Named after: German Surgeon August Bier (first introduced the block in 1908) Definition: It is a peripheral intravenous local anesthetic block (IVRA; Intravenous Regional Anesthesia) of the upper limb using a pneumatic cuff technique Mechanism of action: Local anesthesia diffuses into the small veins surrounding the nerves and then into…
Category: Surgical Skills
Surgical instruments and surgical techniques
Surgical Skills 
Orthopedic Screw Insertion Mnemonic
Don’t Marry Too Soon DRILL Choose the correct drill bit Insert the drill bit correctly in the chuck Tighten the chuck sufficiently Start the drill home perpendicular to the surface Maintain adequate pressure Maintain the proper direction Irrigation with normal saline should be commenced simultaneously with drilling Keep the drill…
Surgical Skills 
Techniques of Securing Surgical Drain to Skin (Drain Fixation)
Choice of Suture: Non-absorbable (braided suture provides slightly superior grip on tubing than monofilament sutures) Technique 1: Create a series of knots around the drain. The long end of the thread (attached to the needle) is passed through the skin directly next to the drain exit site, to create a…
Surgical Skills 
How to make tourniquet for fingers using latex gloves?
Method 1: Digital block Painting with antiseptic solution Application of sterile latex gloves (slightly larger than the patient’s hand) on the patient’s hand A tiny piece of glove fingertip is snipped off to create a 1- to 2-mm hole With very gentle pulling—by either the forceps or the surgeon’s fingers—the…
Surgical Skills 
Zancolli-Lasso Procedure
Based on the preoperative clinical examination, the decision on which donor superficialis (FDS) tendon to use is made (commonly FDS middle finger is used). Transverse incision is made at the level of the distal palmer crease. Care should be taken to avoid the neurovascular bundles and the flexor tendons must…
Surgical Skills 
Corner Stitch
Synonym: Half-buried horizontal mattress suture Indications: V, Y or X-pattern laceration repair Risk: Dermal stitch may be placed too close to the tip of the flap and compromise the tenuous blood supply Suture: Non-absorbable Principle: When repairing, this stitch must be placed first Landmark sites (2 on each site of…
Surgical Skills 
Surgical Sutures – Basics
Monofilament Polyfilament Absorbable Caprosyn (Polyglytone 621)Monocryl (Polyglecaprone 25)Biosyn (Polyglecaprone CV-23)Maxon (Polytrimethylate carbon)PDS (Polydiaxonone) CatgutVicryl rapide (Polyglactin 910 rapide)Vicryl (Polyglactin 910)Dexon (Polyglycolic acid) Non-absorbable NylonEthilon (Monofilament polyamide)Prolene (Polypropylene) SilkDacronEthibond (Polyester)Braided nylon (Surgilon, Nurolon)Supramid Monofilament sutures: Polyfilament/Multifilament sutures: Natural sutures: Synthetic sutures: Absorbability: There are 2 principal methods, by which the sutures…
Surgical Skills 
Surgical Blades
One of the oldest surgical instruments used even today is a Scalpel (Surgical Blade with a Bard Parker Handle). Long before using metals in manufacturing, parts from various flora and fauna were used in making incisions during surgeries. Few examples are listed below. Table 1. Various objects used to make incisions. The…