this short note contains all the necessary information about the basics of topographical anatomy and surgery , which is very helpful to beginners , especially medical aspirants.

1. Introduction to the
topographical anatomy
and operative surgery
by
Kavan vyas
Crimean federal university

2. Whatis topographicalanatomy :
 topographic anatomy - the study of anatomy based on regions
divisions of the body and emphasizing relations between
various structures (muscles and nerves and arteries etc.) in that
region.
 Topographic Anatomystudies the structures of the Human Body
on cross-sections in application to clinical diagnostic: ultrasound
images (USI), computed tomography (CT) and magnetic
resonance (MR). These are tomographic (two-dimensional) slice
images. Imaging technologies using X-ray, USI, CT, MR and
radioisotopes can give precise anatomic delineation (M. Burykh,
1990) and as well as function.
Methods to the study of the human structure.
 Syntopy
 Skeletotopy
 Holotopy
Methods to the study of the human structure.
syntopy(from gr. syn with, together + toposplace) – the
position of organ with others in any cavity;
skeletotopy (from skeleton + topos place) – the position of
organ with skeleton;

3. holotopy (fromgr.: holoswhole, entire + topos place) - the
position of organ to the skin surface.
Surgical Anatomy
 SurgicalAnatomy studies structures of the
Human Body from the surgical point of view, that is their
importance to the performance of incisions and
operative methods (-tomy, -stomy, -ectomy, resection and
so on). This also means a study of anatomical variations
in preparation for structural differences encountered at
the operating table.
History ofAnatomy inpersonals.
Prof.NIKOLAY PIROGOV (1801-1881)
Main works:
 "Is the ligation(vinculum)of abdominal aorta easyand
nondangerousoperationof inguinalaneurysms?"
(Derpt, 1832);
 "Surgical Anatomyof VascularTrunks and Fascia"
(1837);
 "Complete Course of AppliedAnatomy"(1844);
 "Atlas of topographicAnatomyin cross-sections through
frozen cadavers"(1853-1859).
Prof.VICTORSCHEVKUNENKO(1872-1952)

4. Main works:
 "Theory of individualanatomicalvariability";
 "Age and typologicalAnatomy"(1925);
 "Course of OperativeSurgery and Topographic
Anatomy"(1932-1952)
 "Atlas of PeripheralNervous and VenousSystems"
(1949).
Whatis operativesurgery
The operative surgery is a science about surgical
operations, methods of surgical operations, the essence
of which comes to mechanical action upon the organs
and tissues with diagnostic, medical or reconstructive
purpose.
Operative approach means to make the wound for the
exposure of the organ to be operated on.
Operative method – the main part of the operation,
performing the action contained in the name of the
operation
Classificationof operations
Emergency
Urgent
Planned
Bloodless
Bloody
Radical
Palliative
Single stage

5. WOUNDS
WOUNDis a simply disruption of the normalcontinuity
of tissue. When tissue has been disrupted so severely
that it cannot heal naturally (without complications or
possible disfiguration) it must be repaired by a skilled
surgeon.
Classificationof woundsaccordingtothemodeof
damage
1. An incised wound is caused by a sharp instrument; if there
is associated tissue tearing, the wound is said to be
lacerated;
2. An abrasion results from friction damage to the body
surface, and is characterized by superficial bruising and
loss of varying thickness of skin and underlying tissues;
3. Crush injuries are due to severe pressure. The skin may
not be breached even if massive tissue destruction is
present. Oedema, characteristic of this type of injury, can
make wound closure impossible and, by increasing
pressure within fascial compartments, may cause
ischaemic necrosis of muscle and other structures.;
4 Degloving injury occurs as a result of shearing forces which
cause parallel tissue planes to move against each other. Large
areas of apparently intact skin may be deprived of their blood
supply from rupture of feeding vessels.
5 Gunshot wounds may be from shotgun pellets or bullets.
Bullets fired from high-velocity rifles cause massive tissue
destruction.

