GS2 – Day One: Surgical Clinical Basics
Surgical clinical basics
GS2 – Day One: Surgical Clinical Basics
🚨 Key Points
1. Limb Swelling Assessment
Method
- Select a fixed bony landmark (e.g., olecranon).
- Measure circumference at a set distance (e.g., 10 cm proximal or distal).
- Repeat on contralateral limb and compare.
Interpretation:
A difference ≥ 1 cm suggests unilateral swelling.
2. Surgical Wound Healing
- Primary intention (thin scar): clean incision, edges neatly approximated.
- Secondary intention (broad scar): follows infection or dehiscence; wound heals by granulation and contraction.
3. Types of Incisions
3.1 Abdominal Incisions
Transverse
- Lanz: follows Langer’s lines → cosmetic, less pain; common for appendectomy.
Oblique
- Gridiron: muscle-splitting; alternative for appendectomy.
Midline
- Infraumbilical (lower midline)
- Supraumbilical (upper midline)
- Combined “Cape to Cairo”: xiphoid → pubic symphysis for rapid access in trauma
.
Paramedian
- Offset to right/left of midline; muscle-splitting variant.
Subcostal (Kocher’s)
- Right: cholecystectomy, biliary surgery.
- Left: splenectomy (rare).
4. Surgical Specimens
Rule: All excised tissue must be sent for histology—no exceptions.
5. Appendicitis – Age & Anatomy
- Peak: 12–30 years.
- Rare in <5 yrs: lumen wide, low obstruction risk.
- Rare in elderly: lymphoid atrophy; alternate differentials prevail.
6. Parotid Swelling
Key Sign
Swelling that raises the earlobe → pathognomonic for parotid gland involvement.
Differential:
- Mumps parotitis
- Pleomorphic adenoma / Warthin’s tumor
- Sjögren’s syndrome
- Sialadenitis / sialolithiasis
Case: Suspected Parotid Tumor
- Investigations: FNAC, ultrasound/CT.
- Imaging: Lobulated soft‐tissue opacity inferior to mastoid; no calcifications.
- Likely Dx: Pleomorphic adenoma.
7. Mastectomy Types
| Type | Tissue Removed |
|---|---|
| Simple (Total) | Breast tissue only |
| Modified Radical | Breast + Level I/II axillary nodes; pectoralis major preserved |
| Radical (Halsted) | Breast + nodes + pectoralis major & minor |
| Lumpectomy | Tumor + margin (breast preserved; usually + radiotherapy) |
| Skin-/Nipple‐Sparing | Preserves skin envelope and/or nipple complex |
Variants: Patey’s, Auchincloss, Scanlon (vary by muscle dissection).
End of Day One Notes