Surgical positioning is the practice of placing a patient in a particular physical position during surgery. The goal in selecting and adjusting a particular surgical position is to maintain the patient's safety while allowing access to the surgical site. Often a patient must be placed in an unnatural position to gain access to the surgical site. [1]
Positioning normally occurs after the administration of anesthesia. [1] [2]
In addition to considerations related to the location of the surgical site, the selection of a surgical position is made after considering relevant physical and physiological factors, such as body alignment, circulation, respiratory constraints, and the musculatory system to prevent stress on the patient. [1] [2] Physical traits of the patient must also be considered including size, age, weight, physical condition, and allergies. [2] The type of anesthesia used also affects the decision. [2]
Pressure is the force put on the patient's body. Those forces can stem from the surgery itself, instruments, drills, gravity, attachments, and bandages. The duration and intensity of the pressure is inversely correlated. The longer the duration of the pressure, the less pressure the body can endure. However, the body can endure a large amount of pressure for brief periods of time. The amount of pressure on the tissue is based on the size of the area of the contact: the smaller the point of pressure, the greater effect it will have on the tissue. The position of instruments can cause damage to the body if pressure is not relieved periodically. [1]
The patient's own health is also considered. Respiratory and circulatory disorders, blood pressure, the patient's weight, old age, and body temperature may affect a patient's potential for pressure. [1] Other forces that may damage the body are the folding of the tissue, called shear, friction from the tissue rubbing against other tissue, and moisture on the skin that can cause it to be more vulnerable to the other forces and factors, called maceration. [1]
If the patient has been immobilized, it may be important to change the patient's position periodically to prevent blood pooling, to stimulate circulation, and to relieve pressure on tissues. [2] [3] The patient should not be placed in unnatural positions for an extended period of time. [2] After anesthesia, the patient's inability to react to movements may damage joints and muscle groups. Considerations should be taken not to damage these muscle groups by, for example, moving both legs simultaneously. [2]
The most common nerve injuries during surgery occur in the upper and lower extremities. [1] Injuries to the nerves in the arm or shoulder can result in numbness, tingling, and decreased sensory or muscular use of the arm, wrist, or hand. [1] Many operating room injuries could be solved by simply restraining the arms and legs. [1] Other causes of nerve or muscular damage to the extremities is caused by pressure on the body by the surgical team leaning on the patient's arms and legs. The patient's arms can be protected from these risks by using an arm sled. Separation of the sternum during a heart procedure can also cause the first rib to put pressure on the nerves in the shoulder. [1] The lithotomy position is also known to cause stress on the lower extremities.
A surgical fracture table is a table that is used for applying traction to broken limbs while the body is fixed in place, allowing the surgeon to reduce the broken extremity without requiring too much assistance, and then holding the limb in this fixed and reduced position while the surgeon applies external fixation, such as a cast or splint, or internal fixation, such as a nail or plate and screws, to maintain the reduction of the extremity. [4] A surgical fracture table enables the patient to be placed in the following positions:
Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.
Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the leg or arm are most commonly involved.
Abdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. This type of surgery is usually sought by patients with loose or sagging tissues, that develop after pregnancy or major weight loss.
Internal bleeding is a loss of blood from a blood vessel that collects inside the body. Internal bleeding is usually not visible from the outside. It is a serious medical emergency but the extent of severity depends on bleeding rate and location of the bleeding. Severe internal bleeding into the chest, abdomen, retroperitoneal space, pelvis, and thighs can cause hemorrhagic shock or death if proper medical treatment is not received quickly. Internal bleeding is a medical emergency and should be treated immediately by medical professionals.
Spinal anaesthesia, also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true analgesia, motor, sensory and autonomic (sympathetic) blockade. Administering analgesics in the cerebrospinal fluid without a local anaesthetic produces locoregional analgesia: markedly reduced pain sensation, some autonomic blockade, but no sensory or motor block. Locoregional analgesia, due to mainly the absence of motor and sympathetic block may be preferred over locoregional anaesthesia in some postoperative care settings. The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available.
Respiratory arrest is a medical condition caused by apnea or respiratory dysfunction severe enough it will not sustain the body. Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than five minutes may permanently damage vital organs, especially the brain. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if more than five minutes.
