Course Outline
Module 1 – Principles of wound healing and managing small procedures in general practice
Unit 1: Introduction, theoretical and practical concepts: This unit commences with a presenters’ introduction and then outlines the principles of wound healing and management. Overall and specific objectives are listed. Preparation of a patient for a clinical procedure is outlined at the end of this unit. Informed consent and post-operative care are covered.
Unit 2: Skin anatomy, tension lines and wound healing: The unit commences with drawings of skin anatomy and relaxed skin tension lines. The principles of wound healing and the three stages of healing, types of wound healing (primary and secondary intention) as well as wound classification are described. The unit finishes with an overview of factors that affect/aid wound healing and potential sources of wound complications.
Unit 3: Aseptic technique and local anaesthetics: Aseptic techniques which protect patients during invasive clinical procedures by employing infection control measures are shown, divided into four potential sources of contamination. The unit concludes with local anaesthetics techniques, preparation prior to surgery, mechanism, agent dosages and needle technique.
Unit 4: Safety, equipment and complications: The unit lists the use of various equipment used for clinical procedures, illustrated by photos. Potential complications and how to reduce these complications are listed.
Module 2 – Closing the wound
Unit 1: Wound closure - knot tying and suture theory: This unit focusses on the objectives of wound closure and outlines the steps for effective wound closure using staples, glues, tapes or sutures. Characteristics of suture materials are evaluated and classified into absorbable sutures and non-absorbable sutures, including recommended timing for suture removal. At the end of this unit, suture materials including needle components, types and their design are discussed together with a diagram of the square knot for tying sutures.
Unit 2: Suturing techniques: The unit commences with demonstrating the use of simple interrupted sutures. The unit considers anatomy related to skin suturing and the use of buried dermal sutures and continuous subcuticular sutures. Drawings of vertical and horizontal mattress stitches are shown and in which cases the different suture methods are used. The unit concludes with a diagram of the continuous subcuticular suture.
Module 3 –Lacerations and wounds
Unit 1: Types of lacerations, debridement and assessment: This unit commences with an overview of various types of lacerations and how to conduct a wound assessment. Clinical images of wound debridement are included.
Unit 2: Treating wounds and lacerations: This unit begins with the surgical technique for slicing injuries located on the dorsum finger. Images are shown of several pretibial lacerations. The unit continues with surgical techniques for foot lacerations and describes which types of dressings are appropriate to use.
Unit 3: Hand and finger lacerations
Unit 3 commences with surgical techniques for lacerations located on the finger and hand, including a drawing of the nerve supply to the digits. Clinical images for tendon injury testing and wound examination is included. The unit distinguishes four categories of people: babies, children, elderly and frail people. Attention is paid to wound diagnosis and bleeding control.
Module 4 – Foreign bodies and healing by second intention
Unit 1: Assessment, investigation, principles and types of foreign bodies: The unit commences with using diagnostic and surgical skills for patient assessment. After investigation by X-ray and/or ultrasound, the procedure to be followed can be determined. Images of several types of foreign bodies are shown. Surgical technique and images for removing foreign bodies located on the finger, foot, ear and nose as well as removal of Implanon devices are discussed. The surgical technique for removal of glass located on the dorsum of the foot and hand are illustrated by step-by-step images of these procedures. The unit finishes with an overview of required equipment, the ‘mother’s kiss’ technique and reinforces the importance of informed consent.
Unit 2: Healing by second intention: The unit concludes with several images of the procedure to remove debris or infected/dead tissue from a wound and includes the healing process.
Module 5 – Ingrown toenails
Unit 1: Anatomy and Aetiology: This unit focusses on how to treat a variety of nail related conditions. A photo of the anatomical sagittal section germinal matrix as well as the anatomy of nerves and vessels for fingers, toes including dorsal and plantar digital vessels and nerves is shown. Treatment of ingrown toenails in a simulated setting is supported by clinical images.
Unit 2: Surgery and consent: Surgical indications and options for the treatment of ingrown toenails are listed and supported by numerous clinical images.
