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FCP > 1. Basic Surgical Techniques > Flashcards

1. Basic Surgical Techniques Flashcards

1
Q

What is the definition of sterilisation

A

Elimination of all pathogens, including spores

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2
Q

What is the definition of disinfection

A

Removal of microorganisms, sometimes doesn’t include the spores

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3
Q

What is the definition of disinfectant

A

Agent that will destroy microorganisms

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4
Q

What is the theatre cleaning routine

A

Morning damp dusting - first thing
Between cases - disinfect
At the end of the day - damp dust everything and disinfect
Once a week - Deep clean, swabs taken, hard to reach places

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5
Q

Pre-op prep of the patient

A

Some form of starvation - can have water
Owner should bathe them before bringing it
Clipping - prior to induction/once induced
Specific surgical prep - e.g. enema if doing lower GIT surgery

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6
Q

What are the 3 theatre styles

A

First opinion
Referral
Charity

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7
Q

What are the 3 surgical scrub solution options for the patient?

A

Chlorhexidine
Povidone iodine
Isopropyl alcohol

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8
Q

What concentration and contact time is requires for Chlorhexidine and Povidone iodine

A

Chlorhexidine - 2% solution for 5 mins
Povidone iodine - 7.5% for 3 mins - good for patients with chlorhexidine sensitivity

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9
Q

Different strengths of scrubbing solutions for oral and ocular cleaning

A

Oral - 0.1% chlorhexidine
Ocular - 0.2% povodine iodine

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10
Q

What are the 4 types of draping a patient?

A
  1. Plain 4 corner drape
  2. Draping a limb
  3. Fenestrated drape
  4. Adhesive barrier drape
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11
Q

Definition of a bacterial infection

A

Bacterial infection is defined as having more than 10^5 bacteria per gram of tissue

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12
Q

What is a surgical site infection (SSI), and what are the subtypes?

A

Infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure
Incisional infection - superficial or deep
Organ/space infection

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13
Q

What are the 4 classifications of surgical wounds

A
  1. clean
  2. clean-contaminated
  3. contaminated
  4. dirty
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14
Q

Describe a ‘clean’ surgical wound and provide 3 examples

A

Non-traumatic, non-inflamed operative wound
Respiratory, GI, genitourinary and oro-pharyngeal tracts are NOT entered
Examples - ex lap, elective neuter, total hip replacement

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15
Q

Describe a ‘clean-contaminated’ surgical wound and provide 3 examples

A

Operative wound
Respiratory, GI, genitourinary tracts ARE entered but under controlled conditions
OR an otherwise clean wound with a drain placed
Examples - bronchoscopy, cholecystectomy, enterotomy

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16
Q

Describe a ‘contaminated’ surgical wound and provide 2 examples

A

Open, fresh or accidental wounds
Procedures where GI contents or infected urine is spilled
A major break in aseptic technique
Examples - cystotomy with spillage of infected urine, open cardiac massage for CPR

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17
Q

Describe a ‘dirty’ surgical wound and provide 3 examples

A

Old, traumatic wounds with purulent discharge, devitalised tissue or foreign bodies
Procedure where a viscus (viscera) is perforated or faecal contamination occurs
Examples - excision or draining of an abscess, bullae osteotomy for otitis media, perforated intestinal tract

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18
Q

6 host factors that can impact infections

A
  1. Age
  2. physical condition
  3. nutritional status
  4. diagnostic procedures - e.g. catheter
  5. concurrent metabolic disorders e.g. HAC
  6. Current medications e.g. corticosteroids, chemotherapy
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19
Q

what 3 things impact successful outcomes with no infections

A

Patient prep
Surgeon prep
Theatre behaviour

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20
Q

In what 5 surgical situations would you use antibiotics

A

Surgery >90 mins
Contaminated or dirty wound classification
Prosthesis implantation
Patients with pre-existing prosthesis undergoing certain procedures
Severly infected or traumatised wounds

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21
Q

Name 3 antibiotics that could be used during small animal surgery, and name which type of bacteria they are good against

