"
Deportment of Surgery, FaCulty 01 Medicine, eMU
Excision subcutaneous mass (lipoma)
Equipment
""'" iii Q
1. m1-l~I'lLb'i'l:;bUl.H>1
2. Clamp
3. Metzenbaum
4. n'i'l 1n'iIllI'l1V1~
5. Needle holder Lb'i'l:;1V1~~"dyiL1Ju
6. Tissue forceps
7. Allis forceps
B. Set dressing LL'i'l:;~hrifl~
Procedure
1. bl'l~tJ~e1'lVllr~U'jL'lru~'i':;~hllll'l~i'ltJ antiseptic ~~m'i'LiJ1-I pravidine . 70% alcohol VI~'fl hibitaine
t VI'i'l::'fl11'lLL'i'l::fl"i1~ LVltJ~~fl bLi'i'l 'l1~ ~1'li'fl~~t I-m)~fl ~NU'j L'l ru~'i':: ~hIlll'l2. fl1'lQl'ltJ1!f1 tVlQI')'j'flU'J1li1LbVlhi~fi'fl1.j
3. bm'l bL~'i'l~.hllll'l tVl'i'l~LL~'i'lbiJ1-IL-!i1-l1'l"i~U1-l1li1bLVlhi~fi'fl1-l~'i'::~hllll'l LVI'lI1-I11-1nULb1-l'l'llfl~ skin crease
Tl'ltJ~'llJ t VIqj m1~tJ1'l'll'1N LL~'i'l1-11III1'l1~~1LiJ\,lliifl~ tJ1'l Lyj1'l1\,l11'l'llfl~fi'fl\,l11mm"i \11-11Lm fifl\,lfl'fln .
1M t'i1tl'fll-l51'lll-l11'ltVlqjLL'i'l::llll-l~l'lihVl,r~'fl'flmnmn U1~Af~ LL1-I'lLL~'i'l1-l11llI'lm'i'Iii'fl~LiJ\,l'l~~ LYl'fl
IIII'lLm N'lVl,r~~'ll-lL nl-lflfl n1tI M'l tJ
4. n51'l51I'l~Nfi1l-1.ffl-lN'lVl,r~1t1Y1'i'l::.ffl-ll'l'i'lfll'lLLl-l'l'i'l-Iii~.ffl-l1'l1lrl-l L~'flfimJ'Jfl51'l1-l1l-1.ffl-ll'lI~l-I1tI'i'\,lii~
1li1LbVlhi~tlfll-l bL~V1U~fi11'11'l~n'i'l1m"i\1V1"i1U11ii Lci'fl~'i'1flfifl1-l~n'i'::vTl-I\,ll-l'flflflm ('ltl~ 11.) Tl'ltJ• • •'i'::~~LnI'l';i1fifl1-l'i'::51 fibrous connective tissue LriflU1~'J LVI~fl~'J ~~'l'flufi'fll-l
5. ~'ll-l tVlqjt'i1fifll-l51'lll-l1I'l1~L Vlqj~1fl ~fl'i'l1m"i\1 tnn'li'1flnI'lUU LVlfi'fl\,l1Jii.lflflflm'fl~l-IflflLL~'i'l11ii
~1tJ (squeeze and pop method) (~tI~ 12.) VI~~'i'1fl,rl-lLVlmtnn"i"i1fl"j metzenbaum rfII'lLri'flU1~'J
~~I'lnu 1'lJ~l-I"i'flU'Jflflfl fifll-ln'i'l1~1"i\1V1"lI'l'flfln 11ii~1tJmtJ ~'l1-lt Vlqjt'i1vh1jlli'llM U'jL'lrutll-lLL~'i'l
~fl1~i'1i1qjVl1L~'fll'lflfln
6. Tl-Iu1~Af~ fi'fll-l~51'lll-l1I'lTVlqjm'i'Tn1jfi squeeze and pop 1~11ii bLIlit'i1b'i'l1:;'i'l-lii~'lI'flufi'fll-lbbi'i'l ~nmm"i\1 Tn blunt dissection Tl'ltJLnn'l Vl5fl sharp dissection Tl'ltJLn metzenboum fi'fltJ'Jb'i'l1::fifl\,l
fl'flfl'i'1flLifm~flih~LtltJ~ 1M~1tJ Tl'ltJ"i::VI~1~b'i'l1::m'i' Tn Allis forceps VI~fln'li'1fl~u i'i~fi'fll-lfi'fltJ'J
tI il-lflfl fl ~1M1l-1l-1flfl
1
nflW angiolipoma fl1"1Li1WL~WL~fll1l~1Lifl~fl<i1~off~L"IW;;j~~fltiifl~IiI~~fl•
Coaover.c ""Oft..51100 ro' 5tn yE:'U'Jnt'CHO' StuO€""Il
