INHOUD
Hoofdstuk 1: definitie – specialismen – geschiedenis ..................................................................................................5
Heelkunde: terminologie, etymologie en definitie...................................................................................................5
Heelkunde als specialisme..........................................................................................................................................5
Geschiedenis van heelkunde in vogelvlucht .............................................................................................................6
Anesthesie ...............................................................................................................................................................6
Asepsie.....................................................................................................................................................................6
Bloedtransfusie .......................................................................................................................................................6
Vaatanastomose......................................................................................................................................................6
Hoofdstuk 2: de chirurg en zijn activiteit.......................................................................................................................8
Doelstellingen van heelkundige interventies ............................................................................................................8
Multidisciplinaire samenwerking ...............................................................................................................................8
Heelkundige klinische activiteiten .............................................................................................................................9
Heelkundige houding (attitude).................................................................................................................................9
Hoofdstuk 3: de heelkundige patiënt ......................................................................................................................... 10
Profiel van de heelkundige patiënt ......................................................................................................................... 10
Heelkundig risico...................................................................................................................................................... 11
Geïnformeerde besluitvorming en toestemming.................................................................................................. 11
Diagnostische aanpak van een heelkundige aandoening ..................................................................................... 12
Hoofdstuk 4: wondbehandeling .................................................................................................................................. 13
Inleiding .................................................................................................................................................................... 13
Wondsoorten (vulnera) ........................................................................................................................................... 13
Wondverzorging....................................................................................................................................................... 15
Antiseptica................................................................................................................................................................ 16
Tetanusvaccinatie .................................................................................................................................................... 17
Wondheling (cicatrisatie) ........................................................................................................................................ 17
Heling per primam intentionem ......................................................................................................................... 17
Heling per secundam intentionem ..................................................................................................................... 17
Heling per tertiam intentionem .......................................................................................................................... 18
Factoren die wondheling beïnvloeden ............................................................................................................... 19
Kenmerken ........................................................................................................................................................... 19
Technieken voor versnelde heling van wonddefecten.......................................................................................... 20
Huidgreffe ............................................................................................................................................................. 20
Huidplastie (Z-plastie).......................................................................................................................................... 20
Vacuum Assisted Closure (VAC) .......................................................................................................................... 20
Reconstructie met weefselflappen..................................................................................................................... 21
1
, Wondhechting: types............................................................................................................................................... 21
Wondhechting: materiaal........................................................................................................................................ 22
Hechtingsdraad .................................................................................................................................................... 22
Nietjes ................................................................................................................................................................... 23
Weefsellijm ........................................................................................................................................................... 24
Steristrips.............................................................................................................................................................. 24
Wondhechting: knooptechnieken .......................................................................................................................... 24
Wondhechting: basisset .......................................................................................................................................... 25
Lokale anesthesie..................................................................................................................................................... 25
Wondincisies ............................................................................................................................................................ 26
Wonddrainage.......................................................................................................................................................... 26
Kleine heelkunde voor de basisarts ........................................................................................................................ 27
Hoofdstuk 5: heelkundige ingreep .............................................................................................................................. 28
Inleiding .................................................................................................................................................................... 28
Voorbereiding en planning van de ingreep ............................................................................................................ 28
Algemene en lokale maatregelen ........................................................................................................................... 29
Algemene maatregelen ....................................................................................................................................... 29
Lokale maatregelen.............................................................................................................................................. 29
Kledij in het operatiekwartier ................................................................................................................................. 29
Personeel in het operatiekwartier .......................................................................................................................... 30
Verblijf in het operatiekwartier .............................................................................................................................. 31
Operatie: stap per stap............................................................................................................................................ 31
Bijzondere materialen in operatiekwartier ............................................................................................................ 32
Videoscopische en robotische chirurgie................................................................................................................. 33
Chirurgische toegangswegen .................................................................................................................................. 35
Locomotorisch (orthopedie – traumatologie – neurochirurgie – vasculair).................................................... 35
Abdomen (visceraal – vasculair) ......................................................................................................................... 35
Thorax (thoracaal – cardiaal – vasculair)............................................................................................................ 35
Gelaat, hals, schedel (NKO – mond-, kaak- en aangezicht-) ............................................................................. 36
Type ingrepen........................................................................................................................................................... 36
Grote ingrepen ..................................................................................................................................................... 36
Kleine ingrepen .................................................................................................................................................... 36
Hybride ingrepen.................................................................................................................................................. 36
