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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
Q

Describe horizontal mattress

A

Good for big lacs

Give good wound eversion

26
Q

Describe vertical mattress

A

For lacs that don’t evert well

Difficult to master

27
Q

Running suture

A

Like simple interrupted, but keeps going (one long strand)

28
Q

Subcuticular closure is used for:

A

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
Q

Lipoma removal

A

Ok to do in clinic but be careful bc they’re usually larger than they appear and can be highly vascular

2 points

30
Q

Epidermal inclusion cyst

A

Try to remove the whole thing, with the wall intact, or else its gonna just come back

31
Q

What is a Pilar cyst?

A

EIC on the scalp

These bleed a lot (head is highly vascular)

32
Q

How to prepare a hairy site?

A

Clippers, NOT a razor

And paint betadine (disinfect)

33
Q

10 scalpel used for:

A

Larger incisions

Cutting surface along the curve of the blade

34
Q

What to with tissues?

A

Don’t throw em out - send to pathology (except nails)

35
Q

15 scalpel used for?

A

Smaller incisions (like 10 but smaller)

36
Q

11 scalpel is used for:

A

Punctures or cutting

Not primarily for longer incisions

37
Q

How do you close?

A

Along natural skin lines if possible (better cosmetic outcomes)(exception - flexor surface of a joint - closed transversely)

38
Q

How to prevent dog ears?

A

Excise as an ellipse 4x longer than the width

39
Q

When you’re draping, make sure you don’t

A

Drag over the prepped area

40
Q

If no fenestrated drape is available, you may use:

A

2 to 4 folded towels

41
Q

Usual anasthetic

A

1:1 lidocaine and Marcaine

42
Q

Epi is good for:

A

Reducing bleeding

43
Q

Lidocaine and marcaine comparisons

A

Lidocaine = faster onset

Marcaine lasts longer

44
Q

Technique for anesthetizing the area

A

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
Q

If you cut an artery

A

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
Q

Wound closure

A

Do not place dressing under tension

47
Q

Benefits of staples

A

Very high tensile strength
Can be placed quickly
More resistant to infection

Downside - worse scar

48
Q

Disposition

A

Dressing care
Showering
Sxs of infection

No soaks, baths, hot tubs, etc

Protect for 12 months (better cosmetic outcome)

49
Q

Suture removal

A

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
Q

Staple removal

A

Use staple remover tool
- Pull straight up

Can also use 2 hemostats, rotate hands inward, lift up
- no cool points for your clinic

51
Q

If wound is infected

A 
Remove everything
Clean it out
Do not reclose
ABX
Close follow-up
RECORDS
52
Q

Wound care:

A

Wet to dry, dry to dry

Gauze placed in wound bed

Removed and repacked daily

DO NOT USE COVER SPONGE - ONLY GAUZE

53
Q

Wound vacs

A

Black sponge material cut to fit wound

Tegaderm over top

Suction

Beep if air leak detected

Document output and drainage

54
Q

Silver nitrate

A

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
Q

I was at the hospital last week and i asked the Dr. if i could close my own wound

A

He said suture self

Surgery Two (9 decks)

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