Department af Surqery, FaCulty 01 Meaicine, eMU
7. fh)\.IYii1'!1\.11~LVlq) VI~fl
l1i'lfllV1~LYiflVi1~L~fl~
8. VI~~"I1mfl1nfl\.lflflfl LIIi~vi1fl1'lVi1~L~fl~d'i\.lYiL~flU;flfILL-il'l ?i1'lifl~'i1~'!1fl~..r\.lL'!I~\.IYiLV1~fl~fl
~1fl VI~fli1'!1\.11~LVlq) LViLUU,T\.IL'!I~\.I,r\.l~~n\.ll1i'lfiLVI~ft~ft1f1 LviflL~LViLfi~fl1'li~'!Ifl~\hVl~fl~
VI~flL~fl~L~LL~m.hiK~ LL~?i1'lifl~'i1~i1Y1\.11~L~TVlq)~1fl n"'1~1'lmuu1Jl1l,Twi1'lVltr~ LI1iLftfl
9. U"I"IUT,!i1fl1'lLmii percutaneous liposuction Lvifll1l~LmLYI~\.IYifl<iTwlipoma Y1\.11l1lLVIlllflflflLvifl. '.VllIm~fI~ fl1'li1 LL~ft,h iKl1l
Complication
1. Wound infection
2. Hematoma or seroma
2
-----_._-. ----------- ---_. ~--_.~
DfI'portment of Surgery, Faculty 01 Medicine, eMU
Surgical Cricothyroidotomy
Equipment
1. fi1l-1l1~,Blade NO.10
2. Clamp
3. Tracheostomy tube NO.5 VI'lV6 VI'lvLYfEndotracheal tube NO.6
4. Set dressing. ~hriv~
Procedure
1) ~111V111111LLVll..i~"IJfNcricothyroid membrane ('ll~"::VI'i1~ thyroid cartilage nlJ cricoid) LVi'l'l"::LL'<'l::
~'ll miL'l-Ivh neutral position Vl1fljNIlU,:hl1C-spine injury ,,::fi'll~yh manual-in-line stabilization•l"lfi'lu
2) 01~'l1l-1~::'ll1~~~1t'll~
3) Vl1n~l.hmr~~ilf1l;l'l,,::fiv~il~U1'l!1LL'<'l::Lirl1fJ-111EJ~1Jthyroid cartilage YI1~fi1'l-1if1~l~ LYifJl~LVi• • ••••• , 0 Lo' ~
thyroid cartilage "IJUlJ"'l-In'l1";;Y11V1~(ln1"L~'j"
4) '<'l~skin incision L'l-ILL'l-I'ltransverse VI'lfJhorizontal (LyjfJVll1m~U~n1"1J1~L~1JI'ifJanterior jugular
vein) V1ihl'i'llcricothyroid membrane
5) L~fJfi~ cricothyroid membrane ";;'<'l~incision L'l-ILL'l-I'ltransverse ('j;;1"~mhLViLil~n1"1J1~L~1JI'i'llcricoid V1'l'llthyroid cartilages)
6) Lir clamp t'lmu~ incision LVin~1~!1'l-1L'l-ILL'l-I'ltransverse LL'<'l;;V1l-1'l-1clamp 90 v~mLyjvLu~ incision•L'l-ILLW'lhorizontal
7) LI'iendotracheal tube V1'l'lltracheostomy tube f-i1'l-1Lif1cricothyroidotomy incision t~uLVi U'<'l1U
yjfJ~'l-IlUYI1~trachea. V11nLir endotracheal tube Iii'll~LL~h'i11;.jLl'il1mil'l-llu"'l-ILil~one-lungintubation.
8) Inflate cuff LL'<'l;;l'ivnlJVentilator V1'lVAmbu bag LL'<'l;;IW''l''L~~LyjvLViLL~L,,'i1tracheostomy tube
dhluL'l-I trachea l~lfiLil~ false tract !1'l-1.
9) Fix yj'llLViLL~WLL'<'l;;Film chest x-ray LyjfJ~1I11LLVI~~"IJ'll~yjfJt~m>m1;;L'l-In'j&~Ll'ifi'lU•endotracheal tube.