A

Cefuroxime - 2nd gen. ceflosporin, broad-spectrum, good for gram +ve
Amoxicillin/clavulanate - broad spectrum, good for gram +ve, okay for anaerobic
Metronidazole - good for anaerobic e.g. large intestine surgery

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22
Q

Name 3 antibiotics which could be used in equine surgery

A

Procaine penicillin - IV
Gentamicin - IV
Oxytetracycline - NOT IV

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23
Q

Characteristics of an ideal suture

A

Easy to tie a secure knot
High tensile strength
Inhibit tissue actions
Non-toxic
Easily sterilised
Inexpensive

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24
Q

What are the 3 potential origins of suture material

A

Natural
Synthetic
Metal

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25
Q

2 behaviours of suture material

A

Absorbable
Non-absorbable

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26
Q

Advantages and disadvantages of absorbable suture material

A

Adv - They disappear, low risk of long term foreign body reactions
Dis - Lose strength over time, limited period of wound support

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27
Q

Advantages and disadvantages of non-absorbable suture material

A

Adv - Permanent, provide indefinable wound support
Dis - don’t disappear, possibility of delayed reactions

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28
Q

Advantages and disadvantages of braided suture material

A

Adv - easy to handle, very secure knots
Dis - Greater friction and tissue drag, more tissue trauma

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29
Q

Advantages and disadvantages of monofilament suture material

A

Adv - minimal tissue trauma, no capillary action
Dis - Harder to handle and knot, require different knots for security

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30
Q

Advantages and disadvantages of natural suture material

A

Adv - easy to handle and knot, high histocompatibility
Dis - moderate/high tissue reaction, low tensile strength

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31
Q

Advantages and disadvantages of synthetic suture material

A

Adv - high tensile strength, predictable biological behaviour
Dis - poorer knotting than natural materials

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32
Q

2 types of needle fixation, give an advantage and disadvantage of both

A

Eyed needle - multiple uses, increased tissue trauma
Swaged needle - minimal trauma, single-use

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33
Q

3 parts of the needle

A

Point
Body
Eye/swage

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34
Q

3 materials surgical instruments can be made from

A
  1. Stainless steel
  2. Chromium-plated carbon steel
  3. Titanium
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35
Q

What are scalpels used for and what handles and blades are used

A

Cutting skin
Number 3 handle most common
Number 4 handle - large animal
10 blade - commonly used for cutting
11 blade - stab incisions
15 blade - more delicate cutting edge

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36
Q

what are the 4 types of surgical scissors and what they are used for

A
  1. mayo scissors - cutting tough tissue
  2. metzenbaum scissors - delicate subcutaneous tissue and viscera
  3. suture scissors - cutting sutures
  4. iris scissors - 2 sharp tips - fine cuts
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37
Q

What are the 3 types of needle holders, and what is the difference

A
  1. Olsen Hager - have scissor blade built in
  2. Mayo Hager - no scissor blade
  3. Gillies - have scissor blade but no ratchet
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38
Q

What are the 4 types of tissue handling or thumb forceps and what is the difference (not ringed forceps)

A
  1. Treves rat toothed forceps - single tooth, larger
  2. Dressing forceps - no rat teeth
  3. Adson rat tooth forceps - small rat tooth
  4. Debakey forceps - longitudinal and transerve serrations - least traumatic
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39
Q

Name 3 types of haemostat forceps

A
  1. Halsted mosquito
  2. Spencer Wells
  3. Carmalt
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40
Q

Name 3 types of tissue/holding forceps and the differences (ringed instruments)

A
  1. Allis - quite traumatic, not applied to the skin
  2. Babcock - triangular shape, less traumatic
  3. Doyen - atraumatic, designed fr bowel
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41
Q

Name 4 types of self retaining retractors and the differences

A
  1. Balfour retractor - abdominal, 3 point
  2. Finchietto retractor - abdominal, 2 point
  3. Gelpi retractor - most commonly used, placed in pairs
  4. Travers retractor - less prone to twisting, can’t be used in small areas
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42
Q

