Tool sets. Surgical Instrument Sets - Description Skeletal Traction Surgical Instrument Set

In the treatment of severe fractures, injuries of the cervical spine, swelling of muscle tissue, the skeletal traction method is often used. It involves fixing the bones using a splint, knitting needles and weights. As a result, the area is immobilized, the muscles relax, and the bones fuse. Skeletal traction reduces the duration of treatment and rehabilitation.

During treatment, the doctor can observe the process of bone tissue fusion and, if necessary, adjust the structure. Overlay period - more than 1.5 months. Do not prescribe skeletal traction to children, as well as to people in old age. A contraindication is the inflammatory process in the area of ​​damage. There is a method of skeletal traction A.V. Kaplan. It is characterized by the fact that bone fragments are connected and fixed using parallel and crossed spokes.

Before skeletal traction, local anesthesia of the skin, muscle tissue and directly bone tissue is performed. The procedure is performed by the surgeon, taking into account the requirements of the sterility of the room and the instruments used.

Kirschner metal wires are used (knitting needles for skeletal traction). The doctor, using a drill, passes the needle through the holes made in the bone tissue, and fixes it in the bone with special fixators. Outside, in order to prevent infection, the spokes are closed with sterile dressings or napkins. The tension of the spoke occurs through the bracket mounted on the spoke. The skin in the places where the pins exit, the places where the pins are attached are regularly examined by a doctor.

An important aspect of the efficiency of bone reposition in this technology is the correct calculation of the weights used. So, when calculating the load on the lower limb in case of injuries of the femur, the mass of the leg is used, which is 15% of the mass of the human body (6-12 kg). In case of leg injuries, this weight is divided by half (4-7 kg). With old injuries, as well as in case of damage to large bones, the weight of the loads used increases to 15-20 kg. The exact weight of the load is determined by the attending physician two days after the application of the device.

The weight of the loads used depends on the nature of the injury (the length of the displacement of breaks, the duration of the injury), the age of the patient, the state of his muscle tissue and the development of the muscles. The load on the injured limb is given gradually, with 50% of the weight of the planned required weight, which prevents a strong contraction of the muscle tissue near the bone fracture and allows obtaining sufficient accuracy in the reposition of bone fragments.

The patient is placed in a bed with a shield, the lower end of the bed is raised by 40-50 cm to obtain an anti-traction effect, and the more the load is used, the more the end of the bed is raised.

There are 3 stages in therapy:

1. repositioning (up to 72 hours), during which there is a comparison of bone fragments under the control of x-rays;
2. retention (2-3 weeks), rest period to start further regeneration of bone tissue;
3. reparative, ending with the beginning of the formation of callus (4 weeks after the imposition of the mechanism) and the lack of mobility of fragments.

The duration of therapy using such a special design, on average, is from 4 to 8 weeks, but depends on the nature of the injury, the age of the patient, the state of his body and his individual characteristics for tissue regeneration. In the future, the fusion of the bone is carried out by applying a plaster cast.

Indications and contraindications

Skeletal traction is used for:

• helical, comminuted, complex open and closed fractures of the extremities;
• injuries with displacement of bone tissue in a vertical and (or) diagonal direction;
• injuries of the hip bone, as well as the bones of the lower leg, thigh, shoulder;
• injuries of the cervical spine;
• broken calcaneus of the skeleton;
• if it is impossible or inappropriate to use other methods of repositioning and fixing bone fragments;
• postoperative rehabilitation period;
• severe swelling of injured muscle tissue.

The skeletal traction procedure is not applied in case of inflammation of the damaged bone and in the place where the pin exits. This technique is not recommended for young patients and the elderly. In addition, the method is not applicable to persons in a state of intoxication of various types, given the danger to life and health.

Advantages and disadvantages

The advantages of using this technique are:

Among the shortcomings, the following should be mentioned:

• the likelihood of infection of the bone tissue during the installation of instruments for skeletal traction during the treatment period;
• the need for constant antiseptic treatment of the exit points of the needles through the skin with special wipes (by applying antiseptic dressings);
• long course of treatment (more than 6 weeks).

The location of the injured limb, the magnitude and weight of the load applied, and the duration of therapy will depend on the nature of the fracture and the presence of complications.

Skeletal Traction Tools

A set of devices for this technique consists of the following:

1. manual or electric drill;
2. a Kirchner bracket, in the form of a horseshoe with special clamps for the spokes, to which a load is attached for traction;
3. a spoke (several spokes) of skeletal traction, with which Kirchner staples are attached for the procedure;
4. a special key for fixing the fastener;
5. clamp and pin for tensioning the spokes.

