Preventing Excessive Bleeding During Surgical Incisions: Techniques Used by Surgeons

It is often stated that during surgery, surgeons make a deep incision without the patient's body gushing blood. However, this is not due to the surgeon's inherent skill, but rather a series of advanced techniques and precautions employed to minimize bleeding. Let's explore the methods used by surgeons to control bleeding during the procedure.

Hemostasis Techniques

Hemostasis is the process of stopping blood flow. Surgeons use a variety of techniques to control bleeding, ensuring that the surgical procedure is as safe and efficient as possible.

Clamping and Cauterization: Blood vessels may be clamped to temporarily stop the flow of blood. When clamping is not feasible, cauterization, or the use of an electric current to heat and destroy tissue, can seal off blood vessels.

Electrocautery: This technique uses a high-frequency current to coagulate (seal) blood vessels, effectively preventing blood loss. Surgeons often use electrocautery to seal smaller blood vessels and control bleeding during surgery.

Preoperative Assessment

Before any surgical procedure, patients undergo a thorough preoperative assessment to determine their bleeding risk. This includes evaluating factors such as blood clotting disorders, medications (anticoagulants), and overall health. Understanding a patient's bleeding risk allows surgeons to prepare accordingly and minimize the likelihood of excessive bleeding.

Positioning and Access

The surgical team carefully positions the patient to minimize blood flow to the surgical area. They often choose access routes that avoid major blood vessels, reducing the chances of significant blood loss during the procedure.

Surgical Techniques

Surgeons are trained to perform specific techniques that minimize trauma to tissues and blood vessels. This helps minimize bleeding during the surgical procedure. This includes using sutures and staples to close incisions, as well as employing meticulous surgical techniques to coagulate all bleeding vessels as they are encountered.

Use of Tourniquets

In certain surgeries, particularly those involving the limbs, a tourniquet may be applied to temporarily restrict blood flow. This technique helps contain blood within the surgical field, reducing blood loss and aiding in the control of bleeding.

Fluid Management

Maintaining optimal blood volume and pressure during surgery is crucial for controlling bleeding. Surgeons carefully manage fluids to ensure that the patient's circulatory system is stable, which helps to prevent excessive blood loss.

Tranexamic Acid and Other Hemostatic Agents

Sometimes, surgeons may administer Tranexamic Acid before starting the operation. Tranexamic Acid is an anti-fibrinolytic that prevents the breakdown of clots, thereby prolonging the time blood remains clotted.

Mechanism of Action: Tranexamic Acid works by blocking lysine receptors on plasminogen, preventing its conversion to plasmin. This prevents fibrin degradation and subsequent clot breakdown.

Other hemostatic agents may also be used, such as thrombin or coagulation factor concentrates, depending on the patient's specific bleeding risk and the nature of the surgical procedure.

Addressing Misconceptions

Some misconceptions about bleeding during surgical incisions often exist. It is important to dispel these myths:

Vascularity of Underlying Tissue: The amount of bleeding is more related to the vascularity of the underlying tissue than the surgeon's skill. For instance, incisions in the scalp or the palmar surface of the hand often result in profuse bleeding, while an incision in the abdomen may not. Surgeons should be familiar with the underlying anatomy and try to avoid major arteries and veins, but this does not mean that initial incisions do not bleed.

Techniques Employed by Surgeons: Many surgeons use techniques to pre-emptively limit bleeding. This includes the use of medications like Tranexamic Acid, tourniquets, and local anesthetics with epinephrine, which constrict blood vessels and provide a hemostatic effect. Small devices like Raney clips can also be used to pinch skin edges and reduce blood flow.

Control of Bleeding: Although bleeding can sometimes be minimized, it is not always possible to completely eliminate it. Surgeons plan accordingly and use a combination of techniques to manage any bleeding that occurs during the procedure.

Understanding the advanced techniques and preparations used by surgeons helps to ensure that surgical procedures are as safe as possible. By leveraging these methods and addressing common misconceptions, surgeons can achieve better patient outcomes and reduce the risk of complications related to excessive bleeding.