Name 4 types of handheld retractors

A
  1. Senn
  2. Lagenbeck
  3. Hohman
  4. Malleable
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43
Q

Name 2 types of towel clamps

A
  1. Backhaus towel clamp
  2. Cross over towel clamp
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44
Q

What are the 4 stages of wound healing

A
  1. Haemostasis and inflammation
  2. Proliferation
  3. Maturation
  4. Wound contraction
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45
Q

What are they key features of the haemostasis stage of wound healing

A

Tissue damage => blood leaking from vessels
Activation of closing cascade
Platelet aggregation and release of cytokines
Cytokines trigger clotting cascade further and inflammatory phase
Stabilisation of platelet plug by fibrin formation

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46
Q

What are they key features of the inflammatory stage of wound healing

A

Vasodilation following transient vasoconstriction
cytokines in the fibrin clot attract WBCs (neutrophils and macrophages)
Destruction of cells by phagocytosis removes bacteria and devitalised tissue

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47
Q

What are they key features of the proliferation stage of wound healing

A

Formation of granulation tissue (macrophages, fibroblasts, new blood vessels)
Fibroblasts proliferate => extracellular matrix, elastin and collagen
Formation of new epithelial tissue
Wound deficit reduced
Contact inhibition - smooth layer of epithelium

48
Q

What are they key features of the maturation stage of wound healing

A

Type III collagen => type I collagen
Cross-linking of collagen
Takes weeks to months

49
Q

What 3 ‘patient factors’ affect wound healing

A

Age
Comorbidities
Nutrition status

50
Q

What 2 ‘wound factors’ affect wound healing

A

Infection
Location

51
Q

What concurrent treatments can affect wound healing

A

Corticosteroids
Radiation therapy

52
Q

Name the 5 classifications of wound types

A
  1. abrasion
  2. avulsion
  3. incision
  4. laceration
  5. puncture
53
Q

Key features of an abrasion wound

A

Loss of epidermis and some dermis
“Graze wound”

54
Q

Key features of an avulsion wound

A

Tearing of tissues from their attachments
If on the distal limb - called degloving
No loss of skin - just torn away

55
Q

Key features of an incision wound

A

Created by a sharp object - classical surgical wound
Minimal trauma

56
Q

Key features of a laceration wound

A

Tearing causing an irregular defect

57
Q

Key features of a puncture wound

A

Penetrating
Deep damage may be substantial

58
Q

5 things to consider when assessing a wound

A
  1. type of wound
  2. wound age
  3. level of contamination
  4. lavage and debridement
  5. management
59
Q

5 factors that influence bacterial contamination of a wound

A
  1. Vascular supply
  2. Devitalised tissue
  3. Foreign body
  4. Type of contamination e.g. bite wound vs cut by glass
  5. Type of bacteria present
60
Q

3 main goals of wound management

A
  1. Promote healing
  2. convert contaminated => clean
  3. control infection
61
Q

5 ways to debride a wound

A
  1. Surgical
  2. mechanical
  3. autolytic
  4. biological - rare
  5. enzymatic - rare
62
Q

Describe 3 methods of mechanical debridement

A
  1. Lavage debridement - high volumes of lactated ringers solution or saline
  2. wet to dry dressings
  3. topical negative pressure wound therapy
63
Q

describe key principals of autolytic debridement

A

Honey - osmotic effect - draws up fluid and also antimicrobial properties

64
Q

2 things bandages provide

A
  1. stabilisation of wound surface
  2. protection from trauma and contamination
65
Q

What 3 layers should all bandages have

A
  1. primary layer = in contact layer
  2. secondary layer = supportive or padded and applied light pressure
  3. tertiary layer = holds others in place, should stick to itself NOT the patient
66
Q

Name 7 categories of primary layers for bandages

A
  1. Dry
  2. impregnated
  3. semi-occlusive
  4. absorbent
  5. alginates
  6. others e.g. honey, silver, iodine
  7. topical wound gels
67
Q

