MindMap Gallery Basic knowledge and basic operations of oral and maxillofacial surgery
This is a mind map about the basic knowledge and basic operations of oral and maxillofacial surgery, including oral and maxillofacial clinical examination, disinfection and sterilization, basic surgical operations, etc.
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Avatar 3 centers on the Sully family, showcasing the internal rift caused by the sacrifice of their eldest son, and their alliance with other tribes on Pandora against the external conflict of the Ashbringers, who adhere to the philosophy of fire and are allied with humans. It explores the grand themes of family, faith, and survival.
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Basic knowledge and basic operations of oral and maxillofacial surgery
"Three basics": basic theory, basic knowledge, and basic skills
Medical record is the sum of text, symbols, charts, images, slices and other data generated by medical staff during medical activities, including outpatient (emergency) medical records and inpatient medical records.
Inpatient medical records: including the home page of the inpatient medical record, admission record, course of illness record, operation consent form, anesthesia consent form, blood transfusion treatment informed consent form, special examination (special treatment) consent form, critical (serious) illness notice, medical order form, auxiliary examination report sheets, body temperature sheets, medical imaging examination data and pathological data, etc.
admission recond, inpatient medical record
It refers to the record that the treating physician obtains relevant information through consultation, physical examination, and auxiliary examination after the patient is admitted to the hospital, and summarizes, analyzes and writes the information.
Require
Admission records, re- or multiple admission records should be completed within 24 hours after the patient is admitted to the hospital
Entry and discharge records within 24 hours should be completed within 24 hours after the patient is discharged
Recording of admission deaths within 24 hours should be completed within 24 hours of the patient's death
General project
Including name, gender, age, place of origin, ethnicity, marital status, occupation, date of admission, outpatient (emergency) diagnosis, residential address and telephone number, work unit and telephone number. The date and time of medical history collection, the person providing the history (reliability), the admission diagnosis, and the person recording the medical history. For pediatric patients, the names, occupations, workplaces, and phone numbers of parents should be written down.
Medical history
Chief complaint: The main symptoms (or signs), location and duration stated by the patient when seeing a doctor
History of current illness: The patient’s detailed information on the occurrence, evolution, diagnosis and treatment of the disease, written in chronological order. The names of drugs, diagnoses and procedures provided by patients must be distinguished by quotation marks.
Past history: A patient’s past health and illnesses. Such as vaccination history, allergy history, blood transfusion history
Personal history: such as living habits and travel history
Marital and childbearing history, menstrual history
family history
Physical examination: whole body examination, specialist examination
Laboratory inspections and special inspections: Classify and record inspection results or inspections performed in chronological order
Summary: Propose the basis for diagnosis
Discussion/Initial Diagnosis/Treatment Plan/Signature
Course record: a continuous record of the patient's condition and medical treatment after admission to the hospital.
First course record: The first course record written by the treating physician or the doctor on duty after the patient is admitted to the hospital, which should be completed within 8 hours of the patient's admission.
Daily disease course records: Critically ill patients should write disease course records at any time according to changes in condition, at least once a day, and the recording time should be specific to the minute. For seriously ill patients, record at least once every 2 days. For patients with stable condition, recording should be done at least once every 3 days. The attending physician's first ward round record should be completed within 48 hours of the patient's admission.
Operation record: refers to the special record written by the operator that reflects the general situation of the operation, the operation process, intraoperative findings and treatment, etc. Surgical documentation should be completed within 24 hours after surgery
Discharge record: refers to the treating physician’s summary of the patient’s diagnosis and treatment during hospitalization, which should be completed within 24 hours after the patient is discharged.
