Basic Surgical Skills - Exam 1

Question 1

_______ operative wound in which systemic tracts(s) are entered under controlled conditions and without contamination. Give 3 examples

Answer 1

clean, contaminated

lung sx, appendix, vaginal procedures

Question 1

______ is an uninfected operative wound in which no inflammation is encountered and no systemic tracts are entered (respiratory, alimentary, etc). How is closed?

Answer 1

clean wound

Closed by primary intention and are usually not drained

Question 2

_____ are open traumatic wounds and operative procedures involving spillage from GI, GU or biliary tracts or involves a break in aspectic technique such as an open cardiac massage

Answer 2

contaminated

Question 3

_____ are heavily contaminated/infected wound prior to operation which includes: perforated viscera, abscesses, wounds with undetected foreign body/necrotic tissue

Answer 3

infected

Question 4

______ optimum closure method since wound heals in minimum time with no separation of its edges and minimal scar formation

Answer 4

primary intention

Question 5

What are the 3 phases of primary intention?

Answer 5

inflammatory

proliferative

remodeling

Question 7

When does inflammatory phase of primary intention start? How does the wound prepare for repair? 3 things

Answer 7

Begins immediately and completes by Days 3-7

1. Extravasation of tissue fluid, cell, and fibroblasts
2. Increasing blood supply to wound
3. Debridement of tissue debris by proteolytic enzymes

Question 8

in primary intention, what does tensile strength and wound healing depend on?

Answer 8

Increase in tensile strength of tissue and wound healing is dependent on approximation of edges by closure material

Question 9

When does the proliferative phase of primary intention start? What is it made out of?

Answer 9

Starts from Day 3 onwards

Fibroblasts form a collagen matrix

Question 10

What is happening in the matrix of the proliferative phase of primary intention? What happen to the tensile strength?

Answer 10

Determines the tensile strength and pliability of the healing wound
Becomes vascular, supplying the nutrients and oxygen necessary for wound healing

Tensile strength increases until wound is able to withstand normal stress

Question 11

______ occurs when the wound edges pull together to close the wound. Why would it be a good thing? What areas of the body does it help? Harmful?

Answer 11

wound contraction

If successful, it results in a smaller wound with less need for repair by scar formation

helps: buttocks or trochanter

harmful: hand, neck and face because can lead to disfigurement and excessive scarring

Question 12

What phase does wound contraction occur in? ______ can help to reduce contraction in undesirable locations

Answer 12

proliferative phase of primary intention

skin grafting

Question 13

______ phase following completion of collagen deposition, vascularity decreases and any surface scar becomes paler. How long does it last? What does the size of the scar depend on?

Answer 13

remodeling

may continue or a year or longer

Resulting scar size is dependent upon the initial volume of granulation tissue

Question 14

What is the tensile strength of a primary intention wound after 2 weeks? 5 weeks? 10 weeks?

Answer 14

About 20% after 2 weeks
About 50% after 5 weeks
About 80% after 10 weeks

Question 15

What are 3 options you can use to close a primary intention wound?

Answer 15

Sutures
Staples
Tape/glue

Question 16

What is a secondary intention? What are 4 reasons they occur?

Answer 16

Occurs when the wound fails to heal by primary intention

Infection
Excessive trauma
Tissue loss
Imprecise approximation of tissue (Leaving dead space)

Question 17

excessive formation of granulation tissue in secondary intention may lead to what 2 things?

Answer 17

Contains myofibroblasts leading to gradual but marked wound contraction

May protrude above the wound surface, prevent epithelialization and thus require treatment

Question 18

What type of wound?

Answer 18

secondary intention

Question 19

What type of wound?

Answer 19

secondary intention

Question 20

What is delayed primary closure? When would you use it?

Answer 20

Used in management of contaminated and infected wounds with extensive tissue loss and high risk of infection

trauma or penetrating injury

Question 21

What are the 4 steps taken in delayed primary closure?

Answer 21

Debridement of nonviable tissue, usually under sedation

Leaving wound open with gauze packing/wound vac system

Wound approximation within 3-5 days of no infection is evident

If infection is present, the wound is allowed to heal by secondary intention

Question 22

What type of wound?

Answer 22

Question 23

Answer 23

Question 24

Answer 24

Question 25

How should you hold forceps?

Answer 25

in the non dominant hand hold in the first three fingers in a similar way to a pen

Question 26

How should you hold the needle driver?

