Operative Surgery (Oxford Specialist Handbooks in Surgery)

Operative Surgery (Oxford Specialist Handbooks in Surgery)

Language: English

Pages: 888

ISBN: 019851056X

Format: PDF / Kindle (mobi) / ePub


This completely revised handbook provides concise and clear information on how to perform operations in the main surgical specialties. It provides an overview of modern operative surgical practice and gives indications for surgery providing details of operative techniques to supplement hands-on experience. It will enable the inexperienced surgeon to prepare adequately for observing, assisting at and ultimately performing a wide variety of surgical operations. It is up to date and reflects current operative surgery. It complements the highly successful Oxford Handbook of Clinical Surgery.

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replacement for example would have a thrombosis in the soleal sinuses of the calf, or more proximal with a pulmonary embolus (PE) rate of 1–10%. Risk factors relate to hypercoagulability and the fibrinolytic system which depends on the balance of thrombin and antithrombin, tissue plasminogen activator (tPa) and plasminogen activator inhibitors (PAIs). Patients with genetic defects of protein C and S, and factor V Leiden defect for examples have the perioperative risk of hypercoagulability. The

affecting the blood supply. This is done when constructing an ileal pouch for anastomosis to the rectum in patients with inflammatory bowel disease and familial adenomatous polyposis (see Restorative proctocolectomy). The large bowel This is approximately 1.5m long. It comprises of: Ž Appendix Ž Caecum Ž Ascending colon Ž Hepatic flexure Ž Transverse colon Ž Splenic flexure Ž Descending colon Ž Sigmoid colon Ž Rectum Ž Anus. The lumen is wide in the caecum and ascending colon but

and accommodate a variety of sizes of scalpel blades. Care should be taken to mount and remove scalpel blades using an artery clip (Fig. 4.1). Needle holders Most needle holders are ratcheted and have a specially designed surface between the jaws to allow a firm grasp of the needle and prevent it twisting. They should be placed halfway along the needle to avoid damage to the needle point and the swage (which would cause detachment from the suture). (Fig. 4.2) SCALPEL HANDLES 1 Fig. 4.1

multi-filament, and may be used in cardiothoracic surgery for the closure of median sternotomy wounds. It is very strong but difficult to handle and rarely leads to sinus formation. Needle types Needles are either straight or curved. Half-circle needles are most commonly used. Deeper tissues require a larger circle arc. Ž Straight or linear needles are for suturing easily accessible tissues such as skin. Ž Cutting needles are triangular in cross section with the apex of the triangle in the

into a bag by low pressure suction working on the siphon principle. Open systems drain by capillary action or gravity into dressing or stoma bags. Therefore their efficiency depends on the position of the patient and the volume and site of the collection. If a fistulous track is necessary to provide a long period of drainage, such as bilary drainage after exploration of the common bile duct latex drains are preferable as fibrosis is stimulated. Complications Ž Secondary infection (more common

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