Outpatient medical history record: including chief complaint/medical history/physical examination/laboratory examination/preliminary diagnosis/treatment opinions/physician’s complete signature, etc. Follow-up consultation: Those who need follow-up consultation for the same disease more than 3 months apart will, in principle, be treated as first-time consultation patients. Allergy history red record
Emergency medical history record: When a typo occurs during writing, double lines should be used to mark the typo, and methods such as scraping, sticking, and painting are not allowed to cover up or remove the original handwriting. Emergency rescue medical records completed within 6 hours The consultation time should be specific to the minute
electronic medical record
Oral and maxillofacial clinical examination
ordinary inspection
Oral examination
Follow the order from outside to inside, from front to back, from shallow to deep, and conduct contrast examination of the affected side.
Oral vestibular examination
Rely on visual inspection and palpation to check the lips, cheeks, gingival mucosa, labiobuccal grooves, and lip-buccal frenulum in sequence. Pay attention to color abnormalities and texture changes
When heavy metals such as lead and mercury are poisoned, blue-black linear pigmentation may appear on the edge of the gums; Early symptoms of AIDS are mainly oral manifestations, and related symptoms include gingival linear erythema, necrotizing periodontitis and stomatitis, and hairy white spots on the edges of the tongue, etc.
Dental and bite examination
Mainly rely on probing and percussion to clarify the dental hard tissue, periodontal and periapical conditions. For example, whether there is pain on probing or percussion, whether there are caries, defects, fractures and loose teeth.
opening
Refers to the vertical distance between the maxillary and mandibular incisors.
The average normal opening is 3.7cm. If it is less than 3.7cm, it is restricted. If it is greater than 5cm, it is too large. Clinical common measurement with double foot gauge
Mild Moderate Severe completely restricted
Opening type: refers to the movement trajectory of the mandible during the entire process from closing to opening. In normal adults, the opening shape is not skewed and is in the shape of "↓", but patients with temporomandibular joint disorders often have abnormal opening shapes (deviation or distortion).
Oral and oropharyngeal examination
Intrinsic oral cavity/palate/tongue/oral floor examination/oropharyngeal examination
Bimanual diagnosis with two fingers: lips, cheeks, tongue, floor of mouth, submandibular area Bimanual examination: floor of mouth, submandibular Bimanual diagnosis is performed from back to front.
Maxillofacial examination
Expression and consciousness check
Appearance and color inspection
Examination of other facial organs
Eyes: Pupil changes are an important sign of brain injury
Ear: cerebrospinal fluid otorrhea, with or without middle cranial fossa fracture
Nose: cerebrospinal fluid rhinorrhea, with or without anterior cranial fossa fracture
Examination of the location and nature of lesions
Abscesses may fluctuate, The aneurysm may feel pulsating when touched. A cyst in the jaw may feel like a ping pong ball when pressed. Venous malformation postural shift test was positive, etc. For oral and maxillofacial flaccid ducts and sinus tracts, probes can be used for probing.
Speech and auscultation examination
Patients with cleft palate have a very strong nasal sound, which is clinically called "cleft palate speech" The mass at the base of the tongue may have an "olive voice" Arteriovenous malformation can cause obvious blowing murmur during local auscultation.
neck examination
ordinary inspection
Lymph node examination: The examiner stands in the right front or rear of the patient, with the patient's head slightly lowered and slightly tilted to the examination side to relax the skin and muscles for easy palpation. According to a certain order, slide and palpate from shallow to deep. The general sequence is: occiput, behind the ear, in front of the ear, parotid gland, cheek, submandibular and submental; along the anterior and posterior edges of the sternocleidomastoid muscle, the anterior and posterior triangle of the neck until the supraclavicular fossa.
Temporomandibular joint examination
Facial shape and joint mobility examination
Condylar mobility examination: place the index or middle fingers of both hands in front of the tragus on both sides and on the outside of the condyle, and ask the patient to open and close the mouth to feel the condylar mobility. Or insert the little fingers of both hands into the external auditory canal and touch the front wall of the external auditory canal for palpation.
Masticatory muscle examination/mandibular movement examination/occlusal relationship examination
Salivary gland examination
ordinary inspection
Pay attention to the catheter opening and secretions
It is generally advisable to palpate the parotid gland with three fingers: the index, middle and ring fingers. Do not use your fingers to lift and touch the gland to avoid mistaking the gland lobe for a parotid gland mass. The submandibular and sublingual glands are usually palpated using bimanual examination.