Answer 26

Question 27

What is the shape of the need for the corresponding letters? F H D V V G A

Answer 27

Question 28

What are the 5 different designs of needle points? Give a scenario in which each is used

Answer 28

Question 29

When in doubt of taper point or cutting needle, choose _____ for everything except ______.

Answer 29

taper skin sutures = cutting needle

Question 30

When should taper needles NOT be used?

Answer 30

Should NOT be used for dense tissue like skin because the extra force needed to penetrate the tissue causes extra trauma or bends the needle Penetrates tissue, without cutting, creating a round hole

Question 31

Where is the cutting surface on a traditional cutting needle?

Answer 31

Cutting edge is on the inside of the curve (concave surface)

Question 32

Where is the cutting surface on the reverse cutting needle?

Answer 32

Cutting edge on outer surface of the curve (convex surface) More resistant to suture cutting through tissue because the cut edge is opposite to the direction of tension on the tied suture and decreases likelihood of sutures pulling through tissue

Question 33

**What needle type is preferred by most surgeons?

Answer 33

Reverse cutting needle

Question 34

_______ suture has the ability to return to previous shape after deformation. What is one negative thing about it?

Answer 34

Memory (Nylon/PDS) Leads to difficulty in tying sutures and knot unravelling

Question 35

_______ suture has the ability to return to its original length after stretching. What type of tissue is this good for?

Answer 35

Elasticity (Monofilament) edematous tissue

Question 36

______ is the force required for a knot to slip. When is it important to consider?

Answer 36

Knot strength (Surgeon’s knot) when ligating arteries

Question 37

_____ is the force necessary to break a suture

Answer 37

tensile strength

Question 38

tissue reaction due to inflammation of the suture material is highest between _____ and ___

Answer 38

between day 3-7

Question 39

_____ suture consists of a single smooth strand and are less traumatic due to less friction. Lower or higher rates of infection?

Answer 39

monofilament (PDS/monocryl/nylon) -> better cosmetic result LOWER rates of infection

Question 40

How many throws does a monofilament suture need? multifilament?

Answer 40

More likely to slip and should be secured with 5 or 6 ‘throws’ (in contrast to 3 throws with multifilament)

Question 41

______ consists of multiple fibers braided together and are LESS likely to slip. How many throws are needed?

Answer 41

multifilament 3 throws needed

Question 42

What are the 3 options of material for non-absorbable suture material?

Answer 42

silk cotton/steel synthetic: prolene and ethilon

Question 43

Prolene: how what material and how many strands? Ethilon?

Answer 43

Prolene: synthetic mono strand Ethilon: synthetic nylon: mono strand

Question 44

What are the different suture types that are absorbable?

Answer 44

Catgut chromic catgut Vicryl: synthetic

Question 45

What is catgut made out of? How long does it take to break down?

Answer 45

Consists of processed collagen from animal intestines 7 days

Question 46

What is chromic catgut made out of? How long does it take to break down? Give both tensile strength loss and break down

Answer 46

Consists of intestinal collagen treated with chromium Loses tensile strength after 2-3 weeks broken down after 3 months

Question 47

______ is the preferred absorbable suture because it envokes LESS tissue reaction. How is it degraded?

Answer 47

Synthetic (Vicryl) Degraded non-enzymatically by hydrolysis when water penetrates the suture filaments and attacks the polymer chain

Question 48

What are the absorbable synthetic options?

Answer 48

monocryl vicryl PDS

Question 49

What are the absorbable natural options?

Answer 49

collagens

Question 50

What are the non-absorbable synthetic options?

Answer 50

ethilon prolene

Question 51

What are the natural non-absorbable options?

Answer 51

surgical cotton, silk and steel

Question 52

**What is the scale of suture material thickness?

Answer 52

Scale now ranges from 0 (largest) to 12/0 (smallest)

Question 53

What is the chart that shows suture material size correlated with each part of the body? consider looking at this again??

Answer 53

Question 54

When grasping the needle driver, what is the proper technique?

Answer 54

*Grasp the needle-holder by partially inserting the thumb and ring finger into the loops of the handle *The free index finger provides additional control and stability

Question 55

When grasping the needle with the needle driver, where do you grasp it?

Answer 55

Question 56

Review the simple interrupted stitch instructions on slides 44-50 AND watch the video and practice!!

Answer 56

DO IT!!!!

Question 57

What is the day range that suture should be removed based on the body part. Face Scalp Trunk Limb Foot

Answer 57

Face: 3-4 days Scalp: 5 days Trunk: 7 days Limb: 7-10 days Foot: 10-14 days

Question 58

What is the suture removal procedure?

Answer 58