suture treatment, primary healing can be achieved. Care should be taken to protect the wound from contamination. Generally, it is 5-7 after surgery. Skyline. Contaminated wounds refer to wounds stained with bacteria but not yet infected, which can be debrided and sutured. Infected wounds. Due to tissue damage, bacteria invade and multiply, causing acute inflammation, necrosis, or purulent wounds. Infections and dressings should be quickly controlled to promote healthy growth of wound granulation tissue and achieve secondary healing, or create conditions for delayed sutures and skin grafts.

Debridement

The purpose of the treatment method for contaminated wounds is to transform the contaminated wounds into clean wounds and strive for primary healing. The general debridement steps for soft tissue damage are as follows: Wash the wound. After proper anesthesia (usually local anesthesia), wash the skin around the wound, remove the hair, scrub the skin with a soft hair brush dipped in soapy water, and then rinse the wound with a large amount of sterile saline. After cleaning the wound, sterilize the skin around the wound with iodine, alcohol or Xinjieer, lay a sterile towel, carefully inspect the wound, remove the foreign body, remove the necrotic tissue, and repair the wound margin. Suture wounds, usually fresh wounds, are lightly polluted, and are treated within 12 hours of injury. Most of them can be sutured immediately, which is a first-stage suture. If the injury is long and the pollution is serious, you can only suture the deep layer, or temporarily fill in petrolatum gauze or After 3 to 5 days of saline gauze, the secretion is reduced, and the wound is sutured when the color of the wound is better, which is delayed suture. After debridement of contaminated wounds, the treatment is the same as that of general sutured wounds, but close observation is needed. If there is an infection, it should be treated in time.

Dressing change

Also called replacement

Summary

The period from the completion of the operation to when the patient is basically healthy is called the postoperative period. The purpose of post-operative treatment is to take all necessary measures to alleviate the patient's pain, prevent and deal with postoperative complications in a timely manner, and make the patient's health return smoothly. Generally, medium-sized surgery takes about 7 to 14 days.

General reaction and handling

The most common reactions are pain, fever, nausea, vomiting, and hiccups. Pain. After the anesthesia disappeared, the patient began to feel pain in the incision, which was the most severe in 24 hours, and it was significantly reduced after 2 to 3 days. Therefore, within 24 hours after major and major surgery, 50 mg of pethidine or 10 mg of morphine can be injected intramuscularly. Avoid vigorous activities to reduce pain. fever. The initial stage of surgery is the period of tissue decomposition, which is characterized by mild fever and lack of diet. Generally below 38 ° C, it returns to normal within 3 to 5 days. If fever persists for more than a week or increases, concurrent infections should be considered. Nausea and vomiting. The common cause is anesthesia, which can be relieved after the effect of the anesthetic has disappeared. If there is no other reason, no special treatment will be made, but to prevent aspiration. If accompanied by severe abdominal distension, continuous gastrointestinal decompression can be applied. Hiccup. Postoperative hiccups may be caused by direct stimulation of the nerve center or diaphragm muscle. Compression of the supraorbital nerve, short-term inhalation of carbon dioxide, gastrointestinal decompression, administration of sedative drugs or acupuncture can be used.

nutrition

For non-abdominal surgery, the systemic response is small, and the diet can be gradually restored after surgery; for major surgery, the response is more obvious, you need to wait 1 to 2 days before eating. Abdominal surgery, especially after gastrointestinal surgery, usually requires fasting for 2 to 3 days. After the gastrointestinal function is restored, it begins to gradually flow from a small amount of liquid food to 6 to 8 days to resume the ordinary diet. During fasting and small diets, water, electrolytes, and nutrients need to be supplied from the vein.

Nursing

See Nursing, Intensive Care.

Psychological problems of patients undergoing surgery

Surgery is a serious psychological stress for patients. It directly affects the normal psychological activities of patients through psychological doubt and physical trauma, and thus affects the opponent's postoperative recovery, and even determines the success or failure of the operation. Surveys show that most patients have serious concerns before surgery, especially for patients with stable elective surgery. Concerns are often caused by ignorance of the operation, doubts about the effect of the operation, choice of doctor, fear of pain during the operation, and other problems in family, society, and interpersonal relationships (Du Xiaoou, 1984). For example, the causes of anxiety in tonsil surgery in children are: hospitalization, anticipation of anesthesia (risk of death, punishment, and enforcement), the operation itself, and the fear of injections. The cause of anxiety varies with age. For example, in the 1 to 5 year old group, 80% are afraid of hospitalization, 5% are afraid of anesthesia, and 10% are afraid of injections; in the 10 to 13 year old group, only 1% are afraid of hospitalization, about 10% are afraid of anesthesia and 30% are afraid of surgery Fear of injections is only 5% (Jassner 1952).

Preoperative emotional state is related to postoperative adaptation. Those with moderate preoperative fear level had better postoperative adaptation. Because moderate fear reflects the balance of real situations and is accompanied by an adaptive discrimination between danger signs and assurance. Do not show fear before surgery, because of lack of mental preparation for coping, but show poor adaptation. Excessive fearers are troubled by coping with excess (Janis, 1958). About 62% of patients with preoperative fear of anesthesia were afraid of anesthesia, 15% were afraid of surgery; 23% had "other fears", mainly because of "cancer" or loss of control (Ramsay, 1972). About 55% of patients are afraid of losing their independence (such as asking others to help themselves); lack of hospitalization experience can also cause fear (Freuch 1979).

A series of studies by Johnston (1967-1980) showed that patients undergoing surgery can experience high levels of anxiety before admission, during admission, during surgery, and after surgery, and not only for a short period before surgery. Only a few worry about reaching the highest level on the morning of the surgery. ^[2]