Manual of Ambulatory General Surgery

1 General Principles.- 1.1 Introduction.- 1.2 Scrubbing and Gowning.- 1.3 Skin Preparation and Draping.- 1.4 Antibiotic Prophylaxis.- 1.4.1 Principles.- 1.4.2 Types of Antibiotics, Dosages and Routes of Administration.- 1.4.3 Timing of Prophylactic Antibiotics.- 1.5 Protection against HIV and Hepatitis.- 1.6 Accidental Contamination.- 1.6.1 Contamination of the Operation Field.- 1.6.2 Contamination of a Member of the Operating Team.- 1.7 Patient Consent and Medico-legal Aspects.- 1.7.1 Consent.- 1.7.2 Operation Record.- 1.7.3 Medical Notes.- 2 Instruments, Sutures and Diathermy.- 2.1 Introduction.- 2.2 Instrumentation.- 2.2.1 Scalpels.- 2.2.2 Forceps.- 2.2.3 Needle Holders.- 2.2.4 Retractors.- 2.2.5 Curettes.- 2.2.6 Infiltration Needles.- 2.2.7 Tourniquets.- 2.3 Sutures.- 2.3.1 Principles.- 2.3.2 Materials.- 2.3.3 Technique.- 2.3.4 Needles.- 2.3.5 Knots.- 2.3.6 Clips and Staples.- 2.3.7 Removal of Sutures and Clips.- 2.4 Diathermy.- 2.4.1 Monopolar (unipolar).- 2.4.2 Bipolar.- 3 Anaesthetics.- 3.1 Introduction.- 3.2 Types of Local Anaesthetics.- 3.2.1 Short-acting Local Anaesthetics.- 3.2.2 Long-acting Local Anaesthetics.- 3.2.3 Mixtures.- 3.2.4 Precautions.- 3.3 Local Infiltration.- 3.4 Ring Block.- 3.5 Nerve Block.- 4 Vascular Access.- 4.1 Introduction.- 4.2 Venous Cutdown.- 4.3 Central Lines.- 4.3.1 Subclavian Vein Access.- 4.3.2 Internal Jugular Vein Access.- 4.4 Total Parenteral Nutrition and Tunnelled Venous Lines.- 5 Lesions of the Skin and Subcutaneous Tissue.- 5.1 Introduction.- 5.2 Lacerations.- 5.2.1 Suturing Lacerations.- 5.2.2 Other Methods of Closing Skin Lacerations.- 5.2.3 Special Cases.- 5.3 Skin Tag and Papilloma.- 5.4 Sebaceous Cyst.- 5.5 Dermoid Cyst.- 5.6 Lipoma.- 5.7 Pigmented Naevus.- 5.8 Keloid Scar.- 5.9 Abscess.- 5.10 Skin Cancers.- 5.10.1 Basal Cell Carcinoma.- 5.10.2 Squamous Cell Carcinoma.- 5.10.3 Malignant Melanoma.- 5.11 Pinch Skin Graft.- 5.12 Warts and Verrucas.- 5.13 Skin Biopsy.- 5.14 Other Lesions.- 5.14.1 Solar Keratosis.- 5.14.2 Seborrheic Wart.- 5.14.3 Bowen’s Disease.- 5.14.4 Miscellaneous Skin Lesions.- 6 Varicose Veins.- 6.1 Introduction.- 6.2 Indications for Surgery.- 6.3 Investigations.- 6.4 Treatment Rationale.- 6.4.1 Sapheno-femoral Junction Incompetence with Long Saphenous Varices.- 6.4.2 Sapheno-popliteal Junction Incompetence with Short Saphenous Varices.- 6.4.3 Combined Sapheno-femoral and Sapheno-popliteal Junction Incompetence with Long and Short Saphenous Varices.- 6.4.4 Varicosities with no Junction Incompetence.- 6.4.5 Calf Perforator Incompetence.- 6.5 Recurrent Varicose Veins.- 6.6 Sclerotherapy.- 6.7 Junction Ligation.- 6.7.1 Sapheno-femoral Junction.- 6.7.2 Sapheno-popliteal Junction.- 6.8 Stripping.- 6.8.1 Conventional Stripping.- 6.8.2 Inversion stripping.- 6.9 Avulsion of Varicosities (Phlebectomies).- 6.10 Post-operative Care.- 7 Hernia Repair.- 7.1 Introduction.- 7.2 Inguinal Hernia.- 7.3 Femoral Hernia.- 7.4 Para-umbilical Hernia.- 7.5 Other Herniae.- 8 Anal Procedures.- 8.1 Introduction.- 8.2 Investigative Procedures.- 8.2.1 Proctoscopy.- 8.2.2 Rigid Sigmoidoscopy.- 8.2.3 Flexible Sigmoidoscopy.- 8.3 Examination under Anaesthesia (EUA).- 8.4 Haemorrhoids.- 8.4.1 Injection of Haemorrhoids.- 8.4.2 Banding of Haemorrhoids.- 8.5 Skin Tags.- 8.6 Anal Fissure.- 8.6.1 Anal Stretch.- 8.6.2 Lateral (Internal) Sphincterotomy.- 8.7 Fistula-in-Ano.- 8.8 Anal Warts.- 9 Miscellaneous.- 9.1 Ganglion.- 9.2 Procedures on Nails.- 9.2.1 Paronychia.- 9.2.2 Subungual Haematoma.- 9.2.3 Simple Avulsion of Nail.- 9.2.4 Lateral Wedge Excision.- 9.2.5 Zadek’s Operation.- 9.3 Muscle Biopsy.- 9.4 Temporal Artery Biopsy.- 9.5 Amputation of a Toe.- 9.6 Catheterisation.- 9.6.1 Urethral Catheterisation.- 9.6.2 Suprapubic Catheterisation.- 9.7 Circumcision.- 9.7.1 Conventional Technique.- 9.7.2 Plastibell Technique.- 9.8 Vasectomy.- Appendices.- Appendix A Scrub and Operative Field Preparation Solutions.- Appendix B Dosages of Popular Local Anaesthetics, Sedatives and Analgesics used in Local Anaesthetic Operations.- Appendix C Prophylactic Antibiotic Regimens and Dosages.- Appendix D Consent Forms.- Appendix E Medical Defence Organisations in the UK.