Secretory function test
Qualitative check Quantitative examination: 1000~1500ml/d (parotid gland, submandibular 65%) 90%, sublingual gland 3%~5%
Auxiliary inspection
chemical examination
puncture examination
For lumps that have a fluctuating sensation on palpation or are non-solid and fluid-containing, an injection needle can be used for puncture examination.
For clinical abscess puncture, a thick needle with an outer diameter of 0.9mm (20G) is often used, and for vascular lesions, a thin needle with an outer diameter of 0.7m (22G) is used. Puncture is contraindicated when carotid body tumors or arteriovenous malformations are clinically suspected; when tuberculous lesions are suspected, care should be taken when inserting the needle to avoid the formation of long-lasting sinus tracts due to puncture.
biopsy
In principle, diagnosis and treatment should be completed in one phase; if biopsy must be performed first to confirm the diagnosis, the biopsy time and treatment time should be as close as possible.
excisional biopsy
Suitable for superficial or ulcerated tumors.
Using a No. 11 scalpel, it is best to cut a 0.5-1cm wedge of tissue at the junction of the tumor edge and normal tissue, and immediately fix it in 4% formaldehyde solution for pathological examination. Use local compression to stop bleeding, no need for tight suturing. Mucosal lesion specimens should not be smaller than 0.2cm × 0.6cm
When taking a biopsy, try to minimize mechanical damage and avoid using dye-based disinfectants Electrosurgery can denature intracellular proteins and should not be used Do not cut at necrotic areas Vascular tumors or vascular malformations, and malignant melanoma generally do not require biopsy.
excisional biopsy
It is suitable for resectable small tumors or lymph nodes with intact skin and mucous membranes.
frozen biopsy
For lesions that have been decided for surgical treatment, frozen biopsy and surgery should be completed in one stage. A pathological examination method that can quickly confirm the diagnosis. intraoperatively
Frozen biopsy requires fresh specimens and should not be fixed before submission A traditional examination should also be done after surgery to further confirm the diagnosis.
fine needle aspiration biopsy
It is suitable for solid tumors with a certain volume and covered by normal tissue on the surface.
Automatic cutting needle biopsy
Smear examination/ultrasound examination/X-ray examination/CT examination/magnetic resonance imaging/nuclide emission computed tomography/PET-CT examination/arthroscopy/surgical exploration
digital subtraction angiography
It is mostly used for the examination, diagnosis and treatment of maxillofacial and cervical blood vessels, arteriovenous insufficiency and benign and malignant tumors with rich blood supply, especially the interventional embolization treatment of maxillofacial arteriovenous malformations.
radionuclide inspection
Thyroid cancer and intraoral ectopic thyroid can be diagnosed with 131I or 125I, and 125I has better resolution. 99mTc is mainly used to diagnose malignant tumors of the jaw Salivary gland inflammatory diseases and some tumors can be examined by salivary gland radionuclide imaging
salivary gland endoscopy
The gold standard for clinical examination of diseases of the salivary gland duct system
Disinfection and Sterilization
Disinfection and sterilization of operating rooms and surgical equipment
Follow the principle of cleaning first, contamination second, and infection later.
Disinfection and sterilization of surgical instruments and dressings
High pressure steam sterilization
General equipment, cloth, gauze, cotton and rubber can be used.
Boiling sterilization method
It is suitable for heat-resistant and temperature-resistant items, but it may damage the sharpness of the blade.
Disinfection time starts after the water boils and usually takes 15 to 20 minutes. Instruments and items contaminated by hepatitis patients should be boiled for 30 minutes. When 2% sodium bicarbonate is added, the boiling point reaches 105°C, which can shorten the disinfection time and achieve better results (metal instruments can be sterilized by boiling them for 5 minutes) and can prevent rust.
dry heat sterilization
Suitable for glass, ceramics and other utensils, as well as absorbable gelatin sponges, petroleum jelly, grease, liquid paraffin and various powders that are not suitable for high-pressure steam sterilization. Items that are not resistant to high heat, such as cotton fabrics, synthetic fibers, resin and rubber products, cannot be sterilized using this method.