Complication
1. Aspiration
2. False tract
3
Department of Surgery. Faculty of Medicine, eMU
3. Subglottic stenosis (~~U-iU\,l:1l1L~iL\,ILliIn~ml'Jil'1liJfl':h12tI)
4. Laryngeal stenosis
5. Hemorrhage or hematcrna formation
6. Esophageal or tracheal injury
7. Vocal cord paralysis, hoorseness
4
c
A
ti)
B
o
,
l
Cricothyrotomy. After immobilization of the larynx and creation of a vertical midline skin incision, the cricothyroidmembr
ane is incised horizontally (Aj. Upward traction is made with a traction hook and a bladed dilator is used toexpond the
tracheal incision vertically (B). 'The tube is inserted through the blades of the dilator into the tracheo (C).The obturator i
s removed. the inner cannula is replaced. and the tube is inflated (D). (t11"~1n
http://medicine.academic.rul180B8/Cricothyrolany )
5DepanmeOl of Surger)'. !=oculty of Medic,ne, eMU
Venous cut down (Bosilic vein)
Equipment
1. 1ii1l-Jl:ilil.Blade Na.l0
2. Clamp. Mosquito clamp~3. 'C!11'JNG tube '!Ifl~Llilfl'!l\j1lil 8 Fr
4. Set dressing. N1'iifl~
medial epicondyle th~l-J1ru 2 ii'li:1fl (1'1~,;tJ)•
Procedure
1. di1LL'VIli~'!Ifl~'VI~fllilL~fllillihBosilic vein fltiu'lL'lruIii1\j l\j'!lfl~ It'!I\j;'VIi)..1lLL~~1ii1\j'VIij1I1ifll.ll-Jfl"i~lilfl. . ,
sternum bL~~yh~qj~fl" rullllilum,;r;:fl
1'VIl-J1~
2. yhl'l'l1l-J'C!~fl1lil bb~~tJN1'iifl~,3. 1lilIli1bb'VIli~'!Ifl~'C!1UNG vi"l~ll'i "I1fl
rih bb'VIl_i~vill'i~~(iJ';~Ii~fl~1~'!Ifl~ fl'; ~(iJfl,
4. Qlill'J1'lf1 R~(iJ';~di1b\'VIl_i~Yl"l~yhm';fl'llil
5. R~ skin incision '!I\j1liltJ';~l-J1ru 2 - 3
'lfl-J 'V\jil~.ff\j1'!I~\j lliii:i'l'VIl!~
6. l-li clamp bb'VI'lfl'VI1'V1Rfllilbiiifllildi1 !il~
tJ';fl ~fl~l1.,i.ff1.,i1'!l~1.,i 11.,ifl"il1lvii1m,;
LL'VI'lfl"l1.,iLihl'i.ff1.,ifl~1l-JLiimL~'ll "i'>~1~•fl1"1bn(iJfl1.,i(iJ';1unu 'VIRfllilLiiifllilLLlil~
7. Lriflllii'VIRfllilLiiifllildi1LL~'l lVivhm'l
lil~fl~'VIRfllilb~fllil~'lbbR~yhl'Jlii'll'J 1'VIl-J
8. l'1lil'C!flU'i1LU1.,i\-'1RfllilL~fllillii1tlill'Jm'lM~
1'VIl-J11.,i1'i'l1.,i1ii1.,i(Proximal part) LLR~l-liL~l-J
L"I1~ ~hLU1.,i'VIRfllilLiiifllillii1"1~i1
Liiiflt'lflflfl
..... , - - '." ,".'~•...
MedianCephalic Vein
/~ _ ,_,:'~:'~:::,:.Subchwian Vein
•~. .l .'----. Axillary Veini l: .-, , ..
Cephalic Vein' - L--.L ,I r"\ I' ;.', '.~
Brachial Vein \ :', '\(with Brachial ~\ ---'-;:', I, \
Artery) 1/.:. \. \ _ I IIt . fJj\r=BaSilicveini ~,• I,! Iii,., " ...•, Median Basilic
~I~' m Vein
RadiaIVein------.; } Lh~ l f.'
II £:' Ulnar VeinJ I; ,11
Median Vein --b¥ (~/.1 .....f
/ \I ..,.-' \
1/ \ \k 1H~\
rIll 1\ \\JV' J \..
Superficial veins ofthe right upper limb
COCO~f'fICwor~ sr'C() lor 5ln y<:'U!rr<€'Q,Cc'i1••.•Qi'n! Ii6
Oepan.ment 01Surgery, FOCulty of MediCine, eMU!
