1 Flashcards
Why do we suture tissues?
- Increase speed of healing
- Increase strength of healed tissue
- Decrease scar tissues
What are the four main sources of organisms in surgery?
- Patient
- Personnel
- Instruments
- Environment
Why do we preform surgery? (6)
- Therapeutic -> to solve the problem
- Diagnostic -> to find the problem
- Increase suitability -> eg castration
- Palliative -> to decrease pain/discomfort
- Bio-medical research
- Cosmetic
What are some patient factors that affect our choice of whether or not to undertake surgery?
- Nature of disease/trauma (broken leg from playing vs hit by car)
- Overall health of patient
- Physical exam
- Signalment
- Preop diagnostics eg Xray/bloods
What are some Client factors that affect our choice of whether or not to undertake surgery?
- Expected outcomes
- Potential complications
- extent of aftercare
- Costs (before/during/after surgery)
What are some surgical factors that affect our choice of whether or not to undertake surgery?
- Is it the only treatment?
- Is it the best option?
- When?
- What method
- Who should preform it?
- Where should it take place?
List Halsted’s Principles.
Aseptic technique Gentle tissue handling Haemostasis Close approximation of Wound layers Minimise dead space Minimise Tension Minimise foreign material **Phone a friend
What things make a surgical room/environment ideal?
- Isolated from general traffic
- 1 entry/exit point
- Contaminated procedures done elsewhere
- humidity
Explain the phases of wound healing
- Inflammatory phase
- protects body from excessive blood loss and bacterial invasion
- degree/duration reflects severity of injury
- Skin retraction, initial bleeding (flushing) followed by vasoconstriction and clotting
- mast cells and leukocytes - Debridement
- the “get rid of the dead” phase
- neutrophils if infection, macrophages if not - Proliferative/repair phase
- formation of granulation tissue
- migration of fibroblasts -> collagen -> wound contraction
- epithelialisation
- Contraction stops when skin tension = myofibroblast activity or skin meets skin - Re-modelling phase
- collagen orientates itself along lines of tension -> increased strength
- scar tissue will always be 15-20% weaker than surrounding tissue
What factors must be considered before deciding to close a wound (rather than manage it as an open wound)?
- Wound classification (clean/clean-contaminated/contaminated/dirty)
- Amount of tissue trauma (blood supply status, amount of potentially necrotic tissue)
- Patients general health (can they cope w/ anesthesia)
- Extent of free skin in adjacent areas
What steps do you follow when presented with an open wound?
- prevent further contamination (KY gel, clipping etc)
- lavage (the solution to pollution is dilution)
- debride
- Select closure method (if applicable)
- Drainage (if applicable)
- Patient health - analgesia, antibiotics, nutrition
- Selection of bandaging materials
Name some indications/reasons for bandaging (6)
- Provides optimal environment for healing + protection from further injury
- Provide support for internal injuries
- Exert pressure and decrease dead space
- Absorb exudates
- Provide aesthetic appearance
Explain the function of the three main layers of bandages.
Primary -provides a warm, moist, well oxygenated environment Secondary - absorption and support Tertiary - protect primary layer from environment and patient - holds other layers in place - somewhat waterproof but porous - in some cases, apply pressure
How can you manage dead space?
- Bandages for light compression
- close approximation of like tissues
- use of tacking sutures in deep planes
- leave dependent portion of wound open
- placement of surgical drains
Compare and Contrast active and passive drains.
Both drains are used in an attempt to manage dead space Passive - works via capillary action and gravity - wicks around the drain - best for subcutaneous space - Fenestration does not improve activity Active - applied suction - fenestration improves activity - good for high volumes of fluid - Or for when gravity won't work in your favour - better for deep wounds/body cavity - may block with necrotic tissue
What are the three main types of suture patterns? Give reasons for use and examples for each.
- Appositional
- bring like edges together
- rapid healing, strong, less scarring
- eg. simple interrupted/continuous, ford interlocking, intradermal - Inverting
- used when contaminated edges may need protecting for example a gastrotomy
- eg Connel, Utrecht - Everting
- tension relieving
- may suture over stents to distribute tension further
- eg. vertical mattress
- simple interrupted may be added to maintain tissue plane apposition
What questions should be considered when selecting a suture material?
- Absorbable or non-absorbable? If absorbable, short, medium or long acting?
- Synthetic or natural?
- Mono or Multi filament?
- Size (just stronger than the tissue in which it is placed)
What should be considered when choosing a needle?
- Attachment (swaged on or eyed)
- Profile (cutting or round)
- Shape (curved or straight)
- Size
What are some ways you can improve “gentle tissue handling”
- increase surgeons
- sharp dissection where possible
- dissection along tissue planes
- appropriate equipment
- good visualization
- decrease tissue manipulation (eg stay sutures)
- decrease tissue desiccation
- decrease heat when drilling/sawing bone
What are some consequences of haemorrhage?
- decrease visualisation
- increased chance of infection
- increased dead space
- shock w/ >30% blood loss
- > 10% haemodynamically affects the animal
How can you achieve haemostasis in large bleeds? What about smaller ones?
Large bleeds - ligation, haemostats/clips, cellulose/gelatin plug, vasoconstrictors
Small bleeds - digital pressure, haemostats, corterisation
List the 6 ways to reduce tension
undermining tension relieving suture patterns tension relieving incisions skin flaps skin graphs skin stretching
What are the 3 requirements for the establishment of an infection?
- Sufficient dose of pathogenic microorganisms
- Suitable microbial nutrient medium
- impairment of natural host defenses
When are antibiotics indicated?
- In confirmed infected cases
- In contaminated/dirty wounds
- In animals with a low immune system
- In long surgeries
- When infection could be disastrous
If indicated, how/when should antibiotics be administed
Pre-surgery 30min - 1h before first incision
During repeat every 90 min - 2h
Discontinue postoperatively
Why should you not include the peritoneum in an abdominal closure?
Predisposes to adhesions
Increased post operative pain
Decreased closure speed
No increase in strength of closure
What are the 5 main surgical approaches for the abdomen?
Ventral midline Paramedian Flank/Paralumbar Inguinal Colpotomy
What are the advantages and disadvantages of an Ventral midline approach of the abdomen?
Adv - avascular (low bleeding), good suture holding, food visualisation in monogastrics
Dis - high weight of viscera, fascia slow to heal
What are the advantages and disadvantages of an paramedian approach of the abdomen?
adv - good access for abdominal testicle, approach over specific organ especially in cattle, less weight on suture line, highly vascular so quick healing
dis - cutting through muscle = pain and high levels of bleeding, bruising and seromas
What are the advantages and disadvantages of an flank approach of the abdomen?
adv - less weight on suture line, good exposure in ruminants which can be done standing
dis - cutting through muscle = pain and high levels of bleeding, bruising and seromas
When would an inguinal approach of the abdomen be useful?
Accessing reproductive organs
When would a colpotomy approach of the abdomen be useful
Cattle spaying
What is the strength layer of the abdominal wall?
Outer fascia of rectus abdominus muscle
What samples can be taken for oncology diagnosis?
Fine needle aspirate - cheap and easy - can see the type of cells, but not architecture - animal can remain conscious Core Biopsy - core of tissue for histo Incisional biopsy - wedge w/ normal and abnormal tissue Excisional biopsy - take entire lump with margins
What are the 9 post operative considerations?
- Post anaesthesia/surgery recovery
- EDUF, demeanour, clinical exam, TPR
- Wound, bandage and drain care
- Analgesia
- Infection
- Nutritional support
- Exercise restriction
- Client handouts
- Physiotherapy
