A set of tools for skeletal traction. Skeletal Traction Surgical Instrument Set Limb Amputation Surgical Instrument Set

Equipment: a syringe with a capacity of 10 m, needles - 2, Kirschner's knitting needles - 2, a drill - manual or electric, a cyto arc, a set of keys for expanding the arc and fixing the knitting needles in it, two clamps of the knitting needles, tweezers - 2, a hemostatic clamp - 1, scissors, sterile balls, sterile wipes, towels, iodonate, alcohol, 1% - 2% solution of novocaine in ampoules, cables, cargo, Beller's tire

Compilation of a set of tools for applying and removing plaster bandages

Equipment: basin for water, scissors for dissecting a plaster cast, tongs for bending a plaster cast, a saw for sawing a plaster cast, a knife for cutting a plaster cast, dressing material, material scissors

Implementation of transport immobilization with standard tires for injuries of bones, joints and soft tissues of the extremities.

Cramer splint

Equipment: Cramer splints, rollers, bandages, kerchief bandage, soft pads, cotton-gauze pads

Preparation for manipulation:

1. Before applying, the tire is wrapped and put in a cover made of oilcloth or plastic film

2. An inscription is made on the cover (exchange fund)

Performing manipulation:

Shoulder fracture:

1. Wash your hands hygienically

2. Check for a fracture

3. Explain to the victim the meaning of the manipulation, the need for it, reassure the patient

4. Have the casualty sit comfortably facing you.

5. Select the bar length. Remember the rule: obligatory fixation of the above- and underlying joints from the fracture site, and in case of a shoulder fracture, immobilization of 3 joints is required

6. Attach the tire to a healthy limb from the fingertips to the elbow joint and bend it at a right angle in this place

7. Reattach the splint from the elbow to the shoulder joint and in this place bend it at an obtuse angle of 115 degrees, the end of the splint should reach the opposite shoulder joint or the inner edge of the opposite shoulder blade

8. Apply the prepared tire from the fingertips to the opposite shoulder joint or the inner edge of the opposite shoulder blade

9. Give the injured limb a mid-physiological position: put a small cotton roll into the armpit to slightly abduct the shoulder (up to 20 degrees); the forearm in the elbow joint is bent at an angle of 90 degrees and given a position between supination and pronation; the hand is extended at the wrist joint to an angle of 45 degrees

10. In order to avoid additional trauma to the injured limb, the splint is applied over clothes and shoes

11. Lay cotton wool in the places where the bones protrude (epericondyles, processes, etc.)

12. Place your injured hand on the inside of the simulated tire

13. Tie the ends of the tire through a healthy shoulder girdle and axillary fossa

14. Put the roller in the palm of your hand, bandage the splint in the area of ​​​​the wrist joint with an eight-shaped bandage

15. Bandage the elbow splint with a tortoiseshell bandage

16. Bandage the splint around the shoulder joint with a spike bandage

17. Monitor the patient's condition

With a fracture of the leg

1. Cotton-gauze pads, pads, etc. are applied to the bony protrusions of the limb.

2. One splint is modeled for the posterior surface by bending it to match the profile of the leg. The foot is placed at right angles to the shin.

3. For better fixation of fragments of the bones of the lower leg, it is necessary to additionally apply 2 more tires on the sides of it so that they cover the foot in the form of a stirrup

4. Tires are fixed with gauze bandages

5. Monitor the patient's condition

With hip fracture

1. Cotton-gauze pads are applied to the bone protrusions of the limb (for the prevention of bedsores)

2. A tire 110 cm long, modeled according to the bulge of the heel and calf muscle, is placed on the back of the leg

3. Two other tires, fastened together along the length, go from the armpit along the outer surface of the limb to the foot, covering the latter, as well as the rear tire, with its end, curved in the shape of the letter G. Such laying of the tires prevents plantar sagging of the foot

4. If there is a sufficient number of ladder tires, it is advisable to lay the 4th tire along the inner surface of the thigh and lower leg, and also bend its lower end in the shape of the letter G - for the sole

5. Tires are strengthened with gauze bandages

6. Monitor the patient's condition

Skeletal traction is an integral part of the so-called functional treatment and one of the most common trauma manipulations. A thin needle is inserted into the patient's bone and pulled in an arc. With the help of traction along the axis, the displacement of fragments is eliminated. The limb is usually placed on a special splint to create rest for the injured muscles and loosen their tension. For the upper limb, CITO abduction tires are used, for the lower limb, tires of the Beler type are used.

a - an arc for traction; b - screw for compressing the arc and tensioning the spokes; c - socket wrench; g - manual drill with a knitting needle.