Kaplan's way

Method A.V. Kaplan is an osteosynthesis mechanism using a thin metal pin with an artificial narrowing of the bone marrow depression at the site of bone injury. It is a method of fixing damaged bone fragments using cross or parallel wires. It is used in the presence of mobile bone fragments in the ankle and tibia bones.

Kaplan skeletal traction for ankle fracture is applied through three-point traction. The first pin is fixed through the calcaneus, the second through the anterior edge of the distal tibia just above the ankle joint. The injured limb is placed on a Beler splint. For stretching, a load of 6-7 kg is used, with simultaneous pulling upwards using a load of 3-4 kg, put on special hooks. To load downwards to the spoke of the tibia, weights of 3-4 kg are hung.

In order to control the position of the injured limb and the correct installation of the mechanism, an x-ray is taken in two projections in a couple of days. Gradually, as the bone tissue grows together, the load is reduced. A month later, the load is removed, a plaster cast is applied to the injured limb. The gypsum is completely removed after 2.5-3 months.

For complete rehabilitation, therapeutic massage, baths, bandaging with an elastic bandage, physiotherapy and exercise therapy are prescribed.

Skeletal traction is a functional method of treatment.

The main principles are the relaxation of the muscles of the injured limb and the gradual loading.

Indications for implementation:

1. Pronounced displacement of fragments along the length.

2. Late admission of the patient.

3. Inefficiency of one-stage reduction.

4. In the preoperative period to improve the condition of bone fragments before their fixation.

5. In the postoperative period.

Equipment:

1. Tray with sterile wipes.

2.Syringe and needles.

3. Glasses for iodonate, alcohol and 2% novocaine.

4. Scissors, tweezers - 2 pcs.

5. Drill manual or electric.

6, Clamp CITO.

7. Kirchner spoke.

8. Rubber plugs.

Manipulation #37

Skeletal traction

Skeletal traction- functional method of treatment. The main principles are the relaxation of the muscles, the injured limb and the gradual loading.

Indications (for traction)

1) pronounced displacement of fragments along the length

2.) late admission of the patient

3) inefficiency of one-stage reduction

4) in the preoperative period to improve the condition of bone fragments before their fixation

5) in the postoperative period

Equipment:

1. Tray with sterile wipes, balls

2.Syringe 10ml needles

3. Glasses for iodonate, alcohol and novocaine (2%)

4. Scissors, tweezers - 2 pcs.

5.Drill manual or electric

6. Bracket, knitting needles, rubber cork Cyto Kirchner

Pin insertion sites:

1.heel bone

2. upper metaphysis (tuberosity) of the tibia

3.above the condyles of the thigh

Technique:

(carried out by a doctor in strict observance of asepsis)

1. Process the operating field

2. Limit the operating field

3. Perform local anesthesia in the area of ​​​​introduction of the spokes.

4.Introducing the needle with a drill in the transverse direction

5. Put on sterile panty napkins at the ends of the knitting needles and press them with stoppers

6. Attach the CITO arc to the needle.

7. Tie a cord to the arc

8. Put your foot on the Beler splint.

9. Throw the cord over the Beler bus block and install a load from 2 to 10 kg.

Bed preparation:

1. Shield longitudinally or transversely at the foot end for limb abduction

2. Raise the foot end

3. Reinforce the Balkan frame above the bed.

Limb care:

1. Stop at an angle of 90 with the help of a load thrown over the block forward of the foot.

2. Pillows under the ankle-foot knee joint "donut", under the heel

3.Observation of blood circulation: foot temperature, feel the movement of the fingers, the pulsation of the arteries of the foot.

Manipulation #38

Carry out tests on the quality of gypsum

1. When squeezing in a fist, the gypsum should not stick together into a lump.

2. Mix two parts of gypsum with one part of water to a homogeneous mushy mass in an enameled basin with a layer of 1-2 cm, after 5-10 minutes. the plaster should become hard enough that no dents form on its surface when pressed with a finger.

3. Mix 1 part of gypsum and 1 part of water, roll up the ball, notice when it sets. Drop the ball from a height of 1.5 meters to the floor, it should not break.

4. When mixed with water, gypsum should not smell like rotten eggs.

Manipulation #39

Preparation of a plaster bandage

Equipment:

1. Gauze bandage - 1 pc.

2.Gypsum powder.

3. Oilcloth.

Order of execution:

1. A thin layer of gypsum is applied to the table and a part of a gauze bandage is spread on top (50-100cm)

2. A layer of gypsum is poured onto the bandage and the gypsum is rubbed into the pores of gauze with vigorous movements of the brush.

