Republic of the Philippines

CITY OF PARAÑAQUE
__________ HEALTH CENTER

FOR ALL MINOR SURGICAL PROCEDURES

PREPARATORY PROCEDURES
1. Gather all needed equipment
2. Greet the patient and or parents respectfully and with kindness
3. Introduce yourself and describe in general what you are going to do
4. Ask the patient or parents if they have any questions regarding the procedure
5. Verify the patient’s identity and check that informed consent was obtained
6. Make sure that patient has recently washed the area to be done
PREOPERATIVE TASKS
1. Prepare the instrument tray and open sterile instrument pack without touching items
2. Ask the patient to lie in a comfortable position. Position will depend on the body part to
be sutured or for other minor procedures
3. Wash hands thoroughly and dry them with clean, dry towel
4. Put on sterile gown and a pair of sterile surgical gloves or other appropriate and
necessary PPEs
5. Apply antiseptic solution (eg. Betadine solution) two times to the affected area/s
using the inner to outer technique
6. Apply a center “0” to the affected/target area to keep it sterile
7. Perform a gentle examination of the area and plan your course of action
POST PROCEDURE TASKS
1. Dispose of contaminated needles and syringes in puncture-proof container
2. Place soiled instruments in 0.5% chlorine solution for 10 minutes for decontamination
3. Dispose of waste materials in covered leakproof container or yellow plastic bag
4. Remove gloves by turning inside out then place in leakproof container or yellow plastic
bag
5. Wash hands thoroughly and dry them with clean, dry towel
POSTOPERATIVE CARE
1. Observe the patient’s vital signs and record findings
2. Answer patient’s questions and concerns
3. Advise the patient on the appropriate post-operative care
4. When stable, discharge the patient home with mild analgesic or pain reliever and
antibiotics if necessary
5. Inform the patient to come back for follow-up after 48 hrs or anytime earlier should
there be any complications
6. Complete operation notes and other patient record forms
 Republic of the Philippines
CITY OF PARAÑAQUE
__________ HEALTH CENTER

I. DORSAL SLIT CIRCUMCISION PROCEDURE

ANESTHESIA
1. Perform Dorsal Penile Nerve Block using predetermined quantity (3-5 ml) of 1% plain
Lidocaine injected at the base of the penis.
2. Check the anesthetic effect of the nerve block by pinching the penile skin and asking
the patient if he can feel it. Top up as needed.
3. Throughout the procedure, talk to and reassure the patient, or let him play with his cell
phone or other activities which may hold his attention without moving his body.
DORSAL SLIT TECHNIQUE
1. Follow the preparatory and operative procedures done for other minor surgeries
2. Hold the prepuce with artery forceps
3. Make a curved mark (1 cm proximal and parallel to the coronal sulcus) to
outline the planned surgical cut
4. Apply a straight artery forceps to crush the prepuce at 12 o’clock and remove after 1
minute
5. Using a pair of surgical scissors, make a dorsal slit in the prepuce starting from the
preputial orifice to the dorsal corona sulcus
6. Excise the prepuce along the previous mark
7. Identify bleeders, clamp and tie them. Suture with 3/0 plain catgut
8. After ligating all bleeders, clean the area using sterile gauze and sterile water. Inspect for
more bleeders, tie them id identified
9. Using 3/0 chromic catgut, close the gaps using interrupted sutures
10. Clean all cut parts using povidone iodine.
11. Dress the wound with Sofratulle or antibiotic ointment, followed by a regular dressing
bandage and a strapping
12. Advise the patient to rest for 30 minutes
13. Follow the post-operative care and procedures done for other minor surgeries
 Republic of the Philippines
CITY OF PARAÑAQUE
__________ HEALTH CENTER

II. WOUND DEBRIDEMENT PROCEDURES

1. Follow other general procedures for all minor surgeries

2. Remove dressings
3. Put on sterile gloves or clean gloves as appropriate
4. Perform sterile preparation and draping the wound area, as appropriate
5. Sharply cut-away the non-viable tissue until bleeding tissue is encountered
6. Be very careful not to excise arteries, veins, nerves or tendons
7. Control bleeding initially with direct pressure
8. If bleeding persists place a suture as needed
9. If the patient experiences pain, avoid further debridement in the area that produces pain
10. Collect culture specimen if indicated
11. Pack the wound as needed, then dress
12. Follow the general procedures for post-operative tasks and procedures for other
minor surgeries

III. INCISSION AND DRAINAGE (I&D)

Please take note that for I & D possible contraindications are large and deep abscesses,
presence of pulsatile mass at the site of infection, if site is near a vasculature and nerve
structures, presence of foreign bodies and accessible or simple location of the abscess.
When these conditions are present, it is better to refer patients to a higher level of care or
to hospitals.

1. Follow the preoperative preparations and techniques used for other minor
surgeries
2. Using a scalpel, make an incision directly over the center od the abscess until
pus is expressed
3. Incision should be parallel to the skin lines to prevent the formation of
scars
4. Manual expression is used to facilitate drainage
5. After drainage, irrigate the wound thoroughly using sterile normal saline
solution
6. Do not do wound packing if abscess is 5cm or less in diameter
7. Cover the wound with sterile dressing and tape
8. Ask the patient to come back for follow up 2-3 days after the procedure for
removal of the packing.
9. Let the wound close by secondary intention.
 Republic of the Philippines
CITY OF PARAÑAQUE
__________ HEALTH CENTER

IV. SIMPLE INTERRUPTED SUTURE

1. Follow the preoperative preparations and techniques used for other minor
surgeries
2. Load the needle between the Apex of its curvature and two thirds from the
needle tip then straighten
3. Make one tissue bite and then another tissue bite opposite the first one,
followed by knotting and cutting the sutures.
4. Sutures are placed approximately 5mm apart and bites taken 3 to 5 mm from
the tissue edge to prevent dehiscence
5. Do the same sutures until wound is closed
6. Follow the general procedures for post-operative tasks and procedures for
other minor surgeries

NOTE: Cysts excisions are referred to higher level of care due to danger of complications in
doing the procedure