Microsurgery differs from traditional surgery in... (4)
surgeon position, magnification, specialized instrumentation, suture and needle size
Describe the surgeon's position in microsurgery.
arms resting on table or armrest (essential for fine motor control)
What are the purposed of using magnification in microsurgery?
provide improved view of tissues of concern
allow a comfortable working distance for the surgeon
facilitate adjustment of the interpupillary distance to suit the surgeon
permit a wide field of view
What is the appropriate magnification for eyelids/ conj, cornea/ urogenital, and intraocular/ vascular/ neuro?
eyelids/ conj-- 2-5x
cornea/ urogenital- 5-10x
intraocular/ vascular/ neuro- 8-15x
Describe magnification provided by simple head loupes.
one pair of positive meniscus lenses
limited by spherical aberration and color fringing
fixed interpupilary distance
very short working distance (poor surgeon body position and arm position)
Describe the magnification provided by Galilean head loupes.
up to 2.5x
adjustable interpupilary distance
working distance varies
better than simple loupes
Describe the magnification provided by prismatic head loupes.
up to 8x
highest optical quality
greater depth of field
As magnification increases, the...
field of view and depth of field decrease.
What are differences between microsurgical packs and traditional instruments?
microsurgery instruments are:
fine jaws and teeth (more delicate)
finish does not reflect light
For microsurgery, instruments are held in the _________ grip.
What sized suture is typically used in microsurgery?
6-0 to 11-0
must have swaged on needle
What 5 basic instruments are needed for microsurgery?
Microsurgical needle holders
: designed to hold small microneedles and suture
: delicate 1 over 2 toothed forceps.
Suture typing forceps
: small suture (6-0 to 10-0) cannot be tied by hand - forceps are needed.
Microsurgical scissors (Steven's or Wescott tenotomy scissors)
: these scissors have very small blades
Microsurgical blades (Beaver blades #63-65)
: miniature surgical blades designed for small tissues; require Beaver handle
What types of needles are used in microsurgery? (2)
Reverse cutting needle, spatula needle
How can you ensure that there is no patient movement under anesthesia? (5)
paralysis (non-depolarizing neuromuscular blocking drugs- atracurium)
What is epinephrine used for in ophthalmic surgery? (3)