見習醫學生模擬手術教案

Teaching Plan of Simulative Surgery for Clerk

目錄
壹、 術式名稱(Topic) ....................................................................................... 2

貳、 學習目標(Objectives of learning) ............................................................. 2

參、 教學原則和方法(Principles and methods of teaching) ............................ 2

肆、 概觀(Overview) ........................................................................................ 2

伍、 準備和器械(Preparation and instruments) .............................................. 3

陸、 步驟(Procedures) ..................................................................................... 3

柒、 參考文獻(References) .............................................................................. 5

捌、 評量(Evaluation of learning) ..................................................................... 5

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壹、術式名稱(Topic)
Nevus Excision

貳、學習目標(Objectives of learning)
1. By the practice of nevus excision, students will learn and understand the following:
A. Indication, contraindication, pre-operative preparation, surgery procedures, and post-operation
care of nevus excision.
B. How to inject local anesthetic.
C. Build up the interest of minor surgery.
2. Through the whole teaching course done on Silent Mentor, students would learn the medicine
based on humanity and the spirit based on esteeming life.

參、教學原則和方法(Principles and methods of teaching)

1. Ask the students to prepare lessons, read handout, and review basic anatomy before class.
2. Pay respect to Silent Mentor in class.
3. Lead students to pray in silence before class (2 mins).
4. Mark a small spot 0.5cm x 0.5cm on the thigh, leg or abdomen.
5. Explain about overview, indication, contraindication for nevus excision.
6. Explain of pre-OP preparation and students should arrange instruments for OP.
7. Explain how to inject local anesthetic, and demonstrate the procedures.
8. Students should practice the operation on Silent Mentor individually under tutor’s guide.
9. Possible complications of nevus excision and their management could be told during practice.
10. Mention at the same time when epinephrine should and should not be added in the LA, its effect
and timing to onset of its effect.
11. Conclude the whole class and mention post-OP care.
12. Change the table or prepare the next section for tutors or students.
13. A total of 30-45 mins is set for whole class.

肆、概觀(Overview)
⚫ Indications:
1. Suspicious of malignancy ABCDE:
A= asymmetry (one half does not look like the other), B = Border (irregular, scalloped or ill-
defined), C = color (varied from one half to the other), D = diameter (>6mm), E = evolving or
elevation.
2. Cosmetic reason.
⚫ Complications:
1. Excessive bleeding.
2. Injury to underlying vessels and nerves.
3. Scarring

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伍、準備和器械(Preparation and instruments)
1. Gloves, Protective gown, Face shield
2. Chlorhexidine or Povidone iodine
3. Marker pen
4. Gauze
5. Scalpel with No. 10 or 20 blade
6. Sharp dissection scissors
7. Electrocauterization.
8. Suture material

陸、步驟(Procedures)
!!Attention: The following directions are given for right-handed operator. Side-specific designations
should be reversed for left-handed operators.
1. Patient was put in the supine position.
2. Apply Chlorhexidine or Povidone iodine.
3. Stand on the patient’s right side.
4. Mark out the nevus to be excised in the ellipse shape.
5. Inject the local anesthetic, after introduction of the needle, slightly withdraw the plunger to make
sure not injecting into a vessel.
6. Incise through the skin into the subcutaneous fat.
7. Excise the nevu.
8. Hemostasis
9. Wound closure.

⚫ Techniques of wound closure:

1. Needle holder showing proper hand position.
Figure 1: Hand control Figure 2: Finger and thumb control

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 2. Pick-up technique: Tissue forceps are generally held between the thumb and index finger (Two-
finger technique). (Figure3)
Figure 3

3. Simple interrupted suture

A. It is a one-bite suture technique.
B. The needle is passed through the skin perpendicular to the skin edge. (Figure 4)
Figure 4

C. The needle passes through the entire epidermis and dermis.

D. The second portion of the bite comes out through the opposite side at the same distance from
the wound edge and is tied. (Figure 5, Figure 6)
Figure 5 Figure 6

⚫ Post-procedure care: Daily wound care using topical antibiotics, Framycin dressing or advanced
wound dressing and time to removal of sutures.
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柒、參考文獻(References)
1. David A. Sherris, Eugene B. Kern, Essential surgical skills, second edition, 2004, 133-145
2. Gray L Dockery, Mary E Crawford, Lower Extremity Soft Tissue & Cutaneous Plastic Surgery, 2006,
17-27

捌、評量(Evaluation of learning)
1. Pre and post course writing test: describe the indication of nevus excision
2. Class performance
A. Attitude
B. Skill
C. Surgical landmark identification ability; basic surgical anatomy of the skin and its relationship to
deeper layers (subcutaneous tissue, fascial layer and muscular layer).
D. Fluency and time control.