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Surgical Skills > Cathcart > Flashcards

Cathcart Flashcards

1
Q

How does tension slow healing? 4 reasons

A
  • pulls the small vessels closed and reduces blood supply
  • skin can even make a tourniquet
  • can pull apart wound
  • can limit mobility of nearby joints
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2
Q

What affects tension?

A
  • breed/species
  • body position
  • wound shape
  • wound tension
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3
Q

How can you remove dead space after undermining?

A

walking sutures

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4
Q

How can you remove dead space after undermining?

A

walking sutures

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5
Q

What is a releasing incision?

A

nearby small incisions that open after you close your wound

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6
Q

What is the difference between vascularized and nonvascularized grafting

A

vascularized requires micro surgery to reconnect vessels.

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7
Q

What is the difference between vascularized and nonvascularized grafting

A

vascularized requires micro surgery to reconnect vessels.

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8
Q

What should the general shape of a sub dermal flap be?

A

twice as long as it is wide to continue proper blood supply to the flap.

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9
Q

name two kinds of flaps

A

rotation flaps

transposition flaps

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10
Q

What is an axial pattern flap?

A

carries artery or vein so can be larger than a sub dermal flap

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11
Q

What is an axial pattern flap?

A

carries artery or vein so can be larger than a sub dermal flap

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12
Q

“region that an artery supplies”

A

angiosome

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13
Q

What do you need to consider when making a axial pattern flap?

A

can’t rotate more than 180 degrees or you may kink the artery. Also don’t trim dog ears.

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14
Q

What are the important characteristics of a good graft?

A

healthy donor site on to healthy vascular wound
defatting tissue with minimal handling
good graft adherence with good apposition
needs to be immobilized
graft needs to touch all surfaces

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15
Q

How does a graft stay alive initially?

A

vessels in skin still draw out nutrient from the wound bed via osmosis.

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16
Q

Three I’s of graft survival

A
  • plasmatic imbition (graft takin gup oxygen and nutrients from wound bed)
  • Inosculation (open blood vessels on graft meet with those in tissue)
  • Direct vessel ingrowth from wound to the graft
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17
Q

Three I’s of graft survival

A
  • plasmatic imbition (graft takin gup oxygen and nutrients from wound bed)
  • Inosculation (open blood vessels on graft meet with those in tissue)
  • Direct vessel ingrowth from wound to the graft
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18
Q

What is a full thickness graft?

A

epidermis still attached to dermis. - require microvascular anatomosis

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19
Q

What is a split thickness graft?

A

epidermis and part of the dermis. Skin will grow back in donor site so you don’t need to completely close it. Less cosmetic since hair comes from dermis.

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20
Q

How do you implant punch/pinch grafts?

A

cut holes in granulation tissue and implant them

21
Q

if an animal bleeds during surgery what does it do to the tissues? 5

A

irritates them and prevents copatation of wound edges. delays healing, encourages infection. promotes adhesions.

22
Q

What is primary vs secondary and intermediate hemorrhage? what causes each?

A

primary is immediate bleeding during surgery.
immediate is within 24 hrs after surgery.
secondary is after that. often caused by ineffective treatment of primary bleeding OR restoration of normal blood pressure after surgery is over.

23
Q

What is primary vs secondary and intermediate hemorrhage? what causes each?

A

primary is immediate bleeding during surgery.
immediate is within 24 hrs after surgery.
secondary is after that. often caused by ineffective treatment of primary bleeding OR restoration of normal blood pressure after surgery is over.

24
Q

How do you deal with a primary hemorrhage in surgery?

A

gentle digital pressure while you enlarge incision to improve visibility. then you can also lavage or have an assistant aid to make visibility even better

25
Q

How can you stop superficial bleeds?

A

put pressure with a gauze for several minutes. compress, don’t wipe.

26
Q

How can you stop superficial bleeds?

A

put pressure with a gauze for several minutes. compress, don’t wipe.

27
Q

When is it appropriate to use hemostats to stop bleeding?

A

when you do not need to save the vessel. The crushing will activate clotting. Larger vessels require a proper ligation.

28
Q

which way do you point hemostats for small bleeds? large bleeds?

A

small point towards (use tip), large away (use jaw).

29
Q

When selecting a vascular clip, how do you decide a size?

A

diameter of vessel should be 1-2/3 the length of the clip.

30
Q

What are the advantages and disadvantages of using ligatures instead of clips?

A

ligatures are more secure but take longer to place - usually preferred for large vessels.

31
Q

What are the advantages and disadvantages of using ligatures instead of clips?

A

ligatures are more secure but take longer to place - usually preferred for large vessels.

32
Q

For what sized vessels can you use cautery??

A

arteries up to 1mm, veins up to 2mm

33
Q

What is the risk of using mono polar cautery?

A

risk of distant burns due to current taking alternate pathway to ground plate

34
Q

What must you keep in mind using bipolar cautery?

A

don’t let tips touch or it will short circuit.

35
Q

Why is bipolar cautery advantageous?

A

less current needed and less risk of injury to surrounding tissue as there are no pathway burns. Also works in a wet field and very precise.

36
Q

Is cautery as secure as ligation?

A

no, can cause secondary hemorrhage and its associated problems (increased infection, delayed healing)

37
Q

What is ligasure? what is the max vessel size?

A

a biolar vessal sealing device that measures vessel and adjusts current accordingly. can be used up to 7mm diameter vessels

38
Q

When would you use gel foam?

A

diffuse low level bleeds like liver biopsy - can potentiate infection so use sparingly.

39
Q

When would you use gel foam?

A

diffuse low level bleeds like liver biopsy - can potentiate infection so use sparingly.

40
Q

How do you use bone wax?

A

to stop bleeding from cancellous bone but only for surgery since it traps in bacteria

41
Q

Why do we want to avoid dead space?

A 
slows healing (impedes fibrin bridge and compromised blood supply)
increased risk of infection - seroma has nutrients that attract them
42
Q

How can we minimize dead space?

A

mayo dissection
careful technique
don’t remove fat

43
Q

How can we manage dead space?

A

layered wound closure
tacking suture
compression bandages
drainage

44
Q

How can we manage dead space?

A

layered wound closure
tacking suture
compression bandages
drainage

45
Q

How do passive drains remove fluid?

A

capillary action + gravity and or pressure gradients.

46
Q

How do active drains work?

A

use suction to remove fluid

47
Q

What is omentalization?

A

using the omentum as a natural drain

48
Q

What are the advantages to a vacuum assisted closure?

A

pressure stimulates angiogenesis and granulation tissue. Also greatly deduces microorganisms. Also controls dead space.

Surgical Skills (4 decks)

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