The contest’s task of the Olympics

 

The contest “Plastic surgery”

Clinical situation: A man, 65 years old, went to the doctor with complaints of neoplasm in the right thoracic region and its progressive growth over the past two months.

 Objectively: a black-brown formation 2 cm * 3 cm in size, painless, of moderate density, fuzzy, irregular borders that rise above the surface of the surrounding skin, with a moving base and a hyperemia zone around the focus. Regional lymph nodes during palpation are not enlarged, painless, elastic, mobile, not soldered to the skin.

According to a cytological study, a preliminary diagnosis was made: Susp.c-r. Dysplastic melanocytic nevus. A total biopsy with adequate indentation is recommended. Assignment: participants are invited to excise the tumor area. Perform plastic surgery using a diamond-shaped flap on the lower limb. The seams and the method of forming the nodes are selected independently with subsequent justification.

Tools: Each team uses its own set of tools and suture material with justification. In the absence of tools and suture material, the organizing committee has the opportunity to provide them. (Recommended suture material: Prolen 4/0). Plastic must be done manually.

Material: Lamb Leather

Number of participants in the team: 3 people (operator, assistant, nurse) The operator of the competition must not coincide with the operator of the competition "Tendon suture", "Intestinal anastomosis. The replacement of the operator during the competition is prohibited.

Lead time: 30 minutes.

The result will be an addition oft he following criteria:

Criteria for evaluation	Number of points
Aesthetics	5 points – uniform gaps between stitches lack of "harmonica", contractions, "Dog ears" and other deformations, complete excision scar, exact adherence to technology operations; 3 points – even gaps between stitches, uneven knot tightening, presence "Accordions", contractions, edge deformation, complete dissection scar compliance technique operations; 1 point – uneven gaps between stitches uneven tightening of nodes, lack of "accordions", contractions and other deformations, complete scar removal, compliance operation techniques; 0 points – uneven gaps between stitches uneven tightening of nodes the presence of "harmonica", contractions and other deformations, incomplete scar excision, non compliance operation techniques.
Aesthetic seam in plastic surgery	2 points – use sem 0 points – no seam
Precision of wound margins	3 points – precise adaptation the same name wound edges; 2 points – inaccurate adaptation in one wound site; 1 point – inaccurate adaptation in different wound sites; 0 points – complete discrepancy skin edges and subcutaneous fat fiber throughout sutured wounds.
Lack of "pockets", cavities	2 points – lack of "pockets" 1 point – the presence of 1 "pocket"; 0 points – visible pockets.
Teamwork	2 points – without any mistakes; 1 point – misuse of instruments, discoordinated manipulations between team members;  0 points – gross violations during work, affecting the course of the operation..
Work with tools	2 points - full compliance with the principles of neat, safe and effective work with tools; 1 point - potentially dangerous manipulations with tools and needles, capable of injuring tissues (action with an instrument or leaving the needle out of sight, overly sweeping movements of the instrument); 0 points - gross violations of work safety leading to tissue trauma
Time	0 points > 30 minutes; 2 points > 25-30 minutes; 4 points > 20-25 minutes
Total	20 points

 

For questions about the contest, contact Alexey https://vk.com/id125580275

 

Intestinal Suture Contest

Patient N., 43 years old, was admitted to the clinic with complaints of cramping abdominal pain, nausea, profuse vomiting with an unpleasant odor, non-discharge of gases and feces. Ill acutely 26 hours ago. A history of acute appendicitis surgery. The state of moderate severity. The skin is normal color. In the lungs, vesicular breathing. Pulse 100 min., Rhythmic, full, blood pressure 115/70 mm. hg. art. Heart sounds are muffled. The tongue is dry. The abdomen is moderately swollen, painful over the entire surface, more in the right iliac region, where there is a postoperative scar 10 cm long. The symptom of Shchetkin-Blumberg is positive in the lower abdomen. The kidneys are not palpable; Pasternatsky’s symptom is negative. Preliminary diagnosis: intestinal obstruction stage of subcompensation. Peritonitis. It was decided to conduct an emergency operation after preliminary preoperative preparation. Bowel resection within 15-20 cm distally and 30-40 cm proximal to the visible necrosis zone. Signs of necrosis: lack of pulsation of the vessels of the mesentery, discoloration of the intestines (cyanotic, crimson, black) lack of peristalsis.

Task. Within 60 minutes, process 2 adjacent stumps of the small intestine and restore intestinal continuity with the help of an anastomosis of the “side-to-side” type using the double-row suture technique. The operator of the competition must not coincide with the operator of the competition "Skin plastic", "Tendon suture". Replacement of the operator during the competition is prohibited.

Number of participants in the team: 3 people (operator, assistant, nurse)

Order:

1. To process a stump of a small intestine, having immersed the sutured ends with a purse-string or Z-shaped seam.

2. To suture the posterior lip of the anastomosis with a discontinuous nodular serousserous or serous-muscular suture of Lambert. (a)

3. To form an incision in the stitched sections of the jejunum.

4. To put on a back lip of an anastomosis a continuous through through twisted seam. (b)

5. To put on the front lip of the anastomosis a continuous through eversible Schmiden suture. (in)

6. Sew the second row of the front lip with a discontinuous Lambert interrupted suture. (g)

7. At the end of the task, shout the name of the team and “STOP!”, The time will be fixed.

8. After 60 minutes, the contest is not allowed to continue, all instruments are put off by the participants.

 

General view of the anastomosis.

Instruments - each team uses their own set of instruments and material for the suture and needs to be able to justify their choice of items. In case of absence of any instrument of sewing material, the organizing committee might offer those. The recommended suture material: Vircyl USP 3/0 45 cm.

Object: 2 part of the small intestine of a pig.

 

Критерии оценивания

Tightness of the anastomosis: Will be scored by filling the anastomosis with water, applying light pressure to different ts parts of it.
Anastomosis is tight	5 points
Drops of water diffuse through the anastomosis	2 points
Stream of water seeps through the suture	0 points
Tightness of each stump:
Both stumps are tight	5 points
Drops of water diffuse through the anastomosis	2 points
Stream of water seeps through the suture	0 points
Looks: The following will be considered: Equally distributed placement, same direction of the stitch and equal spaces between each stitch, tightness of those stitches.