Generally, 160℃ should last for 120 minutes, 170℃ should last for 90 minutes, and 180℃ should last for 60 minutes.
chemical sterilization
Clinically, chemical disinfectants should be selected with the advantages of broad bactericidal spectrum, low toxicity, non-irritation, stable performance, non-corrosive, and fast action.
ethanol
Medical equipment can be sterilized by soaking it in 70% to 80% ethanol, but only equipment that generally does not enter sterile tissue should be used for sterilization. The soaking time is 30 minutes.
glutaraldehyde
The preparation is 2% alkaline glutaraldehyde. Use it to soak the equipment. Kills cell propagules within 2 minutes It can kill fungi and Mycobacterium tuberculosis within 10 minutes. It can kill hepatitis B virus in 15-30 minutes. It takes 4 to 12 hours to kill bacterial spores
iodophor
When disinfecting instruments, soak them in 1 to 2 mg/mL solution for 1 to 2 hours.
formaldehyde
When used to sterilize surgical instruments, use 10% solution to soak for 60 to 120 minutes. When sterilized instruments are used, the residual liquid should be rinsed with sterilized distilled water.
Chlorine disinfectant
peracetic acid
To kill bacterial spores, use 1% concentration and it will be effective in 5 minutes; To kill reproductive-size microorganisms, only a concentration of 0.01% to 0.5% is required and the time is 30 seconds to 10 minutes. It also has a killing effect on hepatitis B virus.
Disinfection and sterilization of special instruments
The straight head of the micro electric grinder and the electric or pneumatic bone drill head can be sterilized with high-pressure steam or formaldehyde steam.
Formaldehyde steam or immersion sterilization of drill needles
The method of formaldehyde steam sterilization is to put the instruments into a closed sterilizer that should contain 36% to 40% formaldehyde. The purpose of sterilization can be achieved after 40 minutes.
Disinfection of the operator
Disinfection of surgical area
Preoperative preparation
For major surgeries related to the oral cavity, periodontal treatment, filling of cavities, removal of residual roots, etc. should be performed first. Also use 3% hydrogen peroxide solution, 1:3000-1:5000 potassium permanganate solution or 0.1% chlorhexidine solution to gargle or rinse.
In the skin removal area or bone removal area, the hair must be shaved at least 15cm around the incision. The skin removal area is disinfected and bandaged with 75% ethanol or iodophor;
The bone retrieval area should be prepared 2 days before surgery, disinfected and bandaged with ethanol once a day, and disinfected again on the morning of surgery.
Disinfectant drugs
Disinfection method and scope
Disinfection method
Normal wound: Start from the center of the surgical area and gradually apply it around the surrounding area
Infected wounds: the opposite
Disinfection range
The scope of disinfection for head and neck surgery should be 10cm outside the surgical area, and the limbs and trunk should be expanded to 20cm.
Sterile drape placement
Sterile towel wrapping method
Surgical field draping
Hole towel laying method
Suitable for minor outpatient surgeries
Triangular surgical field draping method
Suitable for oral, nasal, lip and cheek surgeries
Quadrilateral surgical field draping method
It is suitable for major surgeries in the parotid gland area, submandibular area, neck and involving multiple parts.
Basic operations of surgery
Follow the basic principles of sterility, tumor-free and minimally invasive
tissue incision
Cutout design
Anatomy
parts
The incision should be chosen above or adjacent to the lesion to obtain better and more direct exposure.
Incisions must be made in relatively hidden areas, such as under the jaw, in front of the ears, behind the jaw, etc., as well as in natural folds, such as the nasolabial folds, etc.