6. 6 Burns are caused by heat, cold, electricity, irradiation or
chemicals. They form a distinct variety of wound requiring
special consideration.
Operative wounds
1 Clean wounds. They are closed by primary union and are not
usually drained. No break in aseptic technique occurs during
this procedure. Here the surgeon does not enter the
oropharyngeal cavity or the respiratory, or alimentary or
genitourinary tracts.
2. Clean-contaminated wounds. These operative wounds
have usual normal flora without unusual contamination.
3. Contaminated wounds. These include fresh traumatic
injuries such as soft tissue laceration, open fractures and
penetrating wounds. Microorganisms multiply so rapidly
that within six hours a contaminated wounds can become
infected.
4. Dirty and infected wounds. These wounds have been
heavily contaminated or clinically infected prior to the
operation. They included perforated viscera, abscesses or
old traumatic wounds in which devitalized tissue or foreign
material have been retained.
THEOPERATION
THE OPERATION is a therapeutic procedure with
instruments to repair damage or arrest disease in a living
body; or any act performed with instruments or by the
hands of a surgeon with the aim of diagnostic or
treatment.

7. Clinicalclassificationof operations:
1. The radical operation (lat.: radix, root) is an operation
which is directed to the cause or directed to the root or
source of a morbid process;
2. The palliative operation (lat.: palliates, cloaked) is an
operation which affords relief but not cure.
Surgicaloperation
The surgical operation is a technological process which includes
following components:
1) the knowledge of Clinical Anatomy (in application to surgical
clinic Surgical Anatomy);
2) an operating room, general and special surgical instruments
and apparatus;
3) an operating room and patient management (aseptic
procedures; anesthesia);
4) surgical technique (operative approach, operative method
and wound closure).
GENERAL PRINCIPLES OF SURGICAL TECHNIQUE
Dissection technique.
Arrest of haemorrhage.
Tissue handling.
SURGICALTECHNIQUE

8. 1. operative approach (lat.: operativus, pertaining to an
operation): exposure of organs with instruments or
incision (lat.: in + cedere, to cut, to open through);
2. operative method: surgical acts performed with
instruments, based on strong precedence rules;
3. wound closure (absorbable and nonabsorbablesutures
and aseptic bandage): holdingtissues in proximity with
means.
Operative approaches (incisions)
The incision should give optimal exposure for the most
difficult part of the operation and should allow for
extension in the event of a greater than expected
procedure being required;
all skin incisions should be carefully planned so as to give
a good view of the deeper parts and at the same time to
avoid important structures;
in general, when an incision has to be made in the
neighborhood of large vessels or nerves, it should be
made parallel to, and not across, their long axis;
an incision of adequate length should always be made;
for cosmetic reasons, however, incision on the face or
neck should be placed in a natural crease, for not only
will the scar be less visible, but there will be less
likelihood of keloid formation.
Operativemethods
There are the following surgical actions:
centesis puncture to aspirate
desis fusion

9. ectomy surgical excision of
lysis freeing of
orrhaphy repair of
oscopy examination of an organ by viewing
ostomy the creation of an artificial or new
opening through the wall of an organ
otomy cutting into an organ or tissue
pexy to fix or suture in place
plasty
restoration of a lost part or piece of
tissue
Prefixes
a or an without or not
ante before, forwards
anti against, opposite
circum around, about
dys bad, difficult
extra outside, beyond, in addition
hemi half
hyper above, over, excessive
hypo below, under
infra underneath, below
inter between, among
intra within, on the inside
peri around, about
post after, behind, during
pre before
retro behind, backwards
semi half

10. sub under, beneath
super above, over
supra on the upper side, above
trans across, beyond
ultra beyond, over
gland neuro nerve
arthro joint oophor ovary
blepharo eyelids ophthalm eye
cardi heart orchio testicle
chole gall os bone
cholecyst gallbladder ot ear
col colon pharyng throat
colpo vagina phleb vein
cranio brain pneumo lung
cysto
urinary
bladder
procto rectum
dent tooth prostate
prostatic
gland
dermat skin pyelo
pelvis of
kidney
entero intestines rhino nose
gastro stomach salping
fallopian
tube
hepato liver spermato semen
hystero uterus splanchno viscera
jejun
second part
of intestine
teno tendon