9. til51I11LU111V1~'1l111L~'1ll11rihLi'h.."JtJ1fl\l,~1l-1 '1~wi1~ TVll-IviAfifl~VI~'1l111L~'1l111"
10. til Mosquito clamp ~1JI11.,~tJ1mUI11'l1'!NLL~~
11. ~flVl~'1lI11L~'1lI11~hri'll.Iyhu"
12. Lri'il1U~'l1.l~l.Iii~'1~t'l1Jviyh-ff~-fffl1,rn1~ ll11uri'1ll.l tri~'1l~51J1 Lfl~'1lLl.I~1ULL~~ T~l'l'1l11111'1
13. '1~Wi1~vi1fl1'1~'1l111~1U LVivi1fl1'1I11I11':i1T~L~'1l111l'i1V1~f1Tl-i '1~'l~mj1~ LVil'll11'1fll11111'1.1'IJrn~ci'~1m'1{l" ,vi 1111'11' 11111'l1l-1t'll.lt '1.11-1'1t ~Vi'1l~'lI'l11J1.ITtl!
14. 1-lflVl ~fll11L~fll11ri'l1.l1l11.1Yi;m.lfl1J~1uml.l"
15. LV1JUI111.J1mL1-l~
I'Il-11ULVlI11fl'1ruviili'1l~I11'1 tVi'il1U~'ll.ll'l LL~~LLUfl'1l'1lfl~1flvi1UVlU~1J1111LL1-l~ (Tunnel) LVivi1111'1LU111LL~~•'lI1.I1111Li&flt ~ iiiflLL1-l~ LL~ ~~'1l111~1ULii1m if~1J1111LL~~ rifll.l~ ~Lri'il1 uml.l Lii1 TtJL l.Il'I~ fll11L~'1l111~h
Complication
1.Bleeding 2.Hematoma 3.Arteriol injury 4.lnfection 5.Venous thrombosis
Grl"".dtsaphenous 'Y8In
A..Palpa!e andlocale veir.
B.
~.~ -"..,C Makea2cmtransverseInCISIOn
o Expose the vein
~ ~
~
~--.~'".~
..y<.."E. Insert sutLJres looselyai proximal and diS!a1end of vein
Make small G. E.xpOSf:the .•,.etnanaU)(::isi(}fl'ill••..ein tnsertcannula
~~L'
H TIe upper sutLJre IOsecure cannula
'""" ;. \~I r
I. Close the \'\-"oIJOd
,? 11 y
1tJ Secure canru.Jla
\,~.;thsllture
n1l'i91n http://hetv.orglresourceslreproductive_
Department 01 Surgery. Faculty 01Medicine, eMU
Intercosta I drainage insertion (fn~ t'i'iyj'fl~::1J11'J'VI~'J'I'flfl)
Equipment
1. Intercostal drainage tube (ICD) (~"111l1i\fl~1V1'i'1.Jdrain air (12-24 FG),~"1I1lLV1\1J~1V1'i'1.Jdrain &'ll1l
V1"l'ileffusion (28-32 FG)
2. ~1'1i'il'lsterile
3. Spigot connector 1 tube adaptor - 2 sizes
4. 1000-4000ml bottle of sterile water
5. Antiseptic solution :pravidone iodine solution or hibitane)
6. 1% lignocaine + 1:100,000 adrenaline 5mL ampoule
7. 5ml/10ml syringe and needle
8. Scalpel blade (No 11)
9. Suture material - black silk or nylon with needle size 2/0 V1"l'il3/0
10. Clamp 11)','1LI'N~TA~
11. fl""lfl"iKI1l1m<
Procedure
1. V111ii1Llml'l~mm~l'll<~~~L~ chest drain Lb'N:~l1lyhLVi~11'lIJ"'il""11.JV1"l'il~'bl;~l'l'l'il'l1'l1 'iJ1~ 45-30• •111'1LI~"1J1'1~~~L~yjm~1.J1U'il'ilflV1"l'ilIJfl~,.m~ 'ilfl"l; ~~'1yj1il,,~vi1LVi'li'il'l~TA"'IflIJ1'1~"