Skeletal traction is most often performed in a plaster, clean dressing or preoperative room. With a large amount of work in large hospitals, it is necessary to have several ready-made sterile sets for skeletal traction. The set includes: a kidney-shaped tray, a syringe with a capacity of 10 ml, a glass for novocaine, needles (2 pcs.), knitting needles for skeletal traction (2 pcs.), tweezers (2 pcs.), a hemostatic clamp, sterile balls (6 pcs.) , sterile wipes (2 pcs.), shaving sticks with alcohol and iodine. The tray is served to the traumatologist with a sterile forceps. After processing the surgical field, it is covered with sterile towels. The needle is inserted into the head of an electric or hand drill and inserted into the bone in the transverse direction. Typical pin insertion sites: calcaneus, upper metaphysis of the tibia, subcondylar region of the thigh, olecranon. After the needle is inserted, sterile balls are put on its ends, which are pressed tightly against the skin with special fixatives or stoppers from penicillin vials put on the needle. The spoke is tensioned in an arc with a special spoke tensioner. In the CITO arcs, the tension is carried out without a spoke tensioner, but by screwing the arc screw. A cord with a load of 2 to 8-10 kg (rarely more) is tied to the arc. With good tension, the spoke does not bend even with very large loads. The cord is thrown over the bus block on which the patient's limb lies.

IV. Instruments for protecting tissues from damage

Operative surgical technique

Implementation of blood transfusion

1. Warm the blood: the vial with the transfused transfusion medium should be at room temperature for 30-40 minutes, in emergency cases it is heated in a water bath to 37 0 C. The heating temperature is controlled using a thermometer.
2. Charge the system (there must be a disposable system with a nylon filter;
3. Perform a puncture of the recipient's vein, take 10 ml of blood. Recheck the blood group of the donor and recipient Cold method without heating; show the results to the doctor.
4. Conduct a test for individual compatibility of blood groups of the donor and recipient according to the ABO system;
5. Conduct a test for individual compatibility according to the Rh factor;
6. Show the results of tests for individual compatibility to the doctor;
7. Conduct a biological test, under the supervision of a physician.
8. Perform blood transfusion. During the blood transfusion, continue to monitor the patient.
9. Leave 100 ml of transfusion medium in the container, place the container in the refrigerator for a day.

Classification of surgical instruments

I. Tools for tissue separation:

1. scalpels

2. amputation knives

3. scissors

6. wire cutters

7. rapators.

II. Tools for clamping (capturing) tissues, as well as fixing:

1. hemostatic clamps (such as Kocher, Billroth, etc.)

2. tweezers (anatomical, surgical, pawl)

3. Mikulich clamp for peritoneum

4. intestinal elastic curved pulp

5. clamp (pulp) intestinal crushing curved

6. Payra gastric crushing forceps

7. linen hoe

8. Terminal clamp

9. tongue holder

10. Farabeuf fixation bone forceps

11. hepatic Fedorov clamp

12. forceps

III. Instruments for widening the wound and natural openings:

1. single-prong sharp hook

2. hooks 2-, 3-, 4-toothed - blunt and sharp

3. lamellar hook Farabef

4. abdominal mirror

5. liver speculum (hook)

6. Mikulich retractor

7. retractor (tracheo dilator) Trousseau

8. mouth expander

9. Rectal speculum

1. grooved probe

2. Kocher probe

3. Buyalsky's spatula

4. retractor

V. Tissue Joining Tools:

1. needle holder

2. surgical needles (stabbing, cutting)

3. Deschamps ligature needles

Set for primary surgical treatment of wounds.

1. Scalpel.
2. Scissors.
3. Needle holder, skin needles.
4. Suture material silk, catgut.
5. Farabef hooks, pointed (toothed) hooks..
6. Probes: grooved, bellied.
7. Syringe with needles, novocaine solution for local anesthesia.
8. Alcohol, brilliant green, iodonate for treating the skin around the wound.
9. Furatsilina solution, 3% hydrogen peroxide solution, hypertonic solution (10% sodium chloride solution).
10. Sterile balls, tampons, napkins, diapers.
11. Tsapki.
12. Kornzang.

