Introduction to Surgical Principles

  • Hamid Abdollahi
  • Deborah YuEmail author


This chapter reviews several key principles that must be understood when caring for a surgical patient, including metabolism and nutrition, inflammation and injury, and wound healing. This chapter also reviews basic surgical technique and some common complications seen in surgical patients.


Metabolism Nutrition Inflammation Wound healing Antiseptic technique Sutures Drains Hernias Fistulas Marjolin’s ulcer 


  1. 1.
    Corbett SA. Systemic response to injury and metabolic support. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, editors. Schwartz’s principles of surgery. 10th ed. New York: McGraw-Hill; 2014.Google Scholar
  2. 2.
    Mitch WE, Price SR. Mechanisms activating proteolysis to cause muscle atrophy in catabolic conditions. J Ren Nutr. 2003;13:149–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Long CL, Schaffel N, Geiger J, et al. Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. J Parenter Enteral Nutr. 1979;3:452.CrossRefGoogle Scholar
  4. 4.
    Vidal-Puig A, O'Rahilly S. Metabolism. Controlling the glucose factory. Nature. 2001;413:125–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Heslin MJ, Brennan MF. Advances in perioperative nutrition: cancer. World J Surg. 2000;24:1477–85.CrossRefPubMedGoogle Scholar
  6. 6.
    Heslin MJ, Latkany L, Leung D, et al. A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg. 1997;226:567–77.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients. 2013;5:608–23.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Khalil AA, Hall JC, Aziz FA, Price P. Tumour necrosis factor: implications for surgical patients. ANZ J Surg. 2006;76:1010–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Dinarello CA. Interleukin-1 in the pathogenesis and treatment of inflammatory diseases. Blood. 2011;117:3720–32.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Stylianou E, Saklatvala J. Interleukin-1. Int J Biochem Cell Biol. 1998;30:1075–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Interleukin-6 in surgery, trauma, and critical care part II: clinical implications. J Intensive Care Med. 2011;26:73–87.CrossRefPubMedGoogle Scholar
  12. 12.
    Rauch I, Muller M, Decker T. The regulation of inflammation by interferons and their STATs. JAKSTAT. 2013;2:e23820. 1–13.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Heitzer MD, Wolf IM, Sanchez ER, Witchel SF, DeFranco DB. Glucocorticoid receptor physiology. Rev Endocr Metab Disord. 2007;8:321–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Silverman MN, Sternberg EM. Glucocorticoid regulation of inflammation and its functional correlates: from HPA axis to glucocorticoid receptor dysfunction. Ann N Y Acad Sci. 2012;1261:55–63.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hardy RS, Raza K, Cooper MS. Endogenous glucocorticoids in inflammation: contributions of systemic and local responses. Swiss Med Wkly. 2012;142:w13650.PubMedGoogle Scholar
  16. 16.
    Wong DL, Tai TC, Wong-Faull DC, et al. Epinephrine: a short- and long-term regulator of stress and development of illness: a potential new role for epinephrine in stress. Cell Mol Neurobiol. 2012;32:737–48.CrossRefPubMedGoogle Scholar
  17. 17.
    Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? J Clin Invest. 2004;114:1187–95.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM. Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005;59:80–3.CrossRefPubMedGoogle Scholar
  19. 19.
    Barbul A, Efron DT, Kavalukas SL. Wound healing. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, editors. Schwartz’s principles of surgery. 10eth ed. New York: McGraw-Hill; 2014.Google Scholar
  20. 20.
    DiPietro LA. Wound healing: the role of the macrophage and other immune cells. Shock. 1995;4:233.CrossRefPubMedGoogle Scholar
  21. 21.
    Zabel DD, Feng JJ, Scheuenstuhl H, et al. Lactate stimulation of macrophage-derived angiogenic activity is associated with inhibition of poly(ADP-ribose) synthesis. Lab Invest. 1996;74:644.PubMedGoogle Scholar