2. vi1Wl1l<l'l~'iJ1I1l1.J")L'1rn~,,~Lj'jyjm~1.J1mti,.1.J'lL'lrnflIJ1'1bL'N~~'1tJ~1tJ'j1 A~1flb:ff'il "l1fl1r"~'1i'lI1lU1"ll1•(xylocain) 'illh'lil'ilIJ bL'N~'iJ1~Vl~1"ru1LViIJ1,,:.r1.JtJ'lI1lYl1'1L1im11'il11l~1V1"l'il.l<'N30 L~l<1flii'l .l<'N10
"1Yi 15-10 U1A'N1Un'l'l'Nri'il,.vi1~11l\lI11"tJ":l<1ru
3. Tii1l1lfl"lI1l~'lV1I!'1~,.iflii'l.ff,.~ilm~'il LIii~'lV1I!'1LtimLm~"1,.n1.J'li'il'l~TA"'1LViU1'ltJ,,~mru 1.5- .'Zil<2
Tillufl"lI1li1I1l~~'il1.J1'i1'1~'il'lfl'j~l'Jfl~TA"'I Lb~'lLiklamp IIV1'lflbilti I~'il~,. ii'l fl~ 1l<IiltJ":V1~1'1~TA"'I
"1fl1r,.~'1 LbV1'lfln'i1i1l<Lil'ilYl1'1~1"~'il1.J1.J"~'il'l~TA"'1"1"Y1~'NL1J1'1i'il'lb~'ilVil<tJ'ill1lLL~'lLViclamp bm'lfl• •tJ,,~mru .'Zil<1
4. L-lin'li1'ill'l'il111b1J1LtJi>:1l<bb"'l'li'il'l~bm'lflLIJb~'ilii,.«,.1ii1LLV111'l~\lfllii'il'lLb'N~III"'l"l'i'l'il1.J~11~i1biltJtJ'ill1l~lil•mjV1"l'ili1~'1i111ll'l1m'j\l L-lin'lb~'ilvi1111'jbm:~'1i1lilYil~~11lLbll,.mfll~ bLIii1'i1~'1~lil~11lIbll,.mfl L~A'l"•L-lin'lLm:m"1:'iJ1"1vi1 Lvhlll1ltJ'illilQfl~1lilL~
,
Deoonment 01 Surger)t, Faculty 01 Medicine, eMU
5. III clomp iifliil1V1wtJtJ\11<JilflIii1u'IJ'[)~yj,[)'l::U1<JTI) "I1fll!U~~ lliyj'[)'j::U1<J TtJ!>I1l-!'liMVhLVI'lflTI) lli1<J'il1"1
III clomp flfliil1V1WtJTI)~tJll'1mL'c1'l~~lliLih ltJlu'li'[)~~ LLVl1fll1) lli1<Jl~'j'ClIi1Yi1<J~!Nyj,[)'l::1.J1<Jmjvh~~.. ~"I1flfj,r~Y1'l1~,[)fl'[)th~u'[)<J Lrlj)l~l;hLLVI~~1iiLL'c1'l~~tJli,[)<J.'lil-! 2c1amp ~VlWtJTl)flfltJmm~'!l
1i1'l'l"l'Cl'[)u':i1\1l-!VI:jmr1lU'6ll~t~'!l~l-!tJ,[)Ii1'l::U1<J'!l,[)flmllii1iiVl:j'[)1l-J "I1fll!u~~ clomp 11)L'liuLiiil-lLL'c11~~
Iii'!lyj,[)'l::U1ULii1nU'Cl1<Jm~ Iii'[)minm 11i1'l::tJ 1U L~tJyjfJ'j::U1<J iiiIi1nu iJ'lVl,r~L~mJj)~nUfl1'l L~'[)U" .VI'i'lIi1~U'l'!lU1ii!l1ii1<J'W'i'l1'ClLVffi{f~LL~t,lLL'c1'l~~tJ Ii!l <Jclomp•
6. L~UUli1tJ1Ii1LLfj'i'lLL'i'l::fjflYi'[)'j::U1<Jl~iiIi1LL~unUfj,r~YJ'j'l~,[)fl UIi1LLfj'i'lLL'i'l::iiIi1Yij)'l::U1<Jl~ LL~U",
7. Chest x-ray LVi!lIil'j1"1'Cl!ltJ~1ii1LLVI~~'IJ'[)~Yi'[)'j::tJ1U
Complication
1. Lung laceration 2. Subcutaneous emphysema 3. Intercostal artery injury: hemothorax
4. liver injury (lli ICD Lii1Yi!l~L~!l~"I1flllilU'j::iilu~1dlultJ) 5. Wound infection
8
1
4
-'
3