11. lamin
posterior
vertebral arch
thoraco chest
mast breast trachelo
neck or
necklike
structure
myo muscle ureter kidney tube
nephro kidney vas
vessel or
duct
 resection (lat.: resecare, to cut off);
 amputation (lat.: amputare, to cut off);
 exarticulation (lat.: ex-, from or outside + articulus, joint
or articulation);
 implantation or transplantation (lat.: in, trans, through +
plan- tare, crop or plant).
Wound closure
The surgeon's goal. — Whether a patient has elected to
have surgery or is undergoing an emergency procedure,
the surgeon's ultimate goal upon closing is the same:
to hold severed tissue in opposition (that is, to hold them
together in proximity with means) until the wound has
healed enough to withstand stress without mechanical
support.
Typeof sutures

12. 1 simple
2 inturrupted
3 blanket
4 Surgical
Suturematerial
Absorbable
- Plain catgut
- Chromic catgut
- Polyglycolic synthetics
Nonabsorbable
- Natural (silk, cotton)
- Synthetic braids (Ticron, Tevdek, Ethibond)
- Synthetic monofilament ( nylon, Prolen)
- Monofilament stainless
- Steel wire
Suturing Techniques
General Principles
Many varieties of suture material and needles are
available. The choice of sutures and needles is
determined by the location of the lesion, the thickness of
the skin in that location, and the amount of tension
exerted on the wound. Regardless of the specific suture
and needle chosen, the basic techniques of needle
holding, needle driving, and knot placement remain the
same.

13. Suture placement
A needle holder is used to grasp the needle at the distal
portion of the body, one half to three quarters of the
distance from the tip of the needle, depending on the
surgeon’s preference. The needle holder is tightened by
squeezing it until the first ratchet catches. The needle
holder should not be tightened excessively, because
damage to both the needle and the needle holder may
result. The needle is held vertically and longitudinally
perpendicular to the needle holder
Incorrect placement of the needle in the needle holder
may result in a bent needle, difficult penetration of the
skin, or an undesirable angle of entry into the tissue.
The needle holder is held by placing the thumb and the
fourth finger into the loops and placing the index finger
on the fulcrum of the needle holder to provide stability
Alternatively, the needle holder may be held in the palm
to increase dexterity
The tissue must be stabilized to allow suture placement.
Depending on the surgeon’s preference, toothed or
untoothed forceps or skin hooks may be used to grasp
the tissue gently. Excessive trauma to the tissue being
sutured should be avoided to reduce the possibility of
tissue strangulation and necrosis.
Forceps are necessary for grasping the needle as it
exits the tissue after a pass. Before removal of the
needle holder, grasping and stabilizing the needle is
important. This maneuver decreases the risk of losing
the needle in the dermis or subcutaneous fat, and it is

14. especially important if small needles are used in areas
such as the back, where large needle bites are
necessary for proper tissue approximation.
The needle should always penetrate the skin at a 90°
angle, which minimizes the size of the entry wound and
promotes eversion of the skin edges. The needle should
be inserted 1-3 mm from the wound edge, depending on
skin thickness. The depth and angle of the suture
depends on the particular suturing technique. In general,
the two sides of the suture should become mirror
images, and the needle should also exit the skin
perpendicular to the skin surface.
Knot tying
Once the suture is satisfactorily placed, it must be
secured with a knot. The instrument tie is used most
commonly in cutaneous surgery. The square knot is
traditionally used.
First, the tip of the needle holder is rotated clockwise
around the long end of the suture for two complete turns
The tip of the needle holder is used to grasp the short
end of the suture. The short end of the suture is pulled
through the loops of the long end by crossing the hands,
so that the two ends of the suture are on opposite sides
of the suture line. The needle holder is rotated
counterclockwise once around the long end of the
suture. The short end is then grasped with the needle
holder tip and pulled through the loop again.
The suture should be tightened sufficiently to
approximate the wound edges without constricting the
tissue. Sometimes, leaving a small loop of suture after