Name 3 types of immobilising bandages/splints

A
  1. Robert Jones’s bandage
  2. Gutter splints
  3. Fibreglass impregnated with resin/ plaster of Paris cast
68
Q

Name 4 common complications associated with incorrectly applied bandages/poorly cared for bandages

A
  1. Swelling
  2. tissue necrosis
  3. decubitus ulcers (pressure ulcers)
  4. patient interference
69
Q

What 3 types of bandage are common in equine practice

A
  1. Simple bandage
  2. Figure of 8 bandage
  3. Robert Jones
70
Q

What 2 situations do you splint in equine practice

A
  1. unstable fractures
  2. unstable tendon injuries
71
Q

What are the main elements of Halstead’s principals of good surgical practice (x7)

A

Gentle tissue handling
Strict asepsis
Haemostasis
Preservation of blood supply
No tension on tissues
Good approximation of tissues
Obliteration of dead space

72
Q

What 5 regions is the abdominal cavity divided into for a exploratory laparotomy

A
  1. Cranial abdomen
  2. GIT
  3. Right paravertebral region
  4. Left paravertebral region
  5. Caudal abdomen
73
Q

What are the 3 main stages of bone healing

A

Inflammatory
Restorative
Remodelling

74
Q

Describe key features of inflammatory phase of bone healing

A

Lysis of osteocytes => attract inflammatory cells and macrophages
Blood clot forms at the fracture site

75
Q

Describe key features of restorative phase of bone healing

A

Soft callus formation
External and internal calluses are formed
New blood vessels
Newly formed cartilages are substituted by bone tissue (endochondral ossification)
Produces a hard callus

76
Q

Describe key features of remodelling phase of bone healing

A

Hard callus replaced by regular bone
Ends of bone are enveloped by a fusiform mass
Remodelling occurs - osteoclasts

77
Q

What 2 types of healing can occur in the restorative phase of bone healing

A

First intention healing - minimal callus formation
Second intention healing - natural healing

78
Q

Describe process of healing by first intention (bone)

A

Direct formation of bone tissue without creation of bone callus

79
Q

What 6 conditions must occur to allow healing by first intention (bone)

A

Immediate stabilisation
Good blood supply
Perfect reduction of fracture edges
Absence of micro-movements at the level of the fracture line
Interfragmentary compression
Absence of infection

80
Q

Describe second intention healing (bone)

A

Where a bony callus forms
Produced due to late treatment, poor blood supply, infection, no compression forces

81
Q

What is an articular fracture

A

Where a bone breaks to the joint (articular surface of the bone)

82
Q

What is a closed vs open fracture

A

Open fracture = when skin is broken with the fracture
Closed = bone is broken but skin is intact

83
Q

What is an avulsion fracture

A

When a small chunk of bone is torn away by a tendon or ligament

84
Q

What ‘patient factors’ affect fracture scores

A

Weight
Age
Ability to manage cage rest
Concurrent illness

85
Q

What about the fracture itself can affect the fracture score

A

Type of fracture
Open or closed
Associated soft tissue injuries
Single or multiple fractures

86
Q

Non patient factors affecting fracture score

A

Owner finances
Owner commitment
Surgical expertise of vet surgeon
Surgical equipment available

87
Q

What 4 forces can be applied to a fracture

A

Bending
Torsion
Tension
Axial compression

88
Q

On the following long jones, which aspect is the tension aspect? (femur, tibia, radius, humerus, mandible)

A

Femur - lateral aspect
Tibia - medial aspect
Radius - cranio-medial aspect
Humerus - latero-cranial aspect
Mandible - dorsal aspect

89
Q

Why is it important to know which is the tension aspect of the bone when applying a plate

A

Plate is always applied to the tension side of the bone
Will not be broken by tensile force but will be broken by successive compressions

90
Q

What is the formula for strain in terms of fractures

A

Strain = change in length/original length

91
Q

Name 5 main options for fixing a fracture

A

Intramedullary pin and cerclage wire
Plating +/- compression
Intramedullary nail
External fixator
Pin and tension band

