Principles

PLISSDE

 

Position

Landmarks

Incisions

Structures at risk

Superficial Dissection

Deep Dissection

Extension

 

Surgical approach

 

Check patient

- check correct procedure

- check side of patient

- pre-op NV assessment

- check skin

- confirm allergies

 

Place X-ray's on viewing box

- pre-op templating

- check implants

- check cement

- check bone graft / substitutes

- check equipment

- check nursing staff familiar with procedure

 

Position

- GA / regional / LA

- type of table / radiolucent / hand table

- supine / prone / lateral decubitus

- protect nerves and pressure areas

- preop antibiotics

- IDC insertion

- table supports - bolsters / sandbags

- accessories - tourniquet / II / shavers / fluid pumps                 

 

Landmarks

 

Incisions

- longitudinal / transverse

- position of incision

- length of incision

 

Structures at risk

- always important to mention early

- i.e. CPN, PIN

 

Superficial Dissection

- subcutaneous tissue

- deep fascia

- structures encountered / first plane

 

Deep Dissection

- second plane

 

Extension

- proximal and distal

 

Wound closure

- drains

- suture

- LA

- dressings

- splints       

 

Post op

- supervise moving patient off table

- check NV status in recovery

- mobilisation / weight bearing etc