Set for opening an abscess.

1. Scalpel (pointed).
2. Scissors.
3. Tweezers anatomical, surgical.
4. Hemostatic clamps Billroth, Kocher, type "mosquito".
5. Tsapki.
6. Kornzang.
7. Probe.
8. Drainages (glove, gauze, tubular)
9. Syringe, needles, 0.25% - 0.5% novocaine solution for local anesthesia.
10. Solutions of 3% hydrogen peroxide, furacilin, hypertonic solution (10% sodium chloride solution).
11. Iodonate, alcohol.
12. Sterile dressing material: balls, turundas, napkins.

Tracheostomy set.

1. Scalpel (pointed, abdominal).
2. Scissors.
3. Hemostatic clamps (Billroth, Kocher, Mosquito type).
4. Tweezers anatomical, surgical, dentate-fingered.
5. Tracheo dilator Trousseau.
6. Single hook.
7. Tracheostomy tubes 1-2.
8. Hooks 3-tooth sharp.
9. Tsapki.
10. Kornzang.
11. Iodonate, alcohol.

Set for laparocentesis (abdominal puncture).

1. The scalpel is pointed.
2. Scissors.
3. Trocar.
4. Needle holder, needles, suture material.
5. Tsapki.
6. Kornzang.
7. Iodonate, alcohol.
8. Sterile dressing material: balls, napkins.
9. Adhesive plaster or cleol.

Set for appendectomy.

1. scalpel - 2.
2. Scissors.
3. Hemostatic clamps (Billroth, Kocher).
4. Clamp Mikulich.
5. Farabef hooks.
6. Abdominal mirrors.
7. Mirror liver.
8. Tweezers are anatomical, surgical.
9. Needle holder, needles (piercing, cutting), silk, catgut.
10. Tsapki.
11. Kornzang.
12. Sterile dressing material: balls, tampons, napkins.
13. Iodonate, chlorhexidine, alcohol.

Set for a puncture of joints.

1. Iodonate, alcohol.
2. Syringes 10, 20 ml, needle.
3. Puncture needle with a diameter of not more than 2 mm.
4. Novocaine solution 0.5%.
5. Tweezers.
6. Kornzang.
7. Sterile test tube for bacteriological research.
8. Sterile dressing material: balls, napkins.
9. Bandages for dressing.
10. test tubes

Set for a puncture of soft fabrics.

1. Syringe 10-20 ml.
2. A set of needles of various lengths and thicknesses.
3. Tweezers.
4. Kornzang.
5. 0.25 - 0.5% novocaine solution,
6. Iodonate, alcohol.
7. Cleol, adhesive plaster.
8. Bandage.
9. Test tubes.

Set for venesection.

1. Scalpel.
2. Scissors.
3. Hemostatic clamps.
4. Tweezers anatomical, surgical.
5. Needle holder, needles, silk, catgut.
6. Deschamp's needle.
7. Sharp-toothed and lamellar hooks.
8. Catheter for insertion into a vein.
9. Kornzang.
10. Tsapki
11. Alcohol, iodonate.
12. Heparin.
13. Drip system for intravenous administration.

Set for setting the subclavian catheter.

1. Iodonate, alcohol.
2. 0.5% novocaine solution.
3. Syringe, needles.
4. Needle with a wide lumen with a cut at an angle of 45 0 10-15 cm long.
5. Sterile, long-term shelf life set for catheterization of the subclavian vein: polyethylene catheter, guide line, 2-3 rubber caps-plugs.
6. Needle holder, needle, silk.
7. Kornzang.
8. Tsapki.
9. Sterile dressing material: balls, napkins, diapers.

Set for trepanation of the skull.

1. Farabef raspators: straight, curved.
2. Rotate. Cutters.
3. Conductor.
4. Saw Gigli.
5. Luer clippers.
6. Bone spoons.
7. Hemostatic clamps Mosquito, Kochera.
8. Tsapki.
9. Scalpels (pointed and abdominal).
10. 2, 3, 4-tooth hooks - 1 pair each.
11. Farabef hook.
12. Tweezers (anatomical and surgical) - 2 each.
13. Forceps are straight and curved.
14. Surgical scissors (straight and curved, blunt and pointed).
15. Needle holders.
16. Needles - surgical, cutting, curved.
17. Suture material.
18. Iodonate, alcohol.
19. Sterile dressing.
20. Electric suction.