Hoofdstuk 6: post-operatieve heelkundige verwikkelingen ..................................................................................... 37
Normaal postoperatief verblijf................................................................................................................................ 37
Dagelijkse zaalronde ................................................................................................................................................ 37
Postoperatieve problemen...................................................................................................................................... 38
2
, Medische problemen........................................................................................................................................... 38
Heelkundige problemen ...................................................................................................................................... 38
Pijn............................................................................................................................................................................. 39
Bloeding .................................................................................................................................................................... 39
Oorzaken............................................................................................................................................................... 39
Diagnose ............................................................................................................................................................... 40
Behandeling.......................................................................................................................................................... 41
Wondprobleem ........................................................................................................................................................ 42
Koorts........................................................................................................................................................................ 42
Nausea en braken .................................................................................................................................................... 43
Ileus ........................................................................................................................................................................... 43
Paralytische ileus.................................................................................................................................................. 44
Mechanische ileus................................................................................................................................................ 44
Acute maagdilatatie................................................................................................................................................. 44
Obstipatie ................................................................................................................................................................. 45
Diepe veneuze trombose......................................................................................................................................... 45
Pathogenese ......................................................................................................................................................... 45
Verwikkelingen..................................................................................................................................................... 45
Voorkeursplaatsen ............................................................................................................................................... 46
Incidentie .............................................................................................................................................................. 46
Preventie............................................................................................................................................................... 47
Symptomen en diagnose ..................................................................................................................................... 47
Therapie ................................................................................................................................................................ 47
Decubitis ................................................................................................................................................................... 48
Specifieke heelkundige verwikkelingen.................................................................................................................. 49
Orthopedisch/traumatologisch........................................................................................................................... 49
Abdominaal .......................................................................................................................................................... 49
Thoracaal .............................................................................................................................................................. 49
Cardiaal ................................................................................................................................................................. 50
Vasculair................................................................................................................................................................ 50
Urologisch............................................................................................................................................................. 50
Plastisch ................................................................................................................................................................ 51
Hoofdstuk 7: heelkundige infecties ............................................................................................................................ 52
Infectie ...................................................................................................................................................................... 52
Definitie ................................................................................................................................................................ 52
Symptomen .......................................................................................................................................................... 52
Diagnose ............................................................................................................................................................... 53
3
, Behandeling.......................................................................................................................................................... 53
Acute vs chronische infectie.................................................................................................................................... 53
Empyeem .................................................................................................................................................................. 54
Flegmone/cellulitis ................................................................................................................................................... 54
Lymfangitis/lymfadenitis ......................................................................................................................................... 55
Gangreen .................................................................................................................................................................. 55
Necrotiserende fasciitis ........................................................................................................................................... 55
Septische embolen................................................................................................................................................... 56
Fistel.......................................................................................................................................................................... 56
Sinus.......................................................................................................................................................................... 56
Postoperatieve infectie............................................................................................................................................ 56
Bevorderende factoren............................................................................................................................................ 57
Bacteriële factoren............................................................................................................................................... 57
Lokale factoren..................................................................................................................................................... 57
Algemene factoren............................................................................................................................................... 57
Behandeling.............................................................................................................................................................. 57
Preventie................................................................................................................................................................... 58
Operatiezaalgebeuren ......................................................................................................................................... 58
Profylactisch gebruik van antibiotica.................................................................................................................. 58
Heelkundige techniek .......................................................................................................................................... 58
Speciale vormen van postoperatieve infecties ...................................................................................................... 59
Wondinfectie........................................................................................................................................................ 59
Secundaire peritonitis .......................................................................................................................................... 59
Superinfectie ........................................................................................................................................................ 60
