Basic Surgery Skills

Basic surgical skills - incision, debridement, suturing, and abscess drainage - are teachable and can save lives when hospital care is impossible. The line between skilled first aid and basic surgery is procedural confidence and anatomical knowledge, not different underlying principles.

Key Concepts

• —Aseptic technique: preventing infection during procedures requires clean instruments (boiled for 20 minutes), clean gloves or thoroughly washed hands, and a clean field; contamination during a procedure is worse than delaying it.
• —Local anesthesia without drugs: subcutaneous injection of 1% lidocaine (if available) eliminates pain in the procedure field; without anesthetics, cold application, pressure, and distraction are the available options - tell the patient every step before doing it.
• —Tissue planes and dissection: cutting through skin, subcutaneous fat, and fascia requires sharp instruments and respect for underlying structures; blunt dissection (spreading with a hemostat rather than cutting) reduces vascular and nerve injury.
• —Suture material and technique: monofilament sutures (nylon, fishing line boiled before use) are the most infection-resistant; simple interrupted sutures are the most reliable closure; sutures should approximate tissue without tension.
• —Wound drainage: abscesses, deep wound infections, and fluid collections require drainage incision before they will heal; once drained, packed open with gauze, and allowed to close from the inside out (healing by secondary intention).

Practical Guide

1. 1.Sterilize instruments by full immersion in boiling water for 20 minutes; allow to cool in a clean covered container and handle only with boiled or gloved hands from that point forward.
2. 2.Prepare the surgical field by cleaning skin with antiseptic (povidone-iodine or dilute bleach) in expanding circles from the center outward; drape with clean cloth to define the sterile zone.
3. 3.For abscess incision, identify the area of maximum fluctuance (most fluid-filled feel), make a single decisive incision large enough to allow drainage (at least 1 cm), and express all contents; probe the cavity with a gloved finger to break any internal pockets.
4. 4.After draining an abscess, irrigate the cavity with clean saline or clean water, pack loosely with gauze to keep the incision open, and change the packing daily until the cavity has granulated closed from the bottom.
5. 5.To close a skin wound with sutures: drive the needle at 90 degrees to the skin surface, pass it through the full depth of dermis, and exit symmetrically on the opposite side; tie with a square knot snug but not tight enough to blanch surrounding skin.
6. 6.Remove sutures at the appropriate time based on location: face at 5 days, scalp at 7 days, trunk at 10 days, extremities at 10-14 days; premature removal risks wound dehiscence; delayed removal increases scarring and infection risk.
7. 7.Practice suture technique on fruit skin or leather before performing it on people; the mechanics of needle driving and knot tying must be familiar so that attention can go to tissue handling and hemostasis.