In Surgery, What Is an Excision?

Surgery is referred to as surgery, commonly known as surgery, and refers to those who enter the human body or other biological tissues through surgical equipment or surgical instruments under the operation of a surgeon or other professionals, and exclude lesions, change structures or implant foreign objects by external means. Process.

Surgery

Surgical abbreviation

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. along with

In the seventeenth century B.C.E. of Babylon, the Nineveh's Hammurabi Code recorded eye surgery regulations, indicating that at that time or earlier, the two river basin civilizations had already undergone surgical operations. This is human. Civilization has the earliest recorded surgery.

Circumcision was recorded on one of the doorposts of the ancient Egyptian temple of KomOmbo. In addition, EbersPapyrus, and

Endoscopic surgery

exclude

E.g:

Cardiac Surgery in Progress Surgery is usually classified by its urgency, purpose, type of procedure, tissue system involved, degree of invasion, and instrumentation.

Urgency

Non-emergency surgery (surgery): A surgery that the patient can determine based on their needs without involving life.

Emergency surgery: An operation that must be performed immediately in order to preserve life, limbs, or physical function.

purpose

Exploratory surgery: Surgery performed in order to detect the lesion. Due to the development of medical imaging, it has rarely been performed on the human body.

Therapeuticsurgery: Surgery performed to treat a known lesion.

Program type

Classified according to different surgical procedures, there are many types, such as:

Amputationsurgery: Surgery to remove part or all of the extremities or limbs.

Excision: Removal of all or part of the tissue.

Plastic surgery: Changing or restoring the shape and function of tissues.

Reconstructive surgery: Reconstruct or repair tissue to restore shape and function.

Replantationsurgery: Surgery to retrieve amputated tissue.

Transplant: Transplanting part or all of tissue from an autologous or allogeneic tissue.

Organizational system involved

Classified by organ, tissue or system involved in the operation, such as:

Abdominal surgery.

Brain surgery (Brainsurgery).

Cardiacsurgery.

Degree of invasion

Minimally invasive surgery (Minimallyinvasivesurgicalprocedure): Minimally invasive surgery to reduce blood loss, avoid damage to normal tissues, and accelerate healing.

General surgery (Generalsurgery): open the body for surgery.

Using the instrument

Laser Surgery (Lasersurgery): Surgery using a laser scalpel or vaporized laser.

It is a chemical-based disinfection process designed to prevent bacterial infection of surgical incisions. 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

In order to perform the operation smoothly, prevent postoperative complications, and achieve the desired effect, it is necessary to make preparations before the operation.

Preparing for the thoughts Before the operation in a regular hospital, pre-operative discussions should be conducted, a comprehensive consideration of the condition and the surgical plan, a good explanation of the patients and their families, the necessary explanations to their families, and the signing of the consent to surgery, so that medical care, patients and their families can Better understanding and cooperation.

Preparation for tolerance includes general preparation and special preparation. General preparation. Including measurement, clotting time, and heart, lung, liver, and kidney functions are checked according to the nature of the operation, blood type and blood matching are determined. Allow patients to exercise to adapt to surgery and postoperative changes, such as thyroid surgery patients training the shoulder cushion pillow vertical position; most patients are not used to urinate on the bed, should be practiced before surgery. According to the specific surgical requirements, some preparative operational treatments are performed, such as oral intestinal bacteriostatic drugs started 3 days before colon and rectal cancer surgery. Haircut, bath, change of clean clothes and shaving of hair in operation area 1 day before operation. Check again for elevated body temperature and menstrual cramps. Fasting 12 hours before surgery and drinking water should be prohibited 4 hours before surgery to prevent

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.

Scalpel

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, it is necessary to pay attention to the appearance as much as possible, leaving fewer scars, so the incisions on the face, joints, and hands should be consistent with the skin lines (Langer's line). When cutting, the blade is perpendicular to the skin, and the force is even. Cut the skin and subcutaneous tissue at one time to avoid uneven edges and oblique cuts of the incision. Deep tissues should be cut layer by layer.

Hemostasis

Is also a key step in surgery,

After each operation, the operator should write the operation record. First of all, the date of the operation, preoperative diagnosis, postoperative diagnosis, name of the operation, operator,

Surgery review

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.

Surgical 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.

