0orsa| 8||t Hethod

Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 35

0orsa| 8||t Hethod
#equ|res rore surg|ca| s|||| lrar lorceps-gu|ded relrod
A surg|ca| ass|slarl |s re|plu| oul rol requ|red
3ra|| r|s| ol asyrrelr|c resu|l
w|de|y used oy surgeors lrrougroul lre Wor|d
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 3
0orsa| 8||t Hethod: 8teps 1-4
8tep 1: 3||r preparal|or, drap|rg ard araeslres|a
8tep 2: #elracl|or ol lores||r ard separal|or ol ary
adres|ors
8tep 3: Var||rg ol |rlerded |rc|s|or ||re
$905. Dpr|ona| - Vark ||ne us|n sna||ou |no|s|on
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 3Z
0orsa| 8||t Hethod: 8tep 5
rasp lre lores||r W|lr lWo arlery
lorceps al lre 3 ard 9 o'c|oc|
pos|l|ors. Take care to app|y the
artery forceps so that there |s
equa| lers|or or lre |nner ard
outer aspecls ol lre lores||r.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 38
0orsa| 8||t Hethod: 8tep
Pr|or lo ra||rg a cul al 12 o'c|oc|, p|ace two artery forceps on the
foresk|n |r lre 11 o'c|oc| ard 1 o'c|oc| pos|l|ors. Crec| lral lre
|rs|de o|ades ol lre lWo arlery lorceps are |y|rg oelWeer lre g|ars
ard prepuce ard rave rol oeer acc|derla||y passed up lre urelrra|
realus.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 39
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Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 10
Aller app|y|rg lorceps al
lre 3 ard 9 o'c|oc|
pos|l|ors, |l re|ps
reduce o|ood |oss |l
pr|or lo ra||rg lre
dorsa| s||l, lWo rore
lorceps are app||ed al
11 o'c|oc| ard
1 o'c|oc| pos|l|ors
1 o'clock
forceps
11 o'clock
forceps
0orsa| 8||t Hethod: 8tep 7
elWeer lre lWo arlery lorceps, |r lre 12 o'c|oc| pos|l|or use d|ssecl|rg
lorceps lo ra|e a cut (the dorsa| s||t} up to the prev|ous|y marked
|nc|s|on ||ne.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 11
%e dorsal slit
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Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 12
lr ra||rg lre dorsa| s||l, a|r lor lre cul lo go as lar as oul ro
larlrer lrar lre scralcr rar|.
$cratc
mark
0orsa| 8||t Hethod: 8tep 8
&s|rg d|ssecl|or sc|ssors, cut the foresk|n free a|org lre
prev|ous|y rar|ed c|rcurc|s|or ||re.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 13
0orsa| 8||t Hethod: 8tep 9
rasp ard lr|r ary s||r lags or lre |rrer edge ol lre lores||r lo |eave
approx|rale|y 5 rr ol s||r prox|ra| lo lre corora. Care rusl oe
la|er lo lr|r or|y lre s||r ard rol lo cul deeper l|ssue.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 11
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Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 15
Ary ragged s||r edge car oe lr|rred W|lr d|ssecl|or sc|ssors
0orsa| 8||t Hethod: 8tep 10
8topp|ng the b|eed|ng:
Pu|| back the sk|n lo expose lre raW area.
dent|fy b|eed|ng vesse|s ard c||p w|th artery forceps. Care srou|d
oe la|er lo calcr lre o|ood vesse|s as accurale|y as poss|o|e ard rol lo
grao |arge arourls ol l|ssue.
T|e each vesse| or under-run w|th catgut ard l|e oll. Ta|e care rol lo
p|ace raeroslal|c sl|lcres loo deep|y. wrer dea||rg W|lr o|eed|rg |r lre
lreru|ar area or or lre urders|de ol lre per|s, care rusl oe la|er rol lo
|rjure lre urelrra.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 1
8topp|ng the |eed|ng.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 1Z
vesse|s ray oe occ|uded oy ||gal|or (A), or oy
lrarsl|x|or sulures ()
A

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Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 18
1. &s|rg lorceps (lWeezers), lre
o|ood vesse| |s |ocaled.
2. Tre o|ood vesse| |s lrer re|d W|lr lre
lorceps ard gerl|y pu||ed up so lral ar arlery
lorceps car oe app||ed.
3. Tre arlery lorceps |s lrer
app||ed, la||rg lre r|r|rur
arourl ol exlra l|ssue.
3lopp|rg lre o|eed|rg: Cul o|ood vesse|s srou|d oe |ocaled accurale|y ard
l|ed or lrarsl|xed.
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Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 19
|ood vesse|s srou|d oe accurale|y c||pped W|lr arlery lorceps, la||rg care lo avo|d la||rg loo o|g a
crur| ol l|ssue. ll |l |s d|ll|cu|l lo see lre source ol o|eed|rg, app|y pressure W|lr a sWao ard Wa|l
lor 2-3 r|rules ard usua||y lre o|eed|rg vesse| car lrer oe occ|uded accurale|y.
8utur|ng P|an
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 50
a b
c
or|zorla| rallress sulure al lre lreru|ur ( o'c|oc|). verl|ca| rallress sulures al 9, 12 ard
3 o'c|oc| ard s|rp|e sulures oelWeer lrese.
0orsa| 8||t Hethod: 8tep 11
P|ace a ror|zorla| rallress sulure al lre lreru|ur. wrer p|ac|rg lre
hor|zonta| mattress suture at o'c|ock pos|t|on, la|e care lo a||gn the
m|d||ne sk|n raphe w|th the ||ne of the frenu|um (see oe|oW). A corror
error |s lo r|sa||gr lre r|d||re ard rapre, Wr|cr resu|ls |r r|sa||grrerl ol
lre Wro|e c|rcurc|s|or c|osure.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 51
0orsa| 8||t Hethod: 8tep 12
P|ace a vert|ca| mattress suture at the 12 o'c|ock pos|t|on. Tre sulure
srou|d oe p|aced so lral lrere |s ar equa| arourl ol s||r or eacr s|de ol lre
per|s oelWeer lre 12 ard o'c|oc| pos|l|ors. P|ace two further vert|ca|
mattress st|tches |n the
3 o'c|ock and 9 o'c|ock pos|t|ons (see oe|oW).
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 52
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Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 53
Ar ass|slarl |s slao|||z|rg lre per|s oy ro|d|rg arlery lorceps allacred lo lre |org
erds ol lre ard 12 o'c|oc| sulure.
Tre surgeor |s aooul lo p|ace lre 9 o'c|oc| verl|ca| rallress sulure.
0orsa| 8||t Hethod: 8tep 13
Aller p|acererl ol lre sulures al
,12, 3 ard
9 o'c|oc|, p|ace lWo or rore
s|rp|e sulures |r the gaps
oelWeer.
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls
51
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Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 55
0rce lre lour rallress sulures are |r p|ace, lurlrer s|rp|e sulures are p|aced
lo accurale|y approx|rale lre Wourd edges.
0orsa| 8||t Hethod: 8tep 14
0rce lre procedure |s l|r|sred, check for b|eed|ng ard
app|y a dress|ng (descr|oed |aler).
Crapler 5: 3urg|ca| Procedures lor Adu|ls ard Ado|escerls 5