The direction of the incision should be consistent with the direction of the skin lines as much as possible
The incision of the biopsy surgery should be consistent with the incision of the reoperation.
length
In principle, it is better to be able to fully reveal
The scalpel is perpendicular to the tissue surface (when starting the knife, insert the tip of the knife vertically, turn it to a 45° angle to cut the skin, and when the cut is completed, keep the knife in a vertical position.
Pay attention to the layers and cut them layer by layer
Tumor surgery mostly uses electrosurgery, but light knife can also be used
The skin layer should still be cut with a steel knife first
Stop bleeding
Compression to stop bleeding
For large areas of venous bleeding or scar tissue and extensive bleeding during resection of certain tumors (such as venous malformations, neurofibromas, etc.), warm saline gauze can be used to compress and stop bleeding.
Clamping and ligation to stop bleeding
The most commonly used and common method
Superficial tiny blood vessels can be simply clamped
Larger bleeding points need to be ligated with silk thread after clamping, which is called ligation to stop bleeding. Electrocoagulation can also be used to stop bleeding.
Ligation of well-known or thick blood vessels to stop bleeding
Generally, the length of the severed end left after ligation and cutting of well-known arteries and veins should be at least twice the diameter of the blood vessel, and double or even triple ligation should be performed to prevent slippage.
external carotid artery ligation
Regional suturing to stop bleeding
Perform loop or fence sutures around the incision or proximal to the blood supply of the tumor
Drugs to stop bleeding
electrocoagulation to stop bleeding
Hypothermia to stop bleeding
Hypothermic anesthesia (body temperature lowered to about 32°C) can effectively reduce the blood volume of surrounding tissues
Lower blood pressure and stop bleeding
During the operation, the systolic blood pressure was reduced to about 10kPa (80mmHg)
Generally, about 30 minutes is appropriate, and it is contraindicated for patients with cardiovascular disease.
tissue separation technology
sharp separation
For fine-level dissection or separation of solid adhesion scar tissue, the instruments used are scalpels and surgical scissors.
This method causes little tissue damage and requires delicate and accurate movements. It should generally be performed under direct vision.
blunt separation
For the separation of normal muscle and loose connective tissue and the removal of encapsulated benign tumors
It is mainly performed with vascular forceps. It can also use knife handles, fingers, gauze, etc. It can be performed under indirect vision, which will cause great damage to the tissue.
tie
Single knot, square knot, triple knot or multiple knots, single-handed knots and needle holder knots are most commonly used in oral and maxillofacial surgery.
The length of the ligation thread left in the tissue is generally about 1mm. When ligating larger blood vessels and large muscle bundles with thick threads, the length can be increased to 3-4mm to prevent slippage. If the suture is catgut, since it is easy to slip, the length of the remaining thread should also be 3 to 4 mm. The suturing of skin and mucous membranes should leave at least 5mm to facilitate traction during suture removal.
suture
in principle
On the basis of complete hemostasis, strict and correct alignment sutures are performed layer by layer from deep to shallow in order to achieve primary healing.
basic requirements
The tissues on both sides of the incision must be in good contact and correctly aligned; each layer must be sutured separately.
The tissue on both sides should be equal and symmetrical to avoid dead space, otherwise blood or fluid will accumulate, which will not only delay the healing process, but also easily lead to infection.
Sutures should be performed under no or minimal tension to avoid wound dehiscence and excessive scarring after healing. Determine the appropriate needle distance and margin according to the nature, site and intraoperative conditions of the surgery
The order of suturing should be the free side first and then the fixed side. On the contrary, it is easy to tear the tissue. This point should be followed when suturing intraoral mucosal flaps and free skin grafts or flaps.
When suturing the skin of the face and neck, in addition to involution sutures along the incisions of depressed wrinkles to make the scars consistent with the depth of the wrinkles, it is generally necessary to prevent involution and excessive eversion of the wound edges to avoid infection and obvious scars after healing. The suture should cover the entire thickness of the skin. When the skin edge is thin, part of the subcutaneous tissue should also be brought in. When inserting the needle, the needle tip should be perpendicular to the skin, and the distance between the needles on both sides of the skin incision should be equal to or slightly smaller than the subcutaneous distance.
