“Minor” Surgical Procedures

Minor Surgical Procedures Overview

• Wound Closure/Approximation: Used for lacerations, surgical incisions, and trauma; promotes healing and reduces infection risk.
• Risks of Wound Closure: Infection, scarring, dehiscence, pain, allergic reactions, and necrosis.
• Benefits of Wound Closure: Faster healing, reduced infection risk, cosmetic improvement, and functional restoration.
• Alternatives to Wound Closure: Healing by secondary intention, delayed primary closure, skin grafting/flap closure, and NPWT.

Incision and Drainage (I&D)

• Indication for I&D: Treatment of abscesses, localized infections, and fluid collections; presents as swollen and painful areas of skin.
• Risks: Infection spread, bleeding, recurrence of abscess, scarring, pain, and damage to surrounding structures.
• Benefits: Immediate resolution of infection, pain relief, prevention of complications, and improved healing.
• Alternatives: Antibiotics alone, needle aspiration, watchful waiting, and warm compresses.

Needle Decompression

• Indication: Emergency procedure for tension pneumothorax; critical intervention to relieve lung compression.
• Risks: Failure to relieve pressure, injury to lung, damage to nearby structures, infection, and bleeding.
• Benefits: Life-saving pressure relief, immediate symptom reduction, and temporary stabilization.
• Alternatives: Chest tube placement and surgical intervention.

Tube Thoracostomy

• Indication: Drainage of air, fluid, blood, or pus from the pleural space; essential for conditions like pneumothorax and hemothorax.
• Risks: Infection, bleeding, lung injury, organ injury, malposition of the tube, and re-expansion pulmonary edema.
• Benefits: Lung re-expansion, fluid drainage, prevention of complications, and patient stabilization.
• Alternatives: Needle aspiration, observation, thoracentesis, and surgical intervention.

Thoracentesis

• Indication: Removes excess fluid from the pleural space for diagnostic or therapeutic purposes; common in pleural effusions.
• Risks: Pneumothorax, bleeding, infection, re-expansion pulmonary edema, and organ injury.
• Benefits: Symptom relief, diagnostic information, improved lung function, and prevention of complications.
• Alternatives: Observation, diuretics, and surgical intervention.

Paracentesis

• Indication: Removal of fluid from the peritoneal cavity (ascites) for diagnostic or therapeutic purposes; indicates liver cirrhosis or malignancy.
• Risks: Bleeding, infection, organ injury, hypotension, and persistent fluid leak.
• Benefits: Symptom relief, diagnostic information, improved mobility, and prevention of complications.
• Alternatives: Diuretics, sodium restriction, and TIPS.

Lumbar Puncture

• Indication: Collect cerebrospinal fluid for diagnosis or therapeutic intervention, essential for conditions like meningitis or multiple sclerosis.
• Risks: Post-lumbar puncture headache, infection, bleeding, nerve injury, and herniation.
• Benefits: Accurate diagnosis, symptom relief, guided treatment, and therapeutic intervention.
• Alternatives: Imaging studies, observation, and blood tests.

Infusaport Placement

• Indication: Long-term venous access for chemotherapy, total parenteral nutrition, or frequent blood draws.
• Risks: Blockage, infection, bleeding, thrombus, and pneumothorax.
• Benefits: Reduces needle sticks, lowers infection risk, and can be easily placed and removed.
• Alternatives: Peripheral IV, PICC, or central venous catheter.

Minimally Invasive Surgical (MIS) Procedures Considerations

• Pros: Decreased physiological stress, shorter hospital stays, reduced pain, and lower infection risk.
• Cons: Increased operative time, technical skill required, and unique complications from CO2 in laparoscopic procedures.

Surgical Procedures for Skin Cancers

• Potential Skin Cancer Procedures: Shave, punch, and excisional biopsies for suspicious lesions.
• Known Skin Cancers Treatments: MOHS for basal/squamous cell cancers; excisional biopsy adjusted based on melanoma depth.

Common MIS Procedures

• Common Procedures: Laparoscopy, cholecystectomy, bariatric surgery, appendectomy, thoracoscopy, and robotic surgery.
• Robotic Surgery: Utilizes da Vinci system for various cardiac and pelvic procedures.

Surgical Trends

• Single Incision Laparoscopic Surgery (SILS): Minimally invasive with fewer incisions.
• Natural Orifice Transluminal Endoscopic Surgery (NOTES): Involves accessing internal cavities through natural openings.

Miscellaneous Procedures

• Nasogastric (NG) Tube Placement: Used for gastric decompression and medication delivery with risks of trauma and discomfort.
• Percutaneous Endoscopic Gastrostomy (PEG) Tube: Inserted for long-term feeding, indicated in various conditions like cirrhosis.

Summary of Risks and Benefits in Procedures

• Needle Decompression & Paracentesis Risks: Infection, bleeding, organ injury, and complications from inadequate care.
• Benefits of Procedures: Relief from symptoms, improvement in patient conditions, and pathology insights guiding treatments.### Enteral Feeding
• Long-term enteral feeding is essential for patients with dysphagia, impaired self-feeding, or gastrointestinal obstructions.
• Malnutrition can occur due to inadequate nutrition delivery methods.
• Common complications include infection, tube dislodgement, bleeding, and pain at the PEG tube site.
• Various feeding methods include NG tube (short-term), surgical gastrostomy, TPN via IV, and jejunostomy tube.

Colostomy

• Indicated for conditions like colorectal cancer, bowel obstruction, trauma, and inflammatory bowel disease (IBD).
• Diverts fecal stream and protects the distal bowel, enhancing patient quality of life.
• Factors like severe comorbidities, stoma care ability, and anastomosis feasibility must be considered.

Ileostomy

• Primarily indicated for IBD, colorectal cancer, bowel rest, and conditions like ulcerative colitis and Crohn’s disease.
• Protects distal anastomosis and effectively manages bowel contents.
• Considerations include the possibility of restoring intestinal continuity and the patient’s nutritional status.

Drainage Systems

• Penrose Drain: Used for abscesses and post-surgical drainage; risks include infection and skin irritation.

  • Offers passive drainage and is simple to manage, though alternatives like closed drains or negative pressure wound therapy exist.

• Abdominal Drain (3-Way Stop Cock): Used for large fluid volumes; risks include infection and discomfort.

  • It allows for continuous or intermittent drainage control in complex abdominal conditions.

• Jackson-Pratt Drain: Utilized for postoperative fluid drainage; reduces risks of infection and seroma formation.

  • Ideal for small, clean wounds, but may not be suitable in certain contaminated fields.

Access Lines

• PICC Line: Provides long-term intravenous access for medication, nutritional support, and blood draws.

  • Inserted into a peripheral vein and advanced to the central venous system; risks include infection and thrombosis.

• Central Line Placement: Long flexible tube for administering medications and fluids, often placed in a hospital setting.

  • Useful for rapid fluid resuscitation and challenging venous access; risk for pneumothorax and blockage.

• Arteriovenous (AV) Fistula: Created for long-term hemodialysis access, connecting an artery and vein in the arm.

  • Lower infection risk and longer lifespan, with the surgery done by a vascular surgeon; potential complications include infection and thrombosis.

Explore the essential aspects of minor surgical procedures, focusing specifically on wound closure techniques. This quiz discusses indications, risks, and objectives associated with the approximation of wound edges to ensure proper healing and minimal complications. Test your knowledge on infection control and cosmetic outcomes.