PrincipleofSurgery.pptVIP

Principle of Surgery 口腔顎面外科 吳崇維 手術基本要件 良好的視野 適當的途徑 適當的燈光 乾淨的手術區 助手 熟悉 訓練有素 無菌技術 減少由致病微生物所以起的傷口污染 Flap（皮瓣） 獲得進入手術區域之途徑 或將組織由一處移至另一處 常見口腔皮瓣種類 Envelop flap Triangular flap Horizontal and single vertical incision Quadrangular flap Horizontal and 2 vertical incisions 組織的處理 溫柔地 避免過度的拉扯或擠壓 Toothed forceps or tissue hooks 切骨時，需大量沖洗，以減少骨頭因熱所受的傷害 開放的傷口需常常加以濕潤或以濕紗布覆蓋 處進傷口止血的方法 自然止血的機制 Fabric sponge or gauze or hemostat Gelfoam, surgicel Small vessels: 20~30 seconds Large vessels: 5~10 minutes 輕敷而非擦拭 用熱來封閉（Thermal coagulation） Hold the vessels by hemostat Removal of any blood or fluid around the vessel 用縫線來結紮（Suture ligation） 直接加壓（Pressure dressing） Most bleeding from dentoalveolar surgery can be controlled by this method. 使用血管收縮素（Vasocontrictive substance） epinephrine Lidocaine with epinephrine Suture ligation 去污及清創 Normal saline irrigation Decrease the bacterial count Lessen the chance of wound infection Wound debridement Necrotic tissue Foreign body Severely ischemic tissue 縫線材料 Resorbable sutures Gut Proteolytic enzymes by inflammatory cells Plain gut : 5-7 days, but 2~4 days in oral cavity Chromic gut : 9~14 days, but 3~5 days in oral cavity Polyglycolic acid (PGA) Hydrolysis Dexon Polyglactin 910 (PLGA) Hydrolysis Vicryl Not used in the skin wound Inflammatory reaction 縫線材料 Nonresorbable sutures Silk Multifilamentous Inflammatory response Nylon Monofilamentous: Ethilon, Dermalon Multifilamentous Polyester Monofilamentous: Polysorb Polypropylene Monofilamentous: Prolene Nylon is suitable for facial laceration wound Suture sizes 7 ~ 11-0 Most oral and maxillofacial surgical procedures require the use of a 3-0 or 4-0 suture 縫線操作 Multifilamentous sutures handle better than monofilamentous sutures Silk 3 knotting throws Polyester, gut, PGA, PLGA 4 knotting throws Nylon 5 knotting throws 縫針 Preattached vs. nonattached (French-eyed needles) Needle points Cutting or tapered Degrees of needle curvature 基本縫合技術 Needle holder ? to ? needle Perpendicular to the surface Followi