Unit 3: Assessment, nerve blocks/ tourniquets and operative technique: This unit commences with the pre-operation assessment of the patient and patient advice. The digital nerve block and tourniquet procedures are explained. Step-by-step clinical images of operative techniques, post-operation care and possible complications complete this unit.
Unit 4: Nail conditions: The final unit outlines several nail conditions including subungual haematoma and paronychia of fingers and thumbs.
Module 6 – Lumps and bumps
Unit 1: Diagnoses and sebaceous cysts: This unit lists the of principles of surgical examinations, pathological processes and procedures in order to develop a clinical/surgical approach to common lumps and bumps. The management of infected and inflamed cysts including cyst surgery is outlined.
Unit 2: Granuloma, Suppurative hidradenitis and Pilar cysts: The surgical excision of granulomas is the first topic of this unit. The operative technique is explained, with clinical images of the procedure. The next topic is Suppurativa Hidradenitis, showing removal of the lumps and the unit concludes with removing pilar cysts using local anaesthesia.
Unit 3: Lipomata and Abscesses: The unit commences with planning and approach to surgical excision of a lipomata including wound closure. It then discusses abscess treatment and removal and concludes with the drainage and dressing after abscess removal.
Module 7 –Diagnosis and management of anal rectal conditions
This module is for diagnosing and referring patients to specialist care. Most listed procedures are not performed in a general practice clinical setting.
Unit 1: Conditions and anatomy: The unit outlines a list of possible anal rectal conditions to assist with diagnosis and referral. Clinical images demonstrate the anal canal transition and sensory nerves, and includes diagrams of venous drainage, arterial supply and lymph drainage of the anal canal.
Unit 2: Haemorrhoids and haematoma: This unit describes the mechanism and symptoms of haemorrhoids, including the four stages of haemorrhoids, and outlines various treatment options. Clinical images are shown of prolapsing haemorrhoids and the unit concludes with a video of perianal haematoma removal.
Unit 3: Haemorrhoids? Polyps? Tags? Warts?: A description is given of possible diagnoses and treatment of anal rectal conditions including haemorrhoids, polyps, tags, warts and fissures. It outlines symptoms, illustrated by diagrams and clinical images to assist with diagnosis and management.
Unit 4: Complex conditions and other procedures: The final unit of this module focusses on procedures including proctoscopy and sigmoidoscopy that are rarely performed in general practice. Surgical management options for haemorrhoids are listed including post-operation instructions and possible complications.
This module is for diagnosing and referring patients to specialist care. Most listed procedures are not performed in a general practice clinical setting.
Module 8 –Diagnosis and management of anal rectal conditions
Unit 1: Venous ulcers – identification and treatment: Leg, foot and venous ulcers are the focus of this first unit, describing diagnosis and outlining treatment options. Clinical images of appropriate dressing and bandaging techniques are provided to maximise healing of venous ulcers.
Unit 2: Venous ulcers – biopsy, healing, grafting: This unit builds on the previous unit and focusses on biopsies as a diagnostic tool and describes the various biopsy techniques including split skin grafts and how to exclude arterial disease including the use of a doppler or duplex ultrasound. Clinical images and diagrams assist with learning.
Unit 3: Pyoderma, Neurovascular ulcers and diabetes, cellulitis and lymphoedema:The unit describes two unusual disorders: Pyoderma gangrenosum and vasculitis disorders including neurovascular ulcers, neurovascular diabetes, cellulitis and lymphoedema. It describes the symptoms and patient information to assist with diagnosis. It outlines the various treatment options including pros and cons of each option.
Unit 4: Varicose vein treatments: The module concludes with practice based varicose vein treatments using (micro) sclerotherapy or puncture and avulsion under local anaesthetic. Images of step-by-step procedural instructions are included. Possible side effects and disadvantages of sclerotherapy are listed. The final section of this unit focusses on treatment options including laser ablation, radio-frequency or embolization.
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