15. the second throw is helpful. This reserve loop allows the
stitch to expand slightly and is helpful in preventing the
strangulation of tissue because the tension exerted on
the suture increases with increased wound edema.
Depending on the surgeon’s preference, one or two
additional throws may be added.
Properly squaring successive ties is important. In other
words, each tie must be laid down perfectly parallel to
the previous tie. This procedure is important in
preventing the creation of a granny knot, which tends to
slip and is inherently weaker than a properly squared
knot. When the desired number of throws is completed,
the suture material may be cut (if interrupted stitches are
used), or the next suture may be placed
Surgical instruments can be generally divided into
five classes by function. These classes are:
1.Cutting instruments and dissecting: scalpels,
scissors, saws.
2.Grasping or holding instruments: smooth
[anatomical] and toothed [surgical] forceps, towel
clamps, vascular clamps, and organ holders.
3.Haemostatic instruments: Kocher’s and Billroth’s
clamps, hemostatic “mosquito” forceps, atraumatic
hemostatic forceps, Deschamp’s needle, Höpfner’s
hemostatic forceps.
4.Retractors:Farabef’s C-shaped laminar hook, blunt-
toothed hook, sharp-toothed hook, grooved probe,
tamp forceps.

16. 5.tissue unifying instruments and materials:
needle holders, surgical needles, staplers,
clips, adhesive tapes.
Instrument class Image Uses Specific instruments
Articulator Galotti articulator
Bone chisel
Cutting
instrument
Cottle cartilage crusher
Bone cutter To cut the bone
Bone distractor
Clamps and
distractors
Ilizarov apparatus
Accessories
and implants

17. Instrument class Image Uses Specific instruments
Intramedullary kinetic
bone distractor
Clamps and
distractors
Bone drill
To drill inside
the bone
Bone lever
Accessories
and implants
Bone mallet Accessories
Bone rasp
Cutting
instruments
Bone saw
Cutting
instruments
Bone skid
Bone splint
Bone button
Caliper
Accessories
and implants
Castroviejo caliper
Cannula
Accessories
and implants
Spackmann Cannula

18. Instrument class Image Uses Specific instruments
Cautery
Accessories
and implants
Curette
for scraping or
debriding
biological
tissue or debris
in a biopsy,
excision, or
cleaning
procedure
Cutting
instrument
Depressor
Dilator
Accessories
and implants
Dissecting knife
cutting
instrument
surgical Pinzette
Grasping/holdin
g

19. Instrument class Image Uses Specific instruments
Dermatome
cutting
instrument
Forceps, Dissecting
Grasping/holdin
g
Adson
Forceps, Tissue
Grasping/holdin
g
Allis Babcock
Forceps (Other) Sponge Forceps
Acanthulus or Acanthabol
os
Thorn removal
Bone forceps
Grasping/holdin
g

20. Instrument class Image Uses Specific instruments
Carmalt forceps
haemostatic
forceps
kalabasa
Cushing forceps
grasping/holdin
g
Non-toothed dissecting
forceps
Dandy forceps
haemostatic
forceps
DeBakey forceps
grasping/holdin
g
Non-toothed dissecting
forceps designed for use
on blood vessels
Doyen intestinal clamp
clamps and
distractors
Non-crushing clamp
designed for use on the
intestines
Epilation forceps
Halstead forceps
haemostatic
forceps
Kelly forceps
haemostatic
forceps
Kocher forceps
haemostatic
forceps

21. Instrument class Image Uses Specific instruments
Mosquito forceps
haemostatic
forceps
Hook retractor
Nerve hook retractor
Obstetrical hook retractor
Skin hook retractor
Lancet (scalpel) cutting
Luxator
Lythotome
Lythotript

