1 - Minor Surgery Flashcards
Cutting needles preferred for:
Skin
Tapered/round needles preferred for:
Delicate tissues inside the body; blood vessels, bowel
What is a swaged needle?
Suture-pre-attached
What are double armed needles for?
To anastomose blood vessels / bowel
Ends in -cryl =
Absorbable
Prolene sutures =
Not absorbable
Sizes of sutures
Higher the number, smaller the thread
i.e. 3-0 = 0.001, 2-0 = 0.01
Absorbable-type suture examples
Vicryl
Gut
Monocryl
Non-absorbable suture types
Ethibond
Proline
Braided sutures are better at:
Holding a knot
More pliable
Negative aspect of braided suture
Bacteria may live in the braids
Describe monofilament
Smooth and stiff
Harder to tie and hold a knot with poor technique
Less instances of wound infection
What are needle drivers?
Instrument designed for suturing
NOT a hemostat
How to load the suture?
Between 50 and 75% past the tip perpendicular to the driver
If you use the rings, only insert to the first joint
Adsons forceps are used for:
Outside the body
Some have a “rat tooth” for better traction (can cause skin/tissue damage)
Debakeys forceps are used for:
Inside the body
How to hold forceps?
Like a pencil (not a baby spoon)
Place counter-traction on the skin to make driving the needle easier
What is extrinsic tension
Forces which pull wounds apart
Angle of insertion of needle?
Perpendicular to the skin, with the wrist pronated
How is the needle driven through the skin?
By turning the wrist, NOT by pushing the needle through
For basic laceration closure, start how far from the wound edge?
1cm
How should wound edges look?
Everted - if not, either try again or change technique
“Do not”s for suturing
Load the needle too far forward
Push the needle through the skin
Crush the suture material with the needle driver
Pull the suture all the way through
Let the wounds invert
Simple interrupted technique:
Good for almost all external closures
Start in the middle and divide the wound in half for subsequent placement
Move knot off of midline
7-10 days then remove (5 for face)
Describe horizontal mattress
Good for big lacs
Give good wound eversion
Describe vertical mattress
For lacs that don’t evert well
Difficult to master
Running suture
Like simple interrupted, but keeps going (one long strand)
Subcuticular closure is used for:
Deeper injuries
Prevents space for hematoma / seroma formation
Absorbable sutures for the deep closure, then normal closure on top (could be steri-strips if you want, or more sutures, or stapler)
Lipoma removal
Ok to do in clinic but be careful bc they’re usually larger than they appear and can be highly vascular
2 points
Epidermal inclusion cyst
Try to remove the whole thing, with the wall intact, or else its gonna just come back
What is a Pilar cyst?
EIC on the scalp
These bleed a lot (head is highly vascular)
How to prepare a hairy site?
Clippers, NOT a razor
And paint betadine (disinfect)
10 scalpel used for:
Larger incisions
Cutting surface along the curve of the blade
What to with tissues?
Don’t throw em out - send to pathology (except nails)
15 scalpel used for?
Smaller incisions (like 10 but smaller)
11 scalpel is used for:
Punctures or cutting
Not primarily for longer incisions
How do you close?
Along natural skin lines if possible (better cosmetic outcomes)(exception - flexor surface of a joint - closed transversely)
How to prevent dog ears?
Excise as an ellipse 4x longer than the width
When you’re draping, make sure you don’t
Drag over the prepped area
If no fenestrated drape is available, you may use:
2 to 4 folded towels
Usual anasthetic
1:1 lidocaine and Marcaine
Epi is good for:
Reducing bleeding
Lidocaine and marcaine comparisons
Lidocaine = faster onset
Marcaine lasts longer
Technique for anesthetizing the area
Bend needle 45 degrees
Insert SQ to the hub
Aspirate to make sure you’re not in a vessel
Inject as you withdraw
Redirect prior to full withdrawal and repeat
If you cut an artery
Suture ligate the artery
- Clamp the artery
- using Curved hemostat with tips up - Suture artery
- place under hemostat (behind) and tie off artery
If its smaller you can also use direct pressure or electrocautery
Wound closure
Do not place dressing under tension
Benefits of staples
Very high tensile strength
Can be placed quickly
More resistant to infection
Downside - worse scar
Disposition
Dressing care
Showering
Sxs of infection
No soaks, baths, hot tubs, etc
Protect for 12 months (better cosmetic outcome)
Suture removal
Clean area
Loosen sutures from wound bed (usually with water soak)
Use scissors or 11 blade
Elevate with Adsons or hemostat
May add steri-stips after removal
Staple removal
Use staple remover tool
- Pull straight up
Can also use 2 hemostats, rotate hands inward, lift up
- no cool points for your clinic
If wound is infected
Remove everything Clean it out Do not reclose ABX Close follow-up RECORDS
Wound care:
Wet to dry, dry to dry
Gauze placed in wound bed
Removed and repacked daily
DO NOT USE COVER SPONGE - ONLY GAUZE
Wound vacs
Black sponge material cut to fit wound
Tegaderm over top
Suction
Beep if air leak detected
Document output and drainage
Silver nitrate
May be used for minor bleeding or to “knock down” granulation tissue
Tissue will turn greyish color and cause necrosis (avoid closing skin overtop if silver nitrate is used)
Tissue will slough off and leave a flat surface for epithelization
I was at the hospital last week and i asked the Dr. if i could close my own wound
He said suture self