4
Hoofdstuk 1: definitie – specialismen – geschiedenis ..................................................................................................5
Heelkunde: terminologie, etymologie en definitie...................................................................................................5
Heelkunde als specialisme..........................................................................................................................................5
Geschiedenis van heelkunde in vogelvlucht .............................................................................................................6
Anesthesie ...............................................................................................................................................................6
Asepsie.....................................................................................................................................................................6
Bloedtransfusie .......................................................................................................................................................6
Vaatanastomose......................................................................................................................................................6
Hoofdstuk 2: de chirurg en zijn activiteit.......................................................................................................................8
Doelstellingen van heelkundige interventies ............................................................................................................8
Multidisciplinaire samenwerking ...............................................................................................................................8
Heelkundige klinische activiteiten .............................................................................................................................9
Heelkundige houding (attitude).................................................................................................................................9
Hoofdstuk 3: de heelkundige patiënt ......................................................................................................................... 10
Profiel van de heelkundige patiënt ......................................................................................................................... 10
Heelkundig risico...................................................................................................................................................... 11
Geïnformeerde besluitvorming en toestemming.................................................................................................. 11
Diagnostische aanpak van een heelkundige aandoening ..................................................................................... 12
Hoofdstuk 4: wondbehandeling .................................................................................................................................. 13
Inleiding .................................................................................................................................................................... 13
Wondsoorten (vulnera) ........................................................................................................................................... 13
Wondverzorging....................................................................................................................................................... 15
Antiseptica................................................................................................................................................................ 16
Tetanusvaccinatie .................................................................................................................................................... 17
Wondheling (cicatrisatie) ........................................................................................................................................ 17
Heling per primam intentionem ......................................................................................................................... 17
Heling per secundam intentionem ..................................................................................................................... 17
Heling per tertiam intentionem .......................................................................................................................... 18
Factoren die wondheling beïnvloeden ............................................................................................................... 19
Kenmerken ........................................................................................................................................................... 19
Technieken voor versnelde heling van wonddefecten.......................................................................................... 20
Huidgreffe ............................................................................................................................................................. 20
Huidplastie (Z-plastie).......................................................................................................................................... 20
Vacuum Assisted Closure (VAC) .......................................................................................................................... 20
Reconstructie met weefselflappen..................................................................................................................... 21
1
, Wondhechting: types............................................................................................................................................... 21
Wondhechting: materiaal........................................................................................................................................ 22
Hechtingsdraad .................................................................................................................................................... 22
Nietjes ................................................................................................................................................................... 23
Weefsellijm ........................................................................................................................................................... 24
Steristrips.............................................................................................................................................................. 24
Wondhechting: knooptechnieken .......................................................................................................................... 24
Wondhechting: basisset .......................................................................................................................................... 25
Lokale anesthesie..................................................................................................................................................... 25
Wondincisies ............................................................................................................................................................ 26
Wonddrainage.......................................................................................................................................................... 26
Kleine heelkunde voor de basisarts ........................................................................................................................ 27
Hoofdstuk 5: heelkundige ingreep .............................................................................................................................. 28
Inleiding .................................................................................................................................................................... 28
Voorbereiding en planning van de ingreep ............................................................................................................ 28
Algemene en lokale maatregelen ........................................................................................................................... 29
Algemene maatregelen ....................................................................................................................................... 29
Lokale maatregelen.............................................................................................................................................. 29
Kledij in het operatiekwartier ................................................................................................................................. 29
Personeel in het operatiekwartier .......................................................................................................................... 30
Verblijf in het operatiekwartier .............................................................................................................................. 31
Operatie: stap per stap............................................................................................................................................ 31
Bijzondere materialen in operatiekwartier ............................................................................................................ 32
Videoscopische en robotische chirurgie................................................................................................................. 33
Chirurgische toegangswegen .................................................................................................................................. 35
Locomotorisch (orthopedie – traumatologie – neurochirurgie – vasculair).................................................... 35
Abdomen (visceraal – vasculair) ......................................................................................................................... 35
Thorax (thoracaal – cardiaal – vasculair)............................................................................................................ 35
Gelaat, hals, schedel (NKO – mond-, kaak- en aangezicht-) ............................................................................. 36
Type ingrepen........................................................................................................................................................... 36
Grote ingrepen ..................................................................................................................................................... 36
Kleine ingrepen .................................................................................................................................................... 36
Hybride ingrepen.................................................................................................................................................. 36
