9 Suturing: canthus, Failure to reform lateral canthus. Canthal angle is misaligned. Canthal angle is roughly in Lateral canthal angle reformed muscle & skin Poor suture technique and or Inadequate wound closure or place but not perfectly with or without an absorbable closure result - difficulty mounting sutures, inappropriate orbicularis aligned. Realizes mistake suture. Orbicularis preserved multiple attempts at placement, excision. and corrects it. and plicated superiorly to the alignment of sutures poor. orbital rim periosteum to support the lower lid. Excess skin trimmed and skin closed without undue tension on the wound. Global Indices 10 Maintaining Poor anatomical knowledge of Has trouble identifying source Hemostasis is good overall, Electrocautery used effectively to haemostasis vasculature. Incorrect settings or of bleeding. Cautery is applied but has trouble managing achieve hemostasis during each usage of electrocautery resulting in to the area instead of the point larger bleeders. step of the procedure allowing burns, collateral damage or failure of bleeding. for clear visualization of to adequately achieve anatomy. haemostasis. Adequate tissue Failure to adhere to surgical Unable to consistently attain Reasonable surgical Sufficient incision size, 11 visualization planes. Failure to expose tissue good surgical exposure. exposure but not respecting hemostasis and retraction to appropriately during dissection. Corrects mistake(s) with surgical planes consistently. allow for consistently good tissue instruction. Realizes mistakes and exposure. attempts to correct. 12 Respect of Repeated unnecessary handling of Some unnecessary tissue Minimal unnecessary tissue Good knowledge of the regional tissue/tissue tissue. Crush injuries through handling and mild tissue handling without tissue anatomy with efficient handling inappropriate use of forceps. damage occurs. damage. manipulation of tissues and Damage to tissue by repeated minimal dissection required to placement of sutures. create and plicate the strip. Demonstrated spatial awareness within the surgical field. 13 Knowledge of Poor or no knowledge of Occasionally uses Occasionally uses an Appropriate instruments used instruments instruments. Inappropriate inappropriate instrument and inappropriate instrument but throughout case. combinations of suture holders, it. realizes mistake and doesn’t realize scissors and forceps resulting in corrects it. unsafe surgery or collateral damage.
9 Suturing: canthus, muscle & skin closure Failure to reform lateral canthus. Poor suture technique and or result - difficulty mounting sutures, multiple attempts at placement, alignment of sutures poor. Canthal angle is misaligned. Inadequate wound closure or inappropriate orbicularis excision. Canthal angle is roughly in place but not perfectly aligned. Realizes mistake and corrects it. Lateral canthal angle reformed with or without an absorbable suture. Orbicularis preserved and plicated superiorly to the orbital rim periosteum to support the lower lid. Excess skin trimmed and skin closed without undue tension on the wound. Global Indices 10 Maintaining haemostasis Poor anatomical knowledge of vasculature. Incorrect settings or usage of electrocautery resulting in burns, collateral damage or failure to adequately achieve haemostasis. Has trouble identifying source of bleeding. Cautery is applied to the area instead of the point of bleeding. Hemostasis is good overall, but has trouble managing larger bleeders. Electrocautery used effectively to achieve hemostasis during each step of the procedure allowing for clear visualization of anatomy. 11 Adequate tissue visualization Failure to adhere to surgical planes. Failure to expose tissue appropriately during dissection. Unable to consistently attain good surgical exposure. Corrects mistake(s) with instruction. Reasonable surgical exposure but not respecting surgical planes consistently. Realizes mistakes and attempts to correct. Sufficient incision size, hemostasis and retraction to allow for consistently good tissue exposure. 12 Respect of tissue/tissue handling Repeated unnecessary handling of tissue. Crush injuries through inappropriate use of forceps. Damage to tissue by repeated placement of sutures. Some unnecessary tissue handling and mild tissue damage occurs. Minimal unnecessary tissue handling without tissue damage. Good knowledge of the regional anatomy with efficient manipulation of tissues and minimal dissection required to create and plicate the strip. Demonstrated spatial awareness within the surgical field. 13 Knowledge of instruments Poor or no knowledge of instruments. Inappropriate combinations of suture holders, scissors and forceps resulting in unsafe surgery or collateral damage. Occasionally uses inappropriate instrument and doesn’t realize it. Occasionally uses an inappropriate instrument but realizes mistake and corrects it. Appropriate instruments used throughout case.
ICO-OSCAR-LTS.docx