The distance between the skin suture needle entry point and the wound edge (margin) and the suture spacing density (needle pitch) should be based on the principle of keeping the wound edge in contact with each other without cracks.
Generally, the suture margin for plastic surgery is 2-3mm, and the needle spacing is 3-5mm; The suturing margin for neck surgery is 3mm and the needle spacing is 5mm; When suturing tongue tissue whose tissue is easily torn, the margin and stitch length should be increased to more than 5 mm.
There should be no other tissue sandwiched between the sutured tissues to avoid affecting healing.
The tightness of the knot after sewing should be moderate
Too tight: compresses the wound edge, affects blood supply, leads to edge necrosis and suture marks left after surgery; can cause tissue tearing
Too loose: The wound edge will be in poor contact and cracks will appear, leading to bleeding and infection. It can also make scars thicker after tissue healing.
Avoid excessively long straight sutures in functional parts (such as corners of the mouth, lower eyelids, etc.) to avoid linear shrinkage of scars after healing, causing tissue and organ displacement.
If it is found that the incision is too long during suturing, additional incisions should be made according to the dual triangular flap method, and sutures should be sutured in a Z-shaped curve. In wounds with excessive tension, sneak separation and tension-reducing suturing should be performed.
Choose the right suture
basic method
In situ wound suturing method
Simple suture
interrupted suture
continuous suture
simple continuous suture
Used for suturing the grafted skin graft itself and the donor tissue area, such as skin suturing when harvesting fascia from the lateral thigh
Continuous overlock stitching
Suturing of alveolar mucosa
eversion suture
Suitable for suturing wounds with thin mucous membranes, loose skin, and wound edges with involution
When choosing vertical or horizontal valgus healing, the direction of the blood supply to the wound edge should also be considered. It is best to make the suture direction consistent with the direction of the blood supply.
Tension-relieving wound suturing
stealth separation
It is suitable for wounds with low tension. The size of the sneak separation range is generally proportional to the tension of the wound.
Assisted tension reduction method
When the wound with tissue defect still has a certain tension after being sutured by sneak separation method
Additional incision tension reduction method
Relaxing incision used during cleft palate or perforation surgery
Sutures in special circumstances
intratissue dead space suturing
Triangular flap tip suture method
If the triangle tip is above 90°, it can be sutured directly. If it is less than 90°, when suturing the tip, first insert the needle from the skin of the contralateral wound edge, then pass through the subcutaneous tissue of the tip, and finally take out the needle from the other side of the contralateral wound edge and tie a knot, so that the tip can be embedded in the contralateral side. Creating a relationship
Suture method for uneven thickness or uneven height of wound edges on both sides
Thin and low side tissue should have many and deep seams, while thick and high side tissue should have few and shallow seams.
surgical drainagesurgical drainage
It refers to the technology of draining exudate, necrotic tissue or other abnormally increased fluids out of the body through drainage tubes or drainage strips.
Basic principles: unobstructed, thorough, minimal tissue damage or interference, compliance with anatomical and physiological requirements, identification of pathogenic bacteria.
Indications
Infected or contaminated wound
Wounds that exude a lot of fluid
Wounds with dead space
Wounds with incomplete hemostasis
Classification
According to the principle of drainage
Passive drainage: relying on adsorption (such as gauze drainage) or gravity (such as postural drainage)
Drainage with the help of external force, such as negative pressure closed drainage.
Commonly used drainage materials and their applications
sheet drainage
Mainly used for drainage of small amounts of exudate from extraoral wounds, and occasionally used for drainage of intraoral wounds.
Yarn drainage
Commonly used for wound drainage of severe and mixed infections, and also used for drainage of intraoral wounds.
tubular drainage
It has the characteristics of strong drainage, easy flushing and injectable medicine. It is mostly used for the drainage of large wounds and abscess cavities in the maxillofacial and neck areas.
