Ch 17 - Instrument and Tissue Handling Flashcards

1
Q

List Halsted’s Principles

A
  • Gentle tissue handling
  • Meticulous haemostasis
  • Strict aseptic technique
  • Preserve blood supply
  • Eliminate dead space
  • Accurate tissue apposition
  • Eliminate tension

Giant Horses Aren’t Bred Due To Teeth

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2
Q

What grips are acceptable for scaple handles?

A
  • Fingertip grip - Places maximum length of blade in contact with the tissue. Offers greatest accuracy and stability
  • Pencil grip - Uses finger motion, more accurate for short and delicate maneuvers
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3
Q

What are the 4 motions of a scapel?

A
  • Sliding - precise depth, length and control of direction
  • Pressing - stab incisions into a chamber
  • Sawing - continuation of a cut without removal and reinsertions of the blade ie. pedicle cut
  • Scraping - seperating tissue layers
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4
Q

What forces are used when cutting with scissors?
What grip is recommended?

A
  • Closing
  • Shearing
  • Torque

Tripod grip (thumb-ring finger) - provides maximal control

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5
Q

What are the benefits of curved and straight scissors?

A
  • Curved - greater maneuverability and visibility
  • Straight - greater mechanical advantage for cutting dense tissue
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6
Q

What part of the scissors should be used to cut and why?

A

Close to the tips

Cutting near the fulcrum results in greater crushing, injury to the tissue, jagged incisions and potential inadvertent trauma

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7
Q

What are the recommended suture tag lengths?

A

Synthetic material - 3mm
Surgical gut material - 6mm

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8
Q

What are the 4 acceptable grips for needle holders?

A
  • Tripod - fast grasping and release, good for delicate work
  • Thenar grip - Saves time during continuous patterns but needle release is less precise
  • Palmed - strongest, provides greatest needle pressure and control in dense tissue and maximal wrist rotation. Needle release and grasping requires adjusting
  • Pencil grip - For spring handles in ophtho surgeries
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9
Q

What are the 2 clamping techniques for haemostats?

A
  • Tip-clamping - haemostats with transversely oriented serrations. Tip pointing down towards the vessel tip
  • Jaw clamping - Haemostats with longitudinally orientated serrations (Rochester-Carmalts). Designed to grasp larger amounts of tissue with the tips pointing away. Facilitates ligature placement but causes increased tissue trauma
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10
Q

What are the 2 options of gripping a haemostat?

A
  • Tripod grip
  • Palmed grip - for removing a haemostat with your nondominant hand
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11
Q

What is a common hazard of self-retaining retractors?

A

Ischaemia at the pressure points

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12
Q

Name the three main types of suction tips

A
  • Poole
  • Frazier
  • Yankauer
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13
Q

What is considered ideal dissection technique?

A

Bloodless and precise dissection, causing minimal complications, including seroma and haematoma incidence

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14
Q

What are the characteristics of an ideal closure technique?

A
  • Maintains tensile strength throughout healing
  • Technically quick and simple
  • Precise wound edge approximation
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15
Q

Name these interrupted suture patterns and state whether they are apposition, everting or inverting

A

A - Simple interrupted (appositional)
B - Modified Gambee - Appositional
C - Horizontal mattress (everting)
D - Vertical mattress (appositional)
E - Cruciate (appositional)
F - Lempert (inverting)

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16
Q

Name the continuous suture patterns and state if they are appositional, inverting or everting

A

A - Simple continuous (appositional/everting)
B - Fords interlocking (appositional)
C - Continuous horizontal mattress (everting)
D - Purse-string (inverting)
E - Cushing - (inverting)
F - Connell - (inverting)
G - Continuous lembert - (inverting)

17
Q

How many throws is considered gold standard?

A

5 throw square knot

Require 2-3 additional throws at the end of a continuous pattern

18
Q

What are the 5 principles of knot tying?

A
  • The simplest secure knot for the suture material and the situation is the goal
  • Avoid friction between strands as suture weakening may occur
  • Use appropriate tension
  • Pull the 2 suture ends in opposite directions with uniform rate and horizontal tension
  • Never apply needle holder to any suture which is going to remain in the patient

Simple Facts Test Hot Heads

19
Q

What is the weakest point of the suture line?

A

The knot

Synthetic absorbable sutures tend to have a relative knot security of 67% (deined as the knot-holding capacity in percent of the tensile strength of the suture. Ranges from 51-92%)

20
Q

Name three types of circumferential knots which are useful on vascular pedicles

A
  • Modified millers knot
  • Constrictor knot
  • Strangle knot
21
Q

Name the 3 main types of transfixation ligatures

A
  • Halstead transfixation ligature
  • Modified transfixation ligature
  • Figure-of-eight