Set for lumbar puncture.

1. Sterile gauze balls and wipes.
2. Vials with 70% alcohol solution, 1% iodonate solution, 0.25% novocaine solution, cleol.
3. The tweezers are anatomical.
4. Sterile sheets.
5. Linen toes.
6. Syringes 5 ml with needles.
7. Needles for spinal puncture (Bira) - 2.
8. Sterile tubes - 2.
9. Glass tube - manometer.

Set for skeletal traction.

1. Sterile gauze balls, wipes.

2. Vials with 70% alcohol solution, 1% iodonate solution, 0.5% novocaine solution, cleol, furatsilin 0.04%.

3. Syringe 20 ml with needles.

4. Kirchner spokes - 3.

5. Scissors.

6. Korntsang.

7. Arcs of CITO - 3.

8. Locksmith cutters.

9. Key for tensioning the spokes.

10. Sterile caps from penicillin vials - 6.

11. A set of weights.

12. Thick fishing line or twine.

13. Beler bus or CITO outlet bus.

Set for puncture of the bladder (1 option).

1. Sterile tray.
2. Beer puncture needle or needle 12-15 cm long.
3. Drainage tube.
4. Clamps.
5. Tweezers.
6. Kornzang.
7. Syringe with injection needles.
8. Sterile dressing material, adhesive plaster.

Set for a puncture of a bladder (2 option).

1. Sterile tray.
2. Trocar.
3. Scalpel.
4. Hemostatic clamps.
5. Drainage tube.
6. Tweezers.
7. Kornzang.
8. Tsapki.
9. Syringe with injection needles.
10. Novocaine solution 0.5%, ethyl alcohol 70%, iodonate.

Set for epicystostomy.

1. Sterile tray.
2. Scalpel.
3. Hemostatic clamps + long clamp.
4. Needle holder, skin needles, suture material.
5. Drainage tube (Petser's tube).
6. Tweezers.
7. Kornzang.
8. Tsapki.
9. Syringe Janet.
10. Furatsilina solution.
11. Syringe with injection needles.
12. Novocaine solution 0.5%, ethyl alcohol 70%, iodonate.
13. Sterile dressing material, adhesive plaster. Sterile diapers.
14. Urine bag with adapters.

Set for hemorrhoidectomy.

1. Rectal mirror.
2. Hemorrhoidal Luer clip.
3. Tsapki.
4. 2, 3, 4 tooth hooks.
5. Forceps.
6. Scissors.
7. Needle holder, set of needles.
8. Suture material.
9. Iodonate, alcohol.
10. Sterile dressing.

A set for amputation of a limb.

1. Tsapki.
2. Scalpels (pointed, abdominal).
3. 2, 3, 4 tooth hooks.
4. Hemostatic clamps (Kocher, Billroth).
5. Tweezers (anatomical, surgical).
6. Forceps.
7. Scissors.
8. Needle holders, a set of needles, suture material.
9. Frame saw.
10. Amputation knife.
11. Liston cutters.
12. Deschamp's needle.
13. Bone raspator Farabef (straight, curved).
14. Retractor.
15. Rasp.
16. Single hook.
17. Arterial tourniquet.
18. Iodonate, alcohol.
19. Sterile dressing.

Set for instrumental wound dressing.

1. Sterile dressing material: napkins, tampons, balls.
2. Iodonate, 70% alcohol solution, 3% hydrogen peroxide solution, 0.5% alcohol solution of gibitan, furatsilin 0.04%.
3. Tweezers (anatomical, surgical) - 3.
4. Scissors.
5. Putty knife.
6. Probe.
7. Drainages, turundas.
8. Syringe for washing the wound.
9. 4-5m beakers (glasses).
10. Wound healing ointments.
11. Bandage, cleol.

Set for pleural puncture.

1. Sterile dressing material: gauze balls and napkins.
2. The tweezers are anatomical.
3. Vials with 70% alcohol solution, iodonate solution, 0.25% novocaine solution, cleol.
4. Syringe 20 ml with needles - 2.
5. Puncture needle with rubber tube and cannula.
6. Hemostatic clamp.
7. Sterile tubes - 2.
8. Pleuroaspirator (Bobrov apparatus, Janet syringe).
9. Adhesive plaster, gloves.

