Basic Principles of surgery.

Dr. F.J. Owotade

• Human tissues have genetically determined properties that make their response to injury predictable. • The principles of surgery are based on proven techniques that help to optimize the healing environment.

Basic necessities for surgery.
1. Adequate visibility. 2. Assistance. Adequate visibility is based on • Adequate access- mouth opening, surgical exposure,

• •

Adequate light Surgical field free of excess blood and other fluids.

however the principles will be outlined. health care staff and objects free from infectious agents and surgical asepsis describes the efforts aimed at preventing microbes from gaining access into surgically created wounds. . The details will be discussed at a later lecture.Aseptic technique. • Medical asepsis is the attempt to keep patients.

• Clean technique. Surgical staff preparation. 2. Instrument sterilization.Universal precautions are applied to prevent sepsis and efforts fall under the following headings. • Hand and arm preparation. 3. 1. . • Sterile technique. Operatory disinfection.

• Avoid cutting vital structures. • Use a sharp blade of proper size. . The following principles apply. • Use firm continuous strokes. • Incise perpendicular to the epithelial surface.Incisions. • Intraoral incisions should be properly placed. Incisions are necessary for many OMFS procedures.

Flap dehiscence 3. 2.Flap design Principles of flap design help to prevent: 1. . Flap necrosis. Flap tearing.

include an axial blood supply in the base. the length should never exceed the width. 2. 1. In the oral cavity. When possible.Preventing flap necrosis. 4. The base should not be twisted. stretched or grabbed with instruments that can interrupt or destroy the blood supply. The tip should never be wider than the base unless a major artery is present at the base. The length of a flap should be no more than twice the width. . 3.

handling the edges gently and minimizing tension. .Preventing flap dehiscence • Approximate the edges over healthy bone. infection and scarring. • Dehiscence exposes underlying bone leading to pain.

Preventing flap tearing. . • Make more than one releasing incision if more access is needed. • Make incisions long enough to give adequate access.



extremes of temperature. . • Excessive crushing. • Apart from careful flap design and incision technique. the careful handling of the tissues is also necessary for optimal and uncomplicated healing. • Toothed forceps and skin hooks are preferred to forceps that crush the wound edges.Tissue handling. pulling. desiccation and harsh chemicals damage tissues and these should be avoided.

• Avoid excessive pulling forces to retract tissue. • Protect soft tissue when drilling or cutting. . • Use copious irrigation when drilling or cutting bone.

thermal coagulation. 2. Wound hemostasis can be obtained by: Assist natural clotting processes by applying pressure on a bleeding vessel or a hemostat. 4. 5.Hemostasis. • No effort should be spared to minimize blood loss. . Use of vasoconstrictors. Suture ligation. 1. Pressure on the wound. Use of heat. 3.

Dead spaces are usually filled with blood which delays healing and predisposes to infection. Use of drains. Defined as an area that remains devoid of tissue after wound closure.Dead space management. 2. 4. Packing. Can be managed in 4 ways. . 1. Suture all tissue planes. Pressure dressing. 3.

Decontamination and debridement. . • Copious irrigation during and after surgery removes debris and reduce the bacteria count and minimizes the likelihood of infection. • Necrotic. foreign and devitalized tissue should be removed.

• Oedema is minimized by: 1. Short term steroids. Careful and gentle tissue handling 2. . • Results from the collection of fluid in the interstitial spaces due to the transudation from damaged vessels and lymphatics obstructed by fibrin. 3.Oedema control. • More severe in areas with loose connective tissue. Use of ice packs.

• However. . • Prevention of medical emergencies is the cornerstone to their management. the dental personnel should be able to recognize and promptly and adequately manage whenever such situations occur. • Serious medical emergencies are rare in the dental clinic.PREVENTING AND MANAGING MEDICAL EMERGENCIES.

2. 3. . Physical examination with vital signs. Adequate medical history. This involves: 1. Review of systems.The first step in prevention is risk assessment.

Preparation for emergencies. .

Basic life support.An important component of continuing education .



Chest discomfort. Respiratory difficulty. Altered consciousness .List of medical emergencies • • • • Hypersensitivity reactions.




Chronic obstructive pulmonary disease. • • • • Asthma Hyperventilation. . Foreign body aspiration.Respiratory difficulty.

Seizure. Diabetes mellitus. Orthostatic hypotension. Cardiovascular compromise. .Altered consciousness. Local anesthetic toxicity. • • • • • • • • Vasovagal syncope. Thyroid storm. Adrenal insufficiency.