Basic Surgical Skills

Question 1

What are the types of wounds

Answer 1

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)

Question 2

How is clean closed?

Answer 2

Primary intention

Question 3

What are the three phases of primary tention

Answer 3

1. inflammatory (takes 3-7 days, hemostasis and wound is prepared for repair, fibroblasts, debridement) increased wound healing is based on)
2. proliferative phase: fibroblasts form a collagen matrix tensile strength increases). Wound contraction
3. Remodeling: occurs for a year or longer. Vascularity decreases and scar is pale).

Question 4

When does wound contraction occur?

Answer 4

proliferative phase

Question 5

How long does it take to get tensile strength back in primary intention?

Answer 5

20% in 2 weeks
50% in 5 weeks
80% in 10 weeks

sutures
staples
glue

Question 6

When does 2ndary intention happen?

Answer 6

Primary intention failed leading to dead space

Question 7

explain 2ndary intention

Answer 7

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)

Question 8

What is delayed primary closure and when is it used?

Answer 8

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

Question 9

primary closure
2ndaery

Answer 9

suturing
left open and heals from base out
left open for days to weeks and then proceed to primary intention

Question 10

What are the skin closure materials

Answer 10

Forceps aka pickups
Hold 1st three fingers with pen
Non-dominant hand to grab tissue to keep open

Question 11

What is a needle-holder

Question 12

What is the suture needle shapes

Answer 12

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

Question 13

What are the different tip types

Answer 13

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)

Question 14

What is preferred for delicate tissue?

Answer 14

taper - when in doubt use this

Question 15

what is an advantage of taper?

Answer 15

smooth

Question 16

What side is the cutting in reverse cutting needle?

Answer 16

convex

Question 17

What is the preferred reverse of conventional?

Answer 17

Reverse
less likely to injure tissue

Question 18

What are the properties of suture material?

Answer 18

memory (nylon/PDS): made of a different material, sturdier, thicker material

elasticity: can

knot strength

Question 19

what is a suture considered in your body?

Answer 19

A foreign body

leading to tissue reactions sometimes and worse healing

Question 20

what is a disadvantage of nylon suture?

Answer 20

non-absorbable requiring manual removal post-surgery

Question 21

What are the filaments of sutures?

Answer 21

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(

Question 22

What are the non-absorbable sutures

Answer 22

natural
silk, cotton/steel

synthetic
prolene
ethilon

Question 23

what are the absorbable sutures?

Answer 23

natural
Catgut (7 days - often use on the face)
Chromic gut (takes 3 months to absorb)

synthetic
Vicryl (dissolves after water penetrates)

Question 24

What is the scale of sutures?

Answer 24

Thickness of the suture

0 is largest
12/0 is smallest

as number gets larger suture gets smaller in diameter

Question 25

what to do do later?

Answer 25

watch simple interrupted suture
gowning gloving

Question 26

When is suture removal

Answer 26

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!