3. Having loosely folded the rubbed part of the bandage into a roll 5-7 cm wide, gypsum is successively rubbed into the following parts of the bandage.

4. The roll of the plaster bandage should be loose, this will ensure rapid and simultaneous impregnation of the bandage when it is immersed in water.

Manipulation #40

Emergency specific prophylaxis for tetanus in the unvaccinated

Equipment:

1.Tetanus toxoid SA - 1 ml.

2. Anti-tetanus serum PSS - 3000 IU

3. Anti-tetanus serum developed PSS 1 ml. 1:100

4. Syringes 1g, 2g, 1 with division 0.1

5. Needles for subcutaneous and intradermal injections

6.Kidney trays 2 pcs.

8. Sterile cotton balls

Medicines for first aid for anaphylactic shock:

Adrenaline solution 1 ml. No. 3, 0.25% solution of novocaine, prednisone - 1 bottle, strophanthin or corglicon, 40% glucose solution - 20 ml

Manipulation algorithm

Strict observance of the rules of asepsis and antisepsis

Manipulation #41

Assemble a set of instruments for tracheostomy

Equipment:

1. Korntsang - 2 pcs.

2. Linen claws - 4 pcs.

3.Scalpel - 2 pcs.

4. Surgical tweezers - 2 pcs

5. Kocher hemostatic clamps - 5 pcs.

6. Scissors - 1 pc.

7. Needle holder with a needle - 1 pc.

8. Farabeuf hook retractors - 1 pair

9. Single-pronged hook - 1 pc.

10. Tracheostomy cannula - 1 pc.

11. Trousseau tracheal dilator - 1 pc.

12. Sterile tray - 1 pc.

Manipulation #42

Tracheostomy Care

Prevention of asphyxia, trecheitis, pneumonia.

Equipment:

1. On the bedside table:

A glass with a disinfectant solution and tweezers in it, a rubber catheter in a glass with a disinfectant solution

Sterile wipes, turundas, button probe, gloves, balls in a small bix

Furacilin solution for washing the catheter

4% soda solution, long pipettes, sterile oil, pipette

Iodonate solution

3% hydrogen peroxide

0.5% chlorhexidine bigluconate

2. Near the bed - electric suction.

Order of execution:

1.Wash your hands with soap and dry with a towel.

2.II and I with the fingers of the left hand fix the plates of the outer cannula of both sides (so that it does not move and does not fall out)

3. Shutter - "flag" of the external tracheostomy cannula to move to the top with the finger of the right hand (separate the external and internal cannula)

4. I and II fingers of the right hand, the nurse takes the "ears" of the inner cannula.

5. Traction towards itself with an arcuate movement of the right hand, the nurse removes the inner cannula from the outer one. Put in a kidney-shaped tray with a solution of 6% peroxide.

6. With the palmar surface of the hand, the nurse checks the patency of the outer tube - the movement of air flow.

7. The removed inner cannula is cleaned with a curved button probe, rinsed with an antiseptic solution (clean the inner cannula from crusts and mucus)

8. Fixing the plates of the outer cannula I and II with the fingers of the left hand, inject a few drops of a 4% soda solution into the hole of the outer cannula. Let the patient cough up (sputum thinning).

9. Suck out mucus, crusts from the tube with a catheter (cannula patency)

10. Continuing to fix the outer cannula by the plates with the fingers of the left hand, take the inner cannula I and II with the fingers of the right hand by the “ears” and insert it into the outer cannula in an arcuate motion.

11. Shutter - lower the “flag” of the outer tube down (fix the inner cannula with the outer one).

12. Drop 2-3 drops of sterile oil with a pipette (to eliminate drying and crusting)

13. Change the napkins under the tube and wash the skin.

14. The outer tube is attached behind the neck with ribbons inserted into the slot of the plate (fixation of the tracheostomy cannula to the neck)

15. The tracheostomy cannula is covered with a moistened napkin in 2 layers (humidification of the inhaled air).

16. The internal cannula is cleaned, as necessary, with an electric suction.

Catheter sterility!!!

Manipulation #43

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.

Instruments:

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:

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. An emergency tracheostomy is performed to immediately provide air access to the lungs, with 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.

Instruments:

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: saving the patient's life from severe intoxication and infection emanating from the lesion and creating 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 assembled 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.

Instruments:

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.

Instruments:

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. An emergency tracheostomy is performed to immediately provide air access to the lungs, with 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.

Instruments:

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: saving the patient's life from severe intoxication and infection emanating from the lesion and creating 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

Skeletal traction is an integral part of the so-called functional treatment and one of the most common traumatological 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.