Set for suturing and removing sutures.

BUT. For suturing:

1. Surgical tweezers.

2. Needle holder, set of needles, suture material.

3. Scissors.

4. Iodonate, alcohol.

5. Sterile dressing.

6. Syringe, needles, novocaine solution 0.5%.

B. To remove stitches:

1. Anatomical tweezers.

2. Pointed scissors.

3. Sterile dressing.

4. Iodonate, alcohol.

Set for drainage of the pleural cavity.

1. The scalpel is pointed.
2. Tweezers surgical, anatomical.
3. Hemostatic clamps (Billroth, Kocher).
4. Scissors.
5. Trocar.
6. Drainage tube.
7. Needle holder, needles, suture material.
8. Syringe, needle, 0.25% - 0.5% novocaine solution.
9. Tsapki.
10. Kornzang.
11. Iodonate, alcohol.
12. Sterile dressing material: balls, napkins.
13. Adhesive plaster or cleol.
14. Pleuroaspirator (Bobrov apparatus).

Of all surgical instruments kits can be made to allow for typical surgical procedures.

On the instrumental table of the operating sister there should be “connecting instruments” - i.e. those with which only the operating sister works - scissors, anatomical tweezers small and long, 2 forceps, 4 linen pins for processing and delimiting the surgical field.

The main set - it includes the tools of the general group, which are used in any operations and are included in the elements of the operation.
For specific operations, special tools are added to them.

Basic set of surgical instruments

Figure 12. Basic set of surgical instruments.
1 - clamp type "Korntsang" (according to Gross-Meyer) straight; 2 - linen caps; 3 - bulbous probe (Voyachek); 4 - grooved probe; 5 - a set of surgical needles; 6 - atraumatic needle with suture thread.

1. Korntsang, used to process the surgical field. There may be two.
2. Linen claws - for holding the dressing.
3. Scalpel - must be both pointed and belly, several pieces, because during the operation they have to be changed, and after the dirty stage of the operation - thrown away.
4. Clips hemostatic Billroth, Kocher, "mosquito", - are used in large quantities.
5. Scissors - straight and curved along the edge and plane - several pieces.
6. Tweezers - surgical, anatomical, pawled, they should be small and large.
7. Hooks (retractors) Farabeuf and serrated blunt - several pairs.
8. Probes - bellied, grooved, Kocher.
9. Needle holder.
10. Needles are different - a set.

A set of surgical instruments for PST wounds

Removal of microorganisms that have entered the wound by excising the edges and bottom of the wound or dissecting tissues;
- removal of all damaged tissues, blood clots, which are a nutrient medium for microorganisms;
- conversion of all types of wounds into incised ones to speed up regeneration processes;
- thorough, complete and final hemostasis;
- restoration of the anatomical integrity of damaged tissues by suturing and, if necessary, draining the wound.

Indications: PHO are subject to:

Extensive soft tissue wounds with crushed, torn, uneven edges and heavily contaminated;
- all wounds with damage to large blood vessels, nerves, bones.

PST is carried out within 24 - 48 hours and should be, if possible, one-stage and comprehensive. Preparation for PST consists in dressing the skin around the wound, processing the surgical field according to the method used in this medical institution, premedication. PHO begins with general or local anesthesia.

Contraindications:

Shock, severe anemia,
- collapse, development of purulent inflammation.

For PHO, a common set of tools is used.

Set of surgical instruments for laparotomy

To perform an operation on any organ of the abdominal cavity, a cerebrosection or laparotomy is performed.

Indications: used for acute and chronic diseases of the abdominal cavity and retroperitoneal space, injuries and injuries, sometimes for diagnostic purposes.

An extended general set is used - a general set, which is expanded with Gosse and Mikulich retractors, abdominal mirrors - Roux and saddle, liver and kidney mirrors.

Hemostatic clamps are expanded and Mikulich, Fedorov, fenestrated, hepato-renal clamps, ligature dissector and Deschamp's needle are added.
- Tweezers and scissors should be both small and large (cavitary).
- Intestinal and stomach ulcers,
- Reverden spatula,
- Liver probe and spoon.

