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Asepsis, hemostasis, and gentleness to tissues are the bases of the surgeon's art. Nevertheless, recent decades have shown a shift in emphasis from the attainment of technical skill to the search for new procedures. Undoubtedly, this attitude resulted from the extraordinary increase in the application of surgical methods to new fields. Historically, such a point of view led to an unremitting search for new procedures when results were unsatisfactory, although faulty technique rather than the procedure itself was the cause of failure. Now that all regions of the body have been explored, it is appropriate to stress the important relationship between the art of surgery and success in surgical therapy. The growing recognition of this relationship should reemphasize the value of precise technique.


The technique described in this book emanates from the school of surgery inspired by William Stewart Halsted. This school, properly characterized as a “school for safety in surgery,” arose before surgeons in general recognized the great advantage of anesthesia. Before Halsted's teaching, speed in operating was not only justified as necessary for the patient's safety but also extolled as a mark of ability. Despite the fact that anesthesia afforded an opportunity for the development of a precise surgical technique that would ensure a minimum of injury to the patient, spectacular surgeons continued to emphasize speedy procedures that disregarded the patient's welfare. Halsted first demonstrated that, with careful hemostasis and gentleness to tissues, an operative procedure lasting as long as 4 or 5 hours left the patient in better condition than a similar procedure performed in 30 minutes with the loss of blood and injury to tissues attendant on speed. The protection of each tissue with the exquisite care typical of Halsted is a difficult lesson for the young surgeon to learn. The preoperative preparation of the skin, the draping of the patient, the selection of instruments, and even the choice of suture material are not so essential as the manner in which details are executed. Gentleness is essential in the performance of any surgical procedure.


Young surgeons have difficulty in acquiring this point of view because they are usually taught anatomy, histology, and pathology by teachers using dead, chemically fixed tissues. Hence, students regard tissues as inanimate material that may be handled without concern. They must learn that living cells may be injured by unnecessary handling or dehydration. A review of anatomy, pathology, and associated basic sciences is essential in the daily preparation of young surgeons before they assume the responsibility of performing a major surgical procedure on a living person. The young surgeon is often impressed by the speed of the operator who is interested more in accomplishing a day's work than in teaching the art of surgery. Under such conditions, there is little time for review of technique, discussion of wound healing, consideration of related basic scientific aspects of the surgical procedure, or the criticism of results. Wound complications become a distinct problem associated with the ...

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