Overview
Definition:
Specimen extraction refers to the careful and meticulous removal of tissue or organs from the surgical field for pathological examination or further analysis
Wound protection involves measures taken to prevent contamination, infection, and mechanical injury to the surgical incision or defect during and after the operative procedure.
Epidemiology:
All surgical procedures involving tissue removal or manipulation carry a risk of contamination and potential wound compromise
the incidence of surgical site infections (SSIs) varies widely based on procedure type, patient factors, and adherence to sterile protocols.
Clinical Significance:
Proper specimen handling ensures accurate histopathological diagnosis, impacting patient treatment decisions and prognosis
Effective wound protection minimizes the risk of SSIs, reduces patient morbidity, shortens hospital stays, and lowers healthcare costs, making it a cornerstone of surgical patient care.
Specimen Extraction
Indications:
Diagnostic biopsy
Tumor resection
Organ transplant
Removal of foreign bodies
Excision of diseased tissue.
Techniques:
Gentle handling to preserve tissue architecture
Avoid crushing or tearing
Use appropriate instruments like forceps and retractors
Secure haemostasis prior to removal
Immediate transfer to appropriate container with fixative (e.g., formalin for histology).
Handling Considerations:
Maintain sterility throughout the process
Label specimens accurately with patient details, date, time, and site of origin
Communicate with the pathologist regarding any specific concerns (e.g., margins, suspected malignancy)
Special handling for frozen sections or cultures.
Documentation:
Record the type, size, and appearance of the specimen removed
Note any unusual findings
Document the method of preservation and transport
Ensure proper chain of custody.
Wound Protection Intraoperative
Principles:
Strict aseptic technique
Use of sterile drapes
Minimizing exposure of internal organs
Careful instrument handling
Gentle tissue manipulation.
Draping Techniques:
Perimeter drapes to create a sterile field
Fenestrated drapes to isolate the surgical site
Secure drapes with clips or adhesive to prevent slippage
Ensure no gaps in the sterile barrier.
Instrument Management:
Use dedicated sterile instrument sets
Avoid passing non-sterile items into the field
Handle instruments with sterile gloves and technique
Instruments should not touch the patient's non-sterile surfaces.
Irrigation And Suction:
Use of sterile saline or appropriate irrigating solutions
Gentle suction to remove blood and fluid
Minimize aerosolization of fluids
Dispose of contaminated suction tips appropriately.
Wound Protection Postoperative
Dressing Application:
Apply a sterile dressing immediately after wound closure
Choose dressing based on wound characteristics (e.g., absorptive, occlusive)
Secure dressing adequately to prevent displacement.
Dressing Changes:
Perform dressing changes using strict aseptic technique
Frequency determined by wound drainage, surgeon's preference, and patient condition
Observe wound for signs of infection, dehiscence, or hematoma.
Patient Education:
Instruct patient on wound care, signs of infection to monitor, and activity restrictions
Advise on showering and bathing protocols
Emphasize hand hygiene before and after touching the wound or dressing.
Monitoring:
Regular clinical assessment of the wound at follow-up appointments
Document wound status, presence of drainage, erythema, swelling, or pain.
Complications Of Poor Technique
Specimen Related:
Inaccurate diagnosis due to tissue artifact or crushing
Missed positive margins
Loss or mislabeling of specimen
Delayed treatment due to inadequate information.
Wound Related Early:
Surgical site infection (SSI)
Wound dehiscence
Hematoma formation
Seroma formation
Skin necrosis.
Wound Related Late:
Chronic wound issues
Scar hypertrophy
Incisional hernia
Persistent pain.
Prevention Strategies:
Adherence to sterile protocols
Rigorous specimen handling
Appropriate closure techniques
Judicious use of drains
Patient optimization pre- and post-operatively.
Key Points
Exam Focus:
Importance of specimen orientation for pathologists
Role of fixatives
Principles of aseptic technique in maintaining surgical field integrity
Management of contaminated instruments
Differentiating between superficial and deep SSIs.
Clinical Pearls:
Always document specimen details thoroughly
When in doubt about sterility, re-glove and re-prepare
Use a specimen bag that is leak-proof
Educate the patient about wound care and red flags for infection before discharge.
Common Mistakes:
Forgetting to label specimens
Inadequate fixation or volume of fixative
Contamination of the sterile field with non-sterile items
Poor wound closure leading to dehiscence
Insufficient patient education on wound care.