Set of surgical instruments for appendectomy and herniotomy

Indications: acute attack of appendicitis, infringement of hernial contents. The operation should be performed urgently, in the first hours from the onset of the disease. With a non-strangulated hernia - in the "cold" period, after a complete examination of the patient.

A set of tools: a general surgical set is used, abdominal instruments are added - Mikulich clamps; ventral mirrors - saddle and Roux.

Set of surgical instruments for laparocentesis (abdominal puncture)

It is carried out with ascites; a similar operation can be used to diagnose injuries and diseases of the abdomen.

A common set of tools is being assembled, because patients are obese and in order to insert a trocar, it is necessary to make an incision in the tissues, and then suture them. In patients with a small amount of subcutaneous fat, only a trocar can be used.

Do not forget PVC tubes according to the diameter of the trocar!

Set of surgical instruments for cholecystectomy

It is used for diseases of the gallbladder, liver, liver injuries.

Surgical instruments:

1. General set of tools, extended for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Liver mirrors,
5. Liver probe and liver spoon
6. Hepato-renal clamp
7. A scoop used for wounding the liver to remove blood from the abdominal cavity.

Set of surgical instruments for resection of the stomach

Figure 17 Lever gastric stapler.

It is used for perforated and ordinary stomach ulcers and 12 - duodenal ulcers, with stomach wounds, stomach tumors.

Tools:

1. Advanced general set for laparotomy
2. Pulp
3. Liver mirrors
4. Fedorov clamp, ligature dissector
5. Window clamps

Instruments for operations on the chest wall and organs of the chest cavity

Tools:

1. General tool kit,
2. Doyen's rib cutter and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer terminals,
5. Fedorov clamp,
6. Ligature dissector and Deschamp's needle.
7. Special instruments used in cardiovascular surgery.

Set of surgical instruments for craniotomy

Figure 18. Special set of instruments for craniotomy.
1 - brace with a set of cutters
2 – Dahlgren cutters, Luer cutters
3, 4 - raspators - straight and curved
5 - Volkman's bone spoon
6 - Jigli saw with handles and Palenov guide

1. Rasp
2. Brain spatulas in various widths
3. Rubber balloon "pear"
4. Special neurosurgical hemostatic forceps

Tracheostomy set

Opening of the windpipe. Emergency tracheostomy is performed to immediately provide air access to the lungs, in case of blockage of the airways, in patients with tumors of the larynx or vocal cords.

Indications:

Damage to the larynx and trachea;
- stenosis of the larynx and trachea due to inflammatory processes and neoplasms;
- foreign bodies of the trachea and larynx;
- the need for prolonged IVL.

Tools:

1. General purpose tools.
2. Special tool kit:
- Single prong hook - small blunt hook
- Trousseau's tracheal dilator
- Double tracheostomy cannulas of various sizes, consisting of outer and inner tubes. The outer tube has holes on the side for ribbons with which it is tied around the neck.

Set of surgical instruments for skeletal traction

This set does not require a common set of tools. It is used to stretch the bone in case of a fracture.

Tools:

Drill, manual or electric
- Kirschner bracket
- Set of spokes
- Nut wrench
- Spoke tension wrench
This set also requires rubber stoppers that fix the gauze ball.

A set of surgical instruments for limb amputation

Removal of the distal limb.

Indications:

limb injuries;
- malignant tumors;
- necrosis of tissues as a result of frostbite, burns, obliterating endarteritis.

The purpose of amputation is to save the patient's life from severe intoxication and infection emanating from the lesion and to create a workable stump suitable for prosthetics.

Set of tools:

General surgical set

1. Tourniquet
2. A set of amputation knives.
3. Raspator for shifting the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Liston or Luer bone cutters
6. Rasp for smoothing sawdust of bones
7. Safety razor blade in Kocher clamp for truncation of nerve trunks
8. Olier or Farabefa bone holder
9. Retractor for protecting soft tissues when sawing bones and for shifting soft tissues before sawing
10. Volkmann's spoon

A set of surgical instruments for suturing and removing sutures

1. Surgical tweezers.
2. Needle holder.
3. A set of needles.
4. Scissors.

To remove stitches

1. Anatomical tweezers.
2. Pointed scissors.

EAT. Turgunov, A.A. Nurbekov.
Surgical instruments

Surgical instruments for dentistry of the German company Kohler can be bought -

All surgical instruments can be combined into kits that allow you to perform typical surgical operations.