Hoofdstuk 6: post-operatieve heelkundige verwikkelingen ..................................................................................... 37
Normaal postoperatief verblijf................................................................................................................................ 37
Dagelijkse zaalronde ................................................................................................................................................ 37
Postoperatieve problemen...................................................................................................................................... 38
2
, Medische problemen........................................................................................................................................... 38
Heelkundige problemen ...................................................................................................................................... 38
Pijn............................................................................................................................................................................. 39
Bloeding .................................................................................................................................................................... 39
Oorzaken............................................................................................................................................................... 39
Diagnose ............................................................................................................................................................... 40
Behandeling.......................................................................................................................................................... 41
Wondprobleem ........................................................................................................................................................ 42
Koorts........................................................................................................................................................................ 42
Nausea en braken .................................................................................................................................................... 43
Ileus ........................................................................................................................................................................... 43
Paralytische ileus.................................................................................................................................................. 44
Mechanische ileus................................................................................................................................................ 44
Acute maagdilatatie................................................................................................................................................. 44
Obstipatie ................................................................................................................................................................. 45
Diepe veneuze trombose......................................................................................................................................... 45
Pathogenese ......................................................................................................................................................... 45
Verwikkelingen..................................................................................................................................................... 45
Voorkeursplaatsen ............................................................................................................................................... 46
Incidentie .............................................................................................................................................................. 46
Preventie............................................................................................................................................................... 47
Symptomen en diagnose ..................................................................................................................................... 47
Therapie ................................................................................................................................................................ 47
Decubitis ................................................................................................................................................................... 48
Specifieke heelkundige verwikkelingen.................................................................................................................. 49
Orthopedisch/traumatologisch........................................................................................................................... 49
Abdominaal .......................................................................................................................................................... 49
Thoracaal .............................................................................................................................................................. 49
Cardiaal ................................................................................................................................................................. 50
Vasculair................................................................................................................................................................ 50
Urologisch............................................................................................................................................................. 50
Plastisch ................................................................................................................................................................ 51
Hoofdstuk 7: heelkundige infecties ............................................................................................................................ 52
Infectie ...................................................................................................................................................................... 52
Definitie ................................................................................................................................................................ 52
Symptomen .......................................................................................................................................................... 52
Diagnose ............................................................................................................................................................... 53
3
, Behandeling.......................................................................................................................................................... 53
Acute vs chronische infectie.................................................................................................................................... 53
Empyeem .................................................................................................................................................................. 54
Flegmone/cellulitis ................................................................................................................................................... 54
Lymfangitis/lymfadenitis ......................................................................................................................................... 55
Gangreen .................................................................................................................................................................. 55
Necrotiserende fasciitis ........................................................................................................................................... 55
Septische embolen................................................................................................................................................... 56
Fistel.......................................................................................................................................................................... 56
Sinus.......................................................................................................................................................................... 56
Postoperatieve infectie............................................................................................................................................ 56
Bevorderende factoren............................................................................................................................................ 57
Bacteriële factoren............................................................................................................................................... 57
Lokale factoren..................................................................................................................................................... 57
Algemene factoren............................................................................................................................................... 57
Behandeling.............................................................................................................................................................. 57
Preventie................................................................................................................................................................... 58
Operatiezaalgebeuren ......................................................................................................................................... 58
Profylactisch gebruik van antibiotica.................................................................................................................. 58
Heelkundige techniek .......................................................................................................................................... 58
Speciale vormen van postoperatieve infecties ...................................................................................................... 59
Wondinfectie........................................................................................................................................................ 59
Secundaire peritonitis .......................................................................................................................................... 59
Superinfectie ........................................................................................................................................................ 60
4