Negative pressure drainage
It has a strong drainage effect and does not require pressure bandaging of the wound, so the patient feels comfortable
It is used for postoperative drainage of major maxillofacial and neck surgeries. In principle, it should not exceed 72 hours.
Precautions
Drainage time
Drainage objects are foreign objects and should be removed as soon as possible after the purpose of drainage is achieved. Contaminated wounds or drainage placed to prevent accumulation of blood or fluid should be removed after 24 to 48 hours; Drains from abscesses or dead spaces should be left in place until pus and exudate are completely eliminated; Negative pressure drainage is generally removed when the drainage volume is less than 20~30mL within 24 hours: Smaller side openings (such as submandibular gland, parotid gland surgery) are removed when the drainage volume is less than 15mL within 24 hours.
Drainage site
Drainage fixation
Use sutures near the drainage port to fix them with sutures
Wound treatment
wound healing process
Cell proliferation includes 2 key processes, namely angiogenesis and fibroblast proliferation
Wound shrinkage refers to the process of closing an open wound by moving the edge of the wound toward the center. It is powered by the contractile components of fibroblasts and myofibroblasts.
In split skin grafting, the degree of wound shrinkage is inversely proportional to the thickness of the skin graft.
Wound reconstruction begins 3 weeks after injury After the wound was sutured with electrocautery, initial histological healing of the wound appeared on the 7th day; The early stage of the wound edge after laser suturing mainly shows coagulation necrosis, and the wound does not heal histologically until the 10th day after surgery.
Wound healing methods
Primary or initial healing: The sutured wound usually heals within 7-10 days.
Secondary or delayed healing: Unsutured wounds often heal through the process of granulation tissue proliferation and then crawling and covering by surrounding epithelium. The healing of tooth extraction wounds is generally secondary healing.
Wound classification
Clean the wound
refers to a wound that has not been invaded by bacteria
Face and neck surgical wounds
contaminated wound
Refers to wounds that occur under non-sterile conditions
Wounds connected to the oral cavity, nasal cavity or intraoral surgery wounds; Wounds caused by various injuries. For example, the injury time is short and the stratomycetes have not invaded the deep tissue to cause purulent inflammation.
infected wound
Wounds where bacteria have invaded, multiplied, and caused acute inflammation, necrosis, and suppuration, and wounds where surgery is performed under these circumstances
Abscess incision and drainage, osteomyelitis focus removal of the jaw
Principles for treating various types of wounds
Basic principles, techniques and precautions for dressing change
The main purpose of dressing change: to ensure and promote normal wound healing
Dressing changes
When removing drainage from a sterile or contaminated wound or when infection is suspected
When the dressing slips and cannot protect the wound
When there is a large amount of purulent secretion or exudate from the wound
When there is bleeding from the wound or suspected hematoma
When the wound is bandaged too tightly, affecting breathing or causing pain
When observing wound healing and skin flap nutrition
When the wound is not clean and hinders normal healing
Other situations should be determined according to different surgical requirements
Time and place of dressing change
It should be completed before the morning ward round to facilitate observation of the changes in the wound on the previous day.
The ideal location for dressing change is a specially designed dressing room. For patients who cannot get up and move around, dressing can be changed at the bedside
Common bandage techniques
effect
Protect the surgical area and wound, prevent contamination or secondary infection, and avoid further damage
Keep warm, stop bleeding, reduce edema and pain
Prevent or reduce fracture displacement
Fix the dressing to prevent it from falling off or shifting
Precautions
When cleaning the wound and dressing it, attention should be paid to aseptic operation
When wrapping the bandage around the submandibular area and neck, special attention should be paid to maintaining a clear airway
The bandage should be smooth, close-fitting, and moderately tight
The wound in the parotid gland area should be bandaged with a certain amount of pressure and should be flexible to avoid salivary fistulas.
For incision and drainage wounds, appropriate pressure should be used for the first bandage to facilitate hemostasis.