On the instrumental table of the operating sister there should be “connecting instruments” - i.e. those with which only the operating sister works - scissors, anatomical tweezers small and long, 2 forceps, 4 linen pins for processing and delimiting the surgical field.
The main set - it includes the tools of the general group, which are used in any operations and are included in the elements of the operation.
For specific operations, special tools are added to them.

Basic set of surgical instruments

Figure 12. Basic set of surgical instruments.
1 - clamp type "Korntsang" (according to Gross-Meyer) straight; 2 - linen caps; 3 - bulbous probe (Voyachek); 4 - grooved probe; 5 - a set of surgical needles; 6 - atraumatic needle with suture thread.

1. Korntsang, used to process the surgical field. There may be two.
2. Linen claws - for holding the dressing.
3. Scalpel - must be both pointed and belly, several pieces, because during the operation they have to be changed, and after the dirty stage of the operation - thrown away.
4. Clips hemostatic Billroth, Kocher, "mosquito", - are used in large quantities.
5. Scissors - straight and curved along the edge and plane - several pieces.
6. Tweezers - surgical, anatomical, pawled, they should be small and large.
7. Hooks (retractors) Farabeuf and serrated blunt - several pairs.
8. Probes - bellied, grooved, Kocher.
9. Needle holder.
10. Needles are different - a set.

A set of surgical instruments for PST wounds(used to work only on soft tissues)

Removal of microorganisms that have entered the wound by excising the edges and bottom of the wound or dissecting tissues;
- removal of all damaged tissues, blood clots, which are a nutrient medium for microorganisms;
- conversion of all types of wounds into incised ones to speed up regeneration processes;
- thorough, complete and final hemostasis;
- restoration of the anatomical integrity of damaged tissues by suturing and, if necessary, draining the wound.

Indications: PHO are subject to:

Extensive soft tissue wounds with crushed, torn, uneven edges and heavily contaminated;
- all wounds with damage to large blood vessels, nerves, bones.
PST is carried out within 24 - 48 hours and should be, if possible, one-stage and comprehensive. Preparation for PST consists in dressing the skin around the wound, processing the surgical field according to the method used in this medical institution, premedication. PHO begins with general or local anesthesia.

Contraindications:

Shock, severe anemia,
- collapse, development of purulent inflammation.

For PHO, a common set of tools is used.

Set of surgical instruments for laparotomy

Figure 13. Laparotomy instrument set.
1 - rack retractor according to Goss; 2 - Collin's retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula

To perform an operation on any organ of the abdominal cavity, a cerebrosection or laparotomy is performed.

Indications: used for acute and chronic diseases of the abdominal cavity and retroperitoneal space, injuries and injuries, sometimes for diagnostic purposes.
An extended general set is used - a general set, which is expanded with Gosse and Mikulich retractors, abdominal mirrors - Roux and saddle, liver and kidney mirrors.
- Expand hemostatic clamps and add Mikulich, Fedorov, fenestrated, hepato-renal clamps, ligature dissector and Deschamp's needle.
- Tweezers and scissors should be both small and large (cavitary).
- Intestinal and stomach ulcers,
- Reverden spatula,
- Liver probe and spoon.

Set of surgical instruments for appendectomy and herniotomy

Surgery to remove the appendix and eliminate the hernia.
Indications: acute attack of appendicitis, infringement of hernial contents. The operation should be performed urgently, in the first hours from the onset of the disease. With a non-strangulated hernia - in the "cold" period, after a complete examination of the patient.
A set of tools: a general surgical set is used, abdominal instruments are added - Mikulich clamps; ventral mirrors - saddle and Roux.

Set of surgical instruments for laparocentesis (abdominal puncture)

Figure 14 Trocar set.

It is carried out with ascites; a similar operation can be used to diagnose injuries and diseases of the abdomen.
A common set of tools is being assembled, because patients are obese and in order to insert a trocar, it is necessary to make an incision in the tissues, and then suture them. In patients with a small amount of subcutaneous fat, only a trocar can be used.

Do not forget PVC tubes according to the diameter of the trocar!

Set of surgical instruments for cholecystectomy

Figure 15. A set of instruments for cholecystectomy.
1 - ligature dissector; 2 - hepatic mirror; 3 - spoon for removing gallstones

It is used for diseases of the gallbladder, liver, liver injuries.