92
Q

Which forces are intramedullary pins good and bad at counteracting

A

Good - bending forces
Bad - Axial compression, rotation

93
Q

What are the 2 placement options for an IM pin

A

Normograde placement (from the proximal end)
Retrograde placement (enters proximal fragment distally)

94
Q

Why are external fixators really useful in fracture repair

A

Counteract all forces applied to a fracture
Good for open fractures where wound management may be required

95
Q

Name some complications associated with external fixators

A

Pins are prone to infection
Require frequent examinations
May require staging down
Several follow up radiographs often required

96
Q

What are the benefits of plate fixation of fractures

A

Allow reconstruction of comminuted fractures
Protect against axial rotations

97
Q

What force do plate fixators NOT protect against in fractures

A

Bending

98
Q

Name 3 types of plates for fixing fractures

A
  1. Buttress plate
  2. Neutralisation plate
  3. Compression plate
99
Q

Explain how lag screws work and why it is used

A

Allow compression to be applied to a fracture
Glide hole and thread hole pulls far fragment of bone against the near fragment

100
Q

Things to consider with avian fractures

A

Pneumatised bone
Periosteal blood supply of pneumatised bone must be preserved
Avian bone heals mostly from the endosteum

101
Q

In what 4 fracture situations do you immediately euthanise a horse

A
  1. Comminuted fractures of proximal and middle phalanx
  2. Compound/open fracture of long bone
  3. Complete fracture of long bones
  4. Pelvic fracture
102
Q

What suture material, size, pattern and other techniques do you use to close a gastrotomy

A

Material - absorbable monofilament
Size - 3/0 in cats, 3/0 or 2/0 in dogs
Pattern - 1 layer closure of 2 layer closure (more common)
Omentalise

103
Q

Why do we “omentalise” when performing intestinal surgery

A

Draping omentum over site of incision
Improves vascular supply
Lymphatic drainage
Rich source of inflammatory and immunogenic cells

104
Q

Name 4 reasons for performing a urinary bladder cystotomy

A
  1. Calculi need removing
  2. Biopsy
  3. Tumour
  4. Ureteral ectopia
105
Q

During which period are the intestine/bladder most likely to breakdown after surgery

A

72-96 hours (lag phase)
This is when all support ad strength is provided by the sutures

106
Q

Name 3 complications which could occur after abdominal surgery

A

Wound infection
Peritonitis
Uroabdomen

107
Q

Clinical signs of postoperative complications abdominal surgery/bladder surgery

A

Dull, lethargy, anorexic
Bladder breakdown => vomiting, diarrhoea
Abdominal guarding
Pyrexia, increased HR and RR

108
Q

Which layer of the lines alba is most important when it comes to closure

A

External rectus sheath

109
Q

Gives examples of prophylactic surgery for tumours

A

Ovariectomy/ovariohysterectomy for mammary neoplasia

110
Q

Give an example of an oncological emergency requiring surgery

A

Bleeding splenic hemangiosarcoma

111
Q

What is ‘staging’ of a tumour and what imaging modality is best

A

looking for metastatic spread - CT scan best

112
Q

Name the 4 types of tumour removal surgeries (margins)

A
  1. debulking/cytoreduction - leaving some behind
  2. marginal resection
  3. wide resection
  4. radical resection
113
Q

Name 2 types of clinical reasoning

A
  1. pattern recognition
  2. problem based clinical reasoning
114
Q

what are the 4 questions/stages to work through during problem based clinical reasoning (type 2)

A
  1. what is the problem
  2. which body system is involved and how
  3. where in the body system ins the problem located
  4. what is the lesion
115
Q

What are the benefits of shared decision making

A

Tailors decisions to individual client
informed consent
Better adherence to treatment plan
Strengthens the relationship between vet and client
Less likely to get complaints

116
Q

What are the disadvantages of shared decision making

A

More time consuming?

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