  22. 22.
    Levenson SM, Geever EF, Crowley LV, et al. The healing of rat skin wounds. Ann Surg. 1965;161:293.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Stenn KS, Depalma L. Re-epithelialization. In: Clark RAF, Hensen PM, editors. The molecular and cellular biology of wound repair. New York: Plenum; 1988. p. 321.CrossRefGoogle Scholar
  24. 24.
    Johnson FR, McMinn RMH. The cytology of wound healing of the body surface in mammals. Biol Rev. 1960;35:364.CrossRefPubMedGoogle Scholar
  25. 25.
    Woodley DT, Bachman PM, O’Keefe EJ. The role of matrix components in human keratinocyte re-epithelialization. In: Barbul A, Caldwell MD, Eaglstein WH, et al., editors. Clinical and experimental approaches to dermal and epidermal repair. Normal and chronic wounds. New York: Wiley-Liss; 1991. p. 129.Google Scholar
  26. 26.
    Lynch SE. Interaction of growth factors in tissue repair. In: Barbul A, Caldwell MD, Eaglstein WH, et al, editors. Clinical and experimental approaches to dermal and epidermal repair. Normal and chronic wounds. New York: Wiley-Liss; 1991:341.Google Scholar
  27. 27.
    Ehrlich HP, Hunt TK. Effects of cortisone and Vitamin A on wound healing. Ann Surg. 1968;167:324.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Anstead GM. Steroids, retinoids, and wound healing. Adv Wound Care. 1998;11:277.PubMedGoogle Scholar
  29. 29.
    Yue DK, McLennan S, Marsh M, et al. Effects of experimental diabetes, uremia, and malnutrition on wound healing. Diabetes. 1987;36:295.CrossRefPubMedGoogle Scholar
  30. 30.
    Dumville JC, McFarlane E, Edwards P, et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2015;(4):CD003949.Google Scholar
  31. 31.
    Dunn DL. Ethicon wound closure manual. Ethicon, Inc. Somerville, NJ; 2005.Google Scholar
  32. 32.
    Masini BD, Stinner DJ, Waterman SM, et al. Bacterial adherence to suture materials. J Surg Educ. 2011;68:101–4.CrossRefPubMedGoogle Scholar
  33. 33.
    Wincour S, Martinez-Jorge J, Habermann E, et al. Early surgical site infection following tissue expander breast reconstruction with or without Acellular Dermal Matrix: National Benchmarking Using National Surgical Quality Improvement Program. Arch Plast Surg. 2015;42:194–200.CrossRefGoogle Scholar
  34. 34.
    Saeedinia S, Nouri M, Azarhomayoun A, et al. The incidence and risk factors for surgical site infection after clean spinal operations: a prospective cohort study and review of the literature. Surg Neurol Int. 2015;6:154.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Schumpelick V, Junge K, Klinge U, et al. Incisional hernia: pathogenesis presentation and treatment. Dtsch Arztebl. 2006;103:A2553–8.Google Scholar
  36. 36.
    Heller L, McNichols CH, Ramirez OOM. Component separations. Semin Plast Surg. 2012;26:25–8.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Tavakkoli A, Ashley SW, Zinner MJ. Small intestine. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, editors. Schwartz’s principles of surgery. 10th ed. New York: McGraw-Hill; 2014.Google Scholar
  38. 38.
    Chamberlain RS, Kaufman HL, Danforth DN. Enterocutaneous fistula in cancer patients: etiology, management, outcome, and impact on further treatment. Am Surg. 1998;64:1204–11.PubMedGoogle Scholar
  39. 39.
    Owen RM, Love TP, Perez SD, et al. Definitive surgical treatment of enterocutaneous fistula: outcomes of a 23-year experience. Arch Surg. 2012;15:1–9.Google Scholar
  40. 40.
    Kerr-Valentic MA, Samini K, Rohlen BH, et al. Marjolin’s ulcer: modern analysis of an ancient problem. Plast Reconstr Surg. 2009;123:184–91.CrossRefPubMedGoogle Scholar
  41. 41.
    Copcu E. Marjolin’s ulcer: a preventable complication of burns? Plast Reconstr Surg. 2009;124:156e–64.CrossRefPubMedGoogle Scholar
  42. 42.
    Collins N. Nutrition 411: selecting the right tube feeding formula. Ostomy Wound Manag. 2011;57:2.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.The Plastic Surgery CenterInstitute for Advanced ReconstructionShrewsburyUSA

Personalised recommendations