22. Instrument class Image Uses Specific instruments
Mallet
Partsch mallet
Mammotome
Needle holder
grasping/holdin
g
Castroviejo Crilewood Ma
yo-Hegar Olsen-Hegar
Occluder
Osteotome cutting
Epker osteotome cutting
Periosteal elevator cutting
Joseph elevator cutting
Molt periosteal elevator cutting

23. Instrument class Image Uses Specific instruments
Obweg periosteal
elevator
cutting
Septum elevator cutting
Tessier periosteal
elevator
cutting
Probe
Retractor retractor
Deaver retractor retractor
Gelpi retractor retractor
Weitlaner retractor retractor
USA-Army/Navy retractor retractor
O'Connor-O'Sullivan retractor
Mathieu Retractor retractor

24. Instrument class Image Uses Specific instruments
Jackson Tracheal Hook retractor
Crile Retractor retractor
Meyerding Finger
Retractor
retractor
Little Retractor retractor
Love Nerve Retractor retractor
Green Retractor retractor
Goelet Retractor retractor
Cushing Vein Retractor retractor
Langenbeck Retractor retractor
Richardson Retractor retractor
Richardson-Eastmann
Retractor
retractor
Kelly Retractor retractor
Parker Retractor retractor
Parker-Mott Retractor retractor
Roux Retractor retractor

25. Instrument class Image Uses Specific instruments
Mayo-Collins Retractor retractor
Ribbon Retractor retractor
Alm Retractor retractor
Self Retaining Retractors
West, Travers and Norfolk
& Norwich
Weitlaner Retractor
Beckman-Weitlaner
Retractor
Beckman-Eaton Retractor
Beckman Retractor
Adson Retractor
Rib spreader
Rongeur
cutting
instrument
Ultrasonic scalpel cutting

26. Instrument class Image Uses Specific instruments
Laser scalpel cutting
Scissors cutting
Iris scissors cutting
Kiene scissors cutting
Metzenbaum scissors
To dissect soft
tissue, etc.
cutting

27. Instrument class Image Uses Specific instruments
Mayo scissors
To cut suture,
etc.
cutting
Tenotomy scissors cutting
Spatula
Speculum retractor
Mouth speculum retractor
Rectal speculum retractor
Sim's vaginal speculum retractor
Cusco's vaginal speculum retractor
Sponge bowl
accessories
and implants

28. Instrument class Image Uses Specific instruments
Sterilization tray
accessories
and implants
Sternal saw cutting
Suction tube
accessories
and implants
Surgical elevator
Surgical hook retractor
Surgical knife
Surgical mesh
accessories
and implants
Surgical needle
accessories
and implants
Surgical snare

29. Instrument class Image Uses Specific instruments
Surgical sponge
Surgical spoon
Surgical stapler
accessories
and implants
Surgical tray
Suture
Tongue depressor
Tonsillotome
Towel clamp clamp

30. Instrument class Image Uses Specific instruments
Towel forceps clamp
Backhaus towel forceps
Lorna towel forceps
Tracheotome
Tissue expander
accessories
and implant
Subcutaneous inflatable
balloon expander
accessories
and implants
Trephine
cutting
instrument
Trocar
cutting
instrument

31. Instrument class Image Uses Specific instruments
Ultrasonic cavitation
device
surgical device
using low
frequency
ultrasound
energy to
dissect or
fragment
tissues with low
fiber conten
Image based surgical anatomy
layers of abdominal wall

32. types of surgical sutures
A - continuous overhead suture; B - continues blanket
suture;
C - ordinary interrupted suture; D - eversion interrupted
suture.

33. knots
Topographicalapproachtostudy oftheHuman
Structure.

35. Types of wound

36. Retractors

37. Needles
Correctposition of holding a needle holder
Main lines of incisionfor opration

39. Connections
Surgical screwing in human bones ( type of
connection)

41. Types of bandages and bandaging

42. Thank you
for your
kind attention