Surgical dressing change

Also called changing dressing. It is mostly used to infect wounds. The purpose is to observe the wound, remove foreign bodies, drain pus, control infection, and promote wound healing. The dressing should be changed according to the rules of aseptic operation of the surgery, and all disinfection instruments and dressings should be used to prevent cross infection. The interval between dressing changes depends on the specific conditions of the wound. Sutures and clean wounds are generally checked 3 days after surgery or when stitches are removed; for wounds with mild infection, dressings can be changed once every 2 to 3 days; wounds with more pus should be replaced once a day, and the dressing can be wet at any time replace. General wounds can be covered with isotonic saline gauze; after secretions are reduced and granulation tissue is healthy, Vaseline gauze can be used for coverage; granulation tissue above the wound affects healing and can be cut off; if granulation tissue is edema, 3 to 5% hypertonic saline can be used Or wet compress with 50% magnesium sulfate solution. Antibiotics are generally not used in the wound. Some bacterial infections can erode wound tissues. Antibacterial drugs can be used. For Pseudomonas aeruginosa infection, 0.1% phenoxyethanol or silver sulfadiazine can be used.

Surgical anesthesia

See Anesthesia, Local Anesthesia, General Anesthesia.

New surgical instruments and equipment for surgery

The high-frequency electric knife has been used for many years. It uses the high temperature generated by the high-frequency current to contact the tissue to cut the tissue and coagulate the blood vessels. Because it is safe and effective and the equipment is easy to purchase, it is still widely used.

Laser has thermal effects on the body, pressure, photochemical effects, electromagnetic fields and biological stimulation. This biological effect can cause protein denaturation, tissue coagulation, necrosis, carbonization or gasification. The laser "knife" mainly uses the thermal effect of lasers, and more uses CO2 lasers, and uses strong laser beams to solidify, vaporize and cut the lesions. While gasifying and cutting tissues, it can also stop bleeding. The laser has the effect of coagulating and closing small blood vessels and lymphatic vessels. Therefore, using the laser to remove the tumor has less bleeding and can reduce the spread of tumor cells. High-power lasers have been used in liver, stomach, kidney, brain, bone and other parts of surgery and burn resection. Due to the precise laser effect, the depth and width of the surgery can be strictly controlled, and the surrounding healthy tissues are less damaged. The surgical range is only about 1mm, and the postoperative response is small. Therefore, it can be used for iris perforation for angle-closure glaucoma and other fine carving Carved surgery. Laser and fiber optic endoscopes are combined to make "fiber optic scalpels", which are used to treat upper gastrointestinal bleeding, or to remove, vaporize or coagulate cancer, polyps, and hemangioma. For early raised gastric cancer, radical laser treatment is reported. It can also be used to crush bile ducts, urinary tract stones, open narrow or occluded sites to remove tumors; it can even be used to treat vascular occlusive diseases; it can also perform surgery on the fundus through eye refractive media without incision of any part. Because the laser uses light and the instruments do not directly contact the surgical field, the chance of infection is also small. At present, laser surgery in China has been used in surgery, gynecology, facial medicine, ophthalmology, stomatology, dermatology, anorectal and plastic surgery, and has been able to design and manufacture various types of laser surgery machines.

Ultrasound "knife" uses ultrasound to cut. Ultrasound is a mechanical pressure wave with a frequency higher than 20,000 Hz. Due to its strong directivity, its mechanical energy is easy to concentrate. Therefore, low-energy ultrasound is often used to diagnose diseases in the body; more powerful ultrasound is used for non-invasive surgery. A scalpel uses its vibrational energy and locally converted thermal energy to cut tissue. For liver lobectomy, an ultrasonic knife can "cut" the liver parenchyma, while retaining bile ducts and blood vessels for further ligation, which is faster and safer than a scalpel.

Microwave "knife" uses microwave to cut. The direction of the microwave electromagnetic field can be changed at a super high speed, which can reach 2450 × 10 times per second. Under its action, the polarized dielectric molecules in the body fluid will also change their direction, generating dielectric heat in local tissue. Therefore, microwave has the effect of coagulation and hemostasis. Microwave knife is used in the operation of parenchymal organs, such as liver, kidney, spleen, lung, brain, ovary and other operations, and can be used for hemostasis, coagulation and early tumor resection through endoscope.

Plasma scalpel is referred to as plasma knife. Plasma refers to the physical state of a thermally ionized gas. There is a DC arc inside the blade tip. When the working gas (argon or neon) passes through the arc, the gas is ionized and the temperature rises. A high-temperature neutral plasma gas is emitted from the blade tip to form a visible, 1mm diameter, about 1cm long. The air jet with a temperature of 3000 can cut and cauterize tissues, and its effect is similar to that of CO2 laser. The advantages of plasma knives are that they are easy to operate, safe to use, and less expensive, and the liquid at the tissue interface does not affect their effectiveness.

Other "cold knives", such as the application of liquid nitrogen through refrigeration equipment, "water knives" and glass scalpels that use high-speed jets of water, have been tried, but they currently lack clinical application value.