In the Trendelenburg position, the body is lain supine, or flat on the back on a 15–30 degree incline with the feet elevated above the head. The reverse Trendelenburg position, similarly, places the body supine on an incline but with the head now being elevated.
Lithotomy from Greek for "lithos" (stone) and "tomos" (cut), is a surgical method for removal of calculi, stones formed inside certain organs, such as the urinary tract, bladder, and gallbladder (gallstones), that cannot exit naturally through the urinary system or biliary tract. The procedure is usually performed by means of a surgical incision. Lithotomy differs from lithotripsy, where the stones are crushed either by a minimally invasive probe inserted through the exit canal, or by an acoustic pulse, which is a non-invasive procedure. Because of these less invasive procedures, the use of lithotomy has decreased significantly in the modern era.
Gluteoplasty denotes the plastic surgery and the liposuction procedures for the correction of the congenital, traumatic, and acquired defects and deformities of the buttocks and the anatomy of the gluteal region; and for the aesthetic enhancement of the contour of the buttocks.
A peripheral vascular examination is a medical examination to discover signs of pathology in the peripheral vascular system. It is performed as part of a physical examination, or when a patient presents with leg pain suggestive of a cardiovascular pathology.
Blunt trauma, also known as blunt force trauma or non-penetrating trauma, is physical trauma or impactful force to a body part, often occurring with road traffic collisions, direct blows, assaults, injuries during sports, and particularly in the elderly who fall. It is contrasted with penetrating trauma which occurs when an object pierces the skin and enters a tissue of the body, creating an open wound and bruise.
Veterinary surgery is surgery performed on animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.
The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.
Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by x-ray radiation. The image acquisition is generally performed by radiographers, and the images are often examined by radiologists. Both the procedure and any resultant images are often simply called "X-ray". Plain radiography or roentgenography generally refers to projectional radiography. Plain radiography can also refer to radiography without a radiocontrast agent or radiography that generates single static images, as contrasted to fluoroscopy, which are technically also projectional.
An abdominal x-ray is an x-ray of the abdomen. It is sometimes abbreviated to AXR, or KUB.
The Trendelenburg Test or Brodie–Trendelenburg test is a test which can be carried out as part of a physical examination to determine the competency of the valves in the superficial and deep veins of the legs in patients with varicose veins.
Lloyd-Davies position is a medical term referring to a common position for surgical procedures involving the pelvis and lower abdomen. The majority of colorectal and pelvic surgery is conducted with the patient in the Lloyd-Davies position. It was popularised for these procedures by Oswald Lloyd-Davies working at St Marks Hospital London.
Free-flap breast reconstruction is a type of autologous-tissue breast reconstruction applied after mastectomy for breast cancer, without the emplacement of a breast implant prosthesis. As a type of plastic surgery, the free-flap procedure for breast reconstruction employs tissues, harvested from another part of the woman's body, to create a vascularised flap, which is equipped with its own blood vessels. Breast-reconstruction mammoplasty can sometimes be realised with the application of a pedicled flap of tissue that has been harvested from the latissimus dorsi muscle, which is the broadest muscle of the back, to which the pedicle (“foot”) of the tissue flap remains attached until it successfully grafts to the recipient site, the mastectomy wound. Moreover, if the volume of breast-tissue excised was of relatively small mass, breast augmentation procedures, such as autologous-fat grafting, also can be applied to reconstruct the breast lost to mastectomy.
Endoscopic laser cordectomy, also known as Kashima operation, is an endoscopic laser surgical procedure performed for treating the respiratory difficulty caused as a result of bilateral abductor vocal fold paralysis. Bilateral vocal fold paralysis is basically a result of abnormal nerve input to the laryngeal muscles, resulting in weak or total loss of movement of the laryngeal muscles. Most commonly associated nerve is the vagus nerve or in some cases its distal branch, the recurrent laryngeal nerve. Paralysis of the vocal fold may also result from mechanical breakdown of the cricoarytenoid joint. It was first described in by Kashima in 1989.
Donut pillow, donat cushion or doughnat cushion is a designation for different types of pillows, all named after the shape of the pastry donut. There are donut pillows as seat cushions, which serve a more favourable distribution of pressure on the abdomen, as well as donut pillows to place under other parts of the body when lying down.