Basic Surgical Skills Flashcards
What are the types of wounds
Clean (uninfected with no inflammation and no systemic tracts)
Clean, contaminated (systemic tracts are entered under controlled conditions, not accidental)
Contaminated (trauma, spillage, penetrating trauma, break in aseptic technique)
Infected (heavily contaminated wound b4 a procedure - such as necrotic tissue)
How is clean closed?
Primary intention
What are the three phases of primary tention
- inflammatory (takes 3-7 days, hemostasis and wound is prepared for repair, fibroblasts, debridement) increased wound healing is based on)
- proliferative phase: fibroblasts form a collagen matrix tensile strength increases). Wound contraction
- Remodeling: occurs for a year or longer. Vascularity decreases and scar is pale).
When does wound contraction occur?
proliferative phase
How long does it take to get tensile strength back in primary intention?
20% in 2 weeks
50% in 5 weeks
80% in 10 weeks
sutures
staples
glue
When does 2ndary intention happen?
Primary intention failed leading to dead space
explain 2ndary intention
Primary intention failed leading to dead space
leading to fluid accumulation, hematomas, ect
takes longer to heal, longer recovery period
granulation tissue fills in the wound leading to a large scar (body heals itself)
What is delayed primary closure and when is it used?
Already infected wound
Debride the non-viable necrotic tissue
Leave wound open
Apply gauze
Apply wound vac the size of the wound to keep the wound closed with plastic
After 3-5 days, you can close the wound if infection disappears - if not body will heal with 2ndary intention
primary closure
2ndaery
suturing
left open and heals from base out
left open for days to weeks and then proceed to primary intention
What are the skin closure materials
Forceps aka pickups
Hold 1st three fingers with pen
Non-dominant hand to grab tissue to keep open
What is a needle-holder
What is the suture needle shapes
swaged = placed into the base of the needle and permenantely attached
shapes vary from a 1/4 a circle to 5/8 a circle
MC is 1/2 circle
What are the different tip types
conventional cutting (skin, triangle pointing up)
reverse cutting (triangle pointing down posterior)
spatula
side cutting
taper point
blunt needle (friable tissue where you do not want to injure tissue)
What is preferred for delicate tissue?
taper - when in doubt use this
what is an advantage of taper?
smooth
What side is the cutting in reverse cutting needle?
convex
What is the preferred reverse of conventional?
Reverse
less likely to injure tissue
What are the properties of suture material?
memory (nylon/PDS): made of a different material, sturdier, thicker material
elasticity: can
knot strength
what is a suture considered in your body?
A foreign body
leading to tissue reactions sometimes and worse healing
what is a disadvantage of nylon suture?
non-absorbable requiring manual removal post-surgery
What are the filaments of sutures?
monofilament (less friction - but more likely to slip, takes about 5-6 throws/nots - better cosmetic result)
multifilament (vicryl/silk - easier to handle and tie and requires less knots as it is less likely to slip(
What are the non-absorbable sutures
natural
silk, cotton/steel
synthetic
prolene
ethilon
what are the absorbable sutures?
natural
Catgut (7 days - often use on the face)
Chromic gut (takes 3 months to absorb)
synthetic
Vicryl (dissolves after water penetrates)
What is the scale of sutures?
Thickness of the suture
0 is largest
12/0 is smallest
as number gets larger suture gets smaller in diameter
what to do do later?
watch simple interrupted suture
gowning gloving
When is suture removal
face = 3-4 days
scalp = 5 days
trunk = 7 days (1 week)
limb 7-10 days
foot: 10-14 days (2 weeks)
as you go from face to feet, it gets longer
memorize this!
