Basics of surgery

Fistula is an abnormal communication between the lumen of one viscus to another or the body surface or between the vessels.

• Congenital: Pre-auricular sinus.
• Acquired: Actinomycosis, tuberculosis, pilonidal sinus, chronic osteomyelitis, median mental sinus.

Sinus is a blind track lined by granulation tissue leading from an epithelial surface into the surrounding tissues.

Infection within 1 month of surgery or 3 month of implant

National Nosocomial Infections Surveillance System (NNIS) describes three types of surgical site infections:

• Superficial incisional SSI - It occurs within 30 days after the operation. It involves only the skin or subcutaneous tissue. It is diagnosed by at least one of the following
• a) Purulent drainage is present (culture documentation is not required).
• b) Organisms are isolated from fluid/tissure of superficial incision.
• c) At least one sign of inflammation (pain, induration, erythema, local warmth or the wound) is present
• d) The surgeon or clinician declares the wound to be infected. 

• Deep incisional SSI - Occurs within 30 days of operation or within 1 year if an implant is present. It involves deep soft tissues (e.g fascia and/or muscle) of incision. It includes at least one of the following 
• - Purulent drainage is present from the deep incision but without organ/space involvent. 
• - Fascial dehiscence or fascia is deliberately separated by the surgeon because of signs of inflammation. 
• - A deep abscess is identified by direct examination or during reoperation, by histopathology or by radiologic examination. 
• - The surgeon or clinician declares that a deep incisional infection is present. 

• Organ/space SSI - Occurs within 30 days of the operation or within 1 year if any implant is present. It involves anatomical structures not opened or manipulated during the operation. It should include at least one of the following 
• - Purulent drainage is present from a drain placed by a stab wound into the organ/space. 
• - Organisms are isolated from the organ/space by aseptic culturing technique
• - An abscess in the organ/space is identified by direct examination, during reoperation or by histopathologic or radiologic examination. 
• - A diagnosis of organ/space SSI is made by the surgeon or clinician.

Delayed wound healing if it takes >1month in general

Do not say name in history taking

• Palliative care is care provided for people living with, and dying from an eventually fatal condition to
• - to improve quality of life 
• - it is not only provided to patient but also to patient party 
• - provided after diagnosis or even after death ??? 

Terminal ill patients like HIV, cardiac diseases, CKD

• Head and face at 5 days
• Upper limb at 7 days
• Abdomen and lower limb at 10 days

Jenkin's Rule is a principle of surgery relating to closure of surgical wounds. It states that the required length of the surgical suture material for closure of a wound with interrupted stitches is four times the length of the wound, as each bite should be 1 cm from the edge, and placed 1 cm from the previous suture.