Ch. 17 Instrument and Tissue Handling Flashcards
Halsted’s surgical principles
- handle tissue gently
- control hemorrhage meticulously
- observe strict aseptic technique
- preserve blood supply to tissues
- eliminate dead space
- appose tissues accurately with minimal tension
Why do Halsted mosquitos, Crile, or Kelly hemostat forceps have transversely oriented tissues?
They are designed to grasp small amounts of tissue with the tip of the forceps directed toward the open vessel
Why do Rochester-Carmalt forceps have longitudinally oriented serrations?
They are designed to grasp larger amounts of tissue
relationship of blood supply to wound tension
the blood supply in the wound edge is inversely proportional to the wound closure tension
Modified Gambee characteristics
appositional
used on intestines because it will lead to additional purchase in the submucosa and minimization of mucosal eversion
What is a far-far, near-near interrupted suture pattern?
Vertical mattress
appositional
What is a far-near, near-far interrupted suture pattern?
Lembert
it is inverting
Principles of knot tying - five tenets
- the simplest secure knot is the goal - minimize knot volume
- avoid friction between strands because suture weakening may result
- use appropriate tension when tying knots
- tie each not with uniform rate and horizontal tension on the suture ends
- avoid damage by never applying needle holders to any portion of the suture that is to remain in the patient
How is knot security related to friction and force?
Knot security is related to the coefficient of friction of the suture and represents the force required to cause a knot to slip
Net tensile strength is determined by the initial tensile strength of the suture and the knot security
What is relative knot security?
knot holding capacity in percent of the tensile strength of the suture
ranges from 51% to 92% but most absorbable monofilaments have 67%
