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A D V E R T I S E M E N T
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A D V E R T I S E M E N T | |||||
Principles of Microsurgery Images | ||||||
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Description / Link to Frame |
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Positioning for microsurgery. |
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Microsurgery instruments. |
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Microsurgery instrument grip. |
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Needle driver. |
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Micro-scissors. |
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Micro-forceps. |
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Micro-clamp applicator. |
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Microsurgery clamps. |
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Opening two clamps at once. |
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Opening one clamp at a time. |
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Opening Kleinert clamp. |
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Vessel dilator. |
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Irrigator. |
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Demagnetizer. |
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Microsuture. |
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Dissecting platform. |
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Retractors. |
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Macro instruments. |
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Grasping the needle. |
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Grasping needle by touching needle tip to background material. |
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Slit made and oriented. |
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Needle passed perpendicular to the surface, about one needle diameter back from edge. Tip passes between the jaws of supporting forceps. |
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Needle is delicately pulled through. |
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Needle pulled through and regrasped. |
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Surface of left side of the slit is grasped with tip of forceps and elevated. |
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Needle passed upward from below. |
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Suture handling. |
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If suture material is kinked over the edge of an instrument by rotation, it weakens the material by 50%. |
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Suture breaking. |
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Low power is used to see a greater length of the suture before pulling through to the proper length (1). |
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Low power is used to see a greater length of the suture before pulling through to the proper length (2). |
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Long end picked up. |
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Suture tying: the needle end is lifted with a curved forceps with the points down. |
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Knot tying. |
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Passing suture between instruments. |
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A slight counter-clockwise rotation sets up the suture as a C-shaped loop with the convex side to the left. |
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The right-hand instrument reaches across and grasps the top of the C-loop with the points of the instrument down. |
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The left-hand instrument releases the strand and the C-loop is now lying directly over the site of the knot. |
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The left-hand instrument, points down, is placed on the far side of the C-loop. |
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With minimal combined motion of the two instruments, the strand is wrapped twice around the left-hand instrument for a surgeons throw (1). |
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With minimal combined motion of the two instruments, the strand is wrapped twice around the left-hand instrument for a surgeons throw (2). |
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The left-hand instrument is advanced through the loops and grasps the tip of the short end. |
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The short end is pulled through the loops toward the left side of the field forming the first (surgeon's) throw. |
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Zoom in to high (20X) power when tightening each throw in order to see precisely how tight the throw needs to be. |
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If the first throw is a surgeon's throw, it should just barely approximate the edges, because the second throw will compress the double loop and make the throw tighter than when it started. |
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Zoom out to low power again and do not release the long end held by the right hand instrument (now on the right side). |
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A slight clockwise rotation sets up another C-loop, this time with the convex side pointing right. |
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The left-hand instrument, point down, reaches across and grasps the top of the C-loop. |
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The right-hand instrument is released and the loop brought over the center of the knot. |
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The right-hand instrument is placed on the far side of the C-loop. |
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A single loop is made over the right hand instrument (1). |
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A single loop is made over the right hand instrument (2). |
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he right-hand instrument is advanced through the loop and grasps the tip of the short end. |
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The free end is pulled through, creating the second throw. |
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The throw is tightened keeping both sides of the loop loose and equal so that the loop remains round as it comes down. |
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The proper tension is achieved when the light in the center of the loop winks out. This can only be seen under high power. |
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The third throw is created using the same principles as the previous throws. |
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Suture cutting. |
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The strand to be cut is drawn across the bevel of the bottom blade so that the outside face of the lower blade is directly up against the knot. |
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The cut automatically results in a tail that is the same length each time and is short enough not to interfere with tying the adjacent suture. |
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This page was last modified on 4/15/2000. A D V E R T I S E M E N T
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