Surgical instruments:

1. General set of tools, extended for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Liver mirrors,
5. Liver probe and liver spoon
6. Hepato-renal clamp
7. A scoop used for wounding the liver to remove blood from the abdominal cavity.

Set of surgical instruments for resection of the stomach

Figure 16. Gastric-intestinal Lane clamp, double.

Figure 17 Lever gastric stapler.

It is used for perforated and ordinary stomach ulcers and 12 - duodenal ulcers, with stomach wounds, stomach tumors.

Tools:

1. Advanced general set for laparotomy
2. Pulp
3. Liver mirrors
4. Fedorov clamp, ligature dissector
5. Window clamps

Instruments for operations on the chest wall and organs of the chest cavity

Instruments are used for injuries of the chest wall, for penetrating wounds, for injuries of the organs of the chest cavity, for purulent pathology and specific diseases of the organs.

Tools:

1. General tool kit,
2. Doyen's rib cutter and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer terminals,
5. Fedorov clamp,
6. Ligature dissector and Deschamp's needle.
7. Special instruments used in cardiovascular surgery.

Set of surgical instruments for craniotomy

Instrument set - a common instrument set is used, but when expanding the wound, the use of pointed hooks is necessary.

Figure 18. Special set of instruments for craniotomy.
1 - brace with a set of cutters
2 – Dahlgren cutters, Luer cutters
3, 4 - raspators - straight and curved
5 - Volkman's bone spoon
6 - Jigli saw with handles and Palenov guide

1. Rasp
2. Brain spatulas in various widths
3. Rubber balloon "pear"
4. Special neurosurgical hemostatic forceps

Tracheostomy set

Figure 20. Tracheostomy set.
1 - a blunt hook for the isthmus of the thyroid gland; 2 - a sharp hook to hold the larynx and trachea; 3 - tracheal dilator; 4,5,6 - tracheostomy cannula assembled and disassembled.

Opening of the windpipe. Emergency tracheostomy is performed to immediately provide air access to the lungs, in case of blockage of the airways, in patients with tumors of the larynx or vocal cords.

Indications:

Damage to the larynx and trachea;
- stenosis of the larynx and trachea due to inflammatory processes and neoplasms;
- foreign bodies of the trachea and larynx;
- the need for prolonged IVL.

Tools:

1. General purpose tools.
2. Special tool kit:
- Single prong hook - small blunt hook
- Trousseau's tracheal dilator
- Double tracheostomy cannulas of various sizes, consisting of outer and inner tubes. The outer tube has holes on the side for ribbons with which it is tied around the neck.

Set of surgical instruments for skeletal traction

Figure 21. A set of tools for skeletal traction.
1 - hand drill; 2 - Kirschner bracket with a wire for skeletal traction.

This set does not require a common set of tools. It is used to stretch the bone in case of a fracture.

Tools:

Drill, manual or electric
- Kirschner bracket
- Set of spokes
- Nut wrench
- Spoke tension wrench
This set also requires rubber stoppers that fix the gauze ball.

A set of surgical instruments for limb amputation

Figure 22. A set of instruments for amputation of a limb.
1 - retractor; 2 - Jigli wire saw; 3 - Palenov's handles; 4 - hemostatic tourniquet; 5 - a set of amputation knives.

Removal of the distal limb.

Indications:

limb injuries;
- malignant tumors;
- necrosis of tissues as a result of frostbite, burns, obliterating endarteritis.

The purpose of amputation is to save the patient's life from severe intoxication and infection emanating from the lesion and to create a workable stump suitable for prosthetics.

Set of tools:

General surgical set

1. Tourniquet
2. A set of amputation knives.
3. Raspator for shifting the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Liston or Luer bone cutters
6. Rasp for smoothing sawdust of bones
7. Safety razor blade in Kocher clamp for truncation of nerve trunks
8. Olier or Farabefa bone holder
9. Retractor for protecting soft tissues when sawing bones and for shifting soft tissues before sawing
10. Volkmann's spoon

A set of surgical instruments for suturing and removing sutures

For suturing

1. Surgical tweezers.
2. Needle holder.
3. A set of needles.
4. Scissors.

To remove stitches

1. Anatomical tweezers.
2. Pointed scissors.

EAT. Turgunov, A.A. Nurbekov.
Surgical instruments