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Surgery Two > 1 - Minor Surgery > Flashcards

1 - Minor Surgery Flashcards

1
Q

Cutting needles preferred for:

A

Skin

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2
Q

Tapered/round needles preferred for:

A

Delicate tissues inside the body; blood vessels, bowel

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3
Q

What is a swaged needle?

A

Suture-pre-attached

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4
Q

What are double armed needles for?

A

To anastomose blood vessels / bowel

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5
Q

Ends in -cryl =

A

Absorbable

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6
Q

Prolene sutures =

A

Not absorbable

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7
Q

Sizes of sutures

A

Higher the number, smaller the thread

i.e. 3-0 = 0.001, 2-0 = 0.01

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8
Q

Absorbable-type suture examples

A

Vicryl
Gut
Monocryl

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9
Q

Non-absorbable suture types

A

Ethibond

Proline

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10
Q

Braided sutures are better at:

A

Holding a knot

More pliable

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11
Q

Negative aspect of braided suture

A

Bacteria may live in the braids

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12
Q

Describe monofilament

A

Smooth and stiff

Harder to tie and hold a knot with poor technique

Less instances of wound infection

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13
Q

What are needle drivers?

A

Instrument designed for suturing

NOT a hemostat

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14
Q

How to load the suture?

A

Between 50 and 75% past the tip perpendicular to the driver

If you use the rings, only insert to the first joint

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15
Q

Adsons forceps are used for:

A

Outside the body

Some have a “rat tooth” for better traction (can cause skin/tissue damage)

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16
Q

Debakeys forceps are used for:

A

Inside the body

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17
Q

How to hold forceps?

A

Like a pencil (not a baby spoon)

Place counter-traction on the skin to make driving the needle easier

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18
Q

What is extrinsic tension

A

Forces which pull wounds apart

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19
Q

Angle of insertion of needle?

A

Perpendicular to the skin, with the wrist pronated

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20
Q

How is the needle driven through the skin?

A

By turning the wrist, NOT by pushing the needle through

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21
Q

For basic laceration closure, start how far from the wound edge?

A

1cm

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22
Q

How should wound edges look?

A

Everted - if not, either try again or change technique

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23
Q

“Do not”s for suturing

A

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

24
Q

Simple interrupted technique:

A

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)

25
Describe horizontal mattress
Good for big lacs Give good wound eversion
26
Describe vertical mattress
For lacs that don’t evert well Difficult to master
27
Running suture
Like simple interrupted, but keeps going (one long strand)
28
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)
29
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
30
Epidermal inclusion cyst
Try to remove the whole thing, with the wall intact, or else its gonna just come back
31
What is a Pilar cyst?
EIC on the scalp These bleed a lot (head is highly vascular)
32
How to prepare a hairy site?
Clippers, NOT a razor And paint betadine (disinfect)
33
10 scalpel used for:
Larger incisions Cutting surface along the curve of the blade
34
What to with tissues?
Don’t throw em out - send to pathology (except nails)
35
15 scalpel used for?
Smaller incisions (like 10 but smaller)
36
11 scalpel is used for:
Punctures or cutting Not primarily for longer incisions
37
How do you close?
Along natural skin lines if possible (better cosmetic outcomes)(exception - flexor surface of a joint - closed transversely)
38
How to prevent dog ears?
Excise as an ellipse 4x longer than the width
39
When you’re draping, make sure you don’t
Drag over the prepped area
40
If no fenestrated drape is available, you may use:
2 to 4 folded towels
41
Usual anasthetic
1:1 lidocaine and Marcaine
42
Epi is good for:
Reducing bleeding
43
Lidocaine and marcaine comparisons
Lidocaine = faster onset Marcaine lasts longer
44
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
45
If you cut an artery
Suture ligate the artery 1. Clamp the artery - using Curved hemostat with tips up 2. Suture artery - place under hemostat (behind) and tie off artery If its smaller you can also use direct pressure or electrocautery
46
Wound closure
Do not place dressing under tension
47
Benefits of staples
Very high tensile strength Can be placed quickly More resistant to infection Downside - worse scar
48
Disposition
Dressing care Showering Sxs of infection No soaks, baths, hot tubs, etc Protect for 12 months (better cosmetic outcome)
49
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
50
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
51
If wound is infected
``` Remove everything Clean it out Do not reclose ABX Close follow-up RECORDS ```
52
Wound care:
Wet to dry, dry to dry Gauze placed in wound bed Removed and repacked daily DO NOT USE COVER SPONGE - ONLY GAUZE
53
Wound vacs
Black sponge material cut to fit wound Tegaderm over top Suction Beep if air leak detected Document output and drainage
54
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
55
I was at the hospital last week and i asked the Dr. if i could close my own wound
He said suture self

Surgery Two (9 decks)

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