Chapter 12 - Surgical techniques Flashcards
A) The surgeon’s hand is stretched out to the assistant, indicating the need for a clamping instrument. (
B) The surgeon requests scissors by the repeated motion of the index and middle fingers in a back and forth cutting action
C) By pronating the hand back and forth with the tips of thumb, index, and middle fingers together, the need for a scalpel is signaled.
(D) By pronating the hand and making a grasping motion with the index and thumb, the surgeon indicates the request for a thumb forceps. (
E) The needle holder with mounted needle is requested by performing a rotating wrist movement with closed hand.
F) By showing a pronated motionless open hand, the surgeon indicates the need for a free tie ligature suture.
G) Using a peaked hand and a dipping movement, the surgeon requests the need for surgical sponges. (
(H) The surgeon signals for a right-angle clamp by a motionless thumb and index finger in a clawed position.
I) By making a pronated outstretched hand, the surgeon indicates the need for a retractor
J) By pronating the open hand and spreading the fingers, the surgeon requests a wound spreader.
(I) By making a pronated outstretched hand, the surgeon indicates the need for a retractor.
(J) By pronating the open hand and spreading the fingers, the surgeon requests a wound spreader.
A) In this scenario, one loose strand is held horizontally and the other vertically; it is the latter that will be cut by the assistant.
What are the “Halsted Principles” primarily aimed at minimizing?
A) Surgical costs B) Surgical site infections C) Tissue trauma and blood loss D) Patient discomfort
C) Tissue trauma and blood loss
What type of incision technique is most commonly associated with a scalpel?
A) Blunt dissection B) Laser incision C) Steel scalpel incision D) Electrosurgical incision
C) Steel scalpel incision
In terms of grip techniques, which grip is most effective for precise cuts with a scalpel?
A) Palm grip B) Pencil grip C) Finger grip D) Tripod grip
B) Pencil grip
Which scalpel grip is best suited for long, straight incisions?
A) Pencil grip B) Palm grip C) Fingertip grip D) Tripod grip
C) Fingertip grip
Which grip is commonly used to hold operating scissors?
A) Palm grip B) Tripod grip C) Fingertip grip D) Pencil grip
B) Tripod grip
Which grip provides stability for cutting with scissors?
A) Pencil grip B) Fingertip grip C) Tripod grip D) Palm grip
C) Tripod grip
The fingertip grip for holding a surgical scalpel.
The palm grip for holding a surgical scalpel.
The palm grip of a needle holder.
Figure 12-10. The thenar grip of a needle holder.
Figure 12-11. Proper technique for holding and using thumb forceps
Figure 12-12. Several mosquito forceps are held in the surgeon’s palm, allowing effective sequential application to a number of vessels.
Figure 12-13. Stabilizing and stretching the skin between the thumb and index finger facilitates incision of the skin.
Figure 12-14. Skin incisions. Correctly performed incision (a). Timid slide cutting resulted in jagged incision edges (b). Slide cutting with a sideways-angled blade resulting in an obliquely angled skin incision (c).
VetBooks
Figure 12-15. Stab or press cutting into a hollow organ.
Figure 12-16. Bumper cutting into a structure elevated and stretched between two Allis forceps.
Figure 12-17. The technique of inverted-blade press cutting facilitates blade control.
Figure 12-19. Circumferential (A) and transfixation (B) ligatures.
Figure 12-25. Proper technique for holding a curette.
In which situation should thumb forceps be used to minimize tissue trauma?
A) Grasping heavy tissue B) Closing superficial layers C) Holding needles during suturing D) Applying pressure to major vessels
B) Closing superficial layers
Which type of thumb forceps generates the least tissue trauma?
A) Sponge forceps B) Rat-toothed forceps C) Tree frog-inspired forceps D) Allis forceps
C) Tree frog-inspired forceps
What is the preferred method for controlling hemorrhage in small vessels?
A) Direct pressure with gauze B) Mechanical clamping C) Chemical cautery D) Suture ligation
A) Direct pressure with gauze
When should a stab incision technique be used?
A) For incisions in thick skin B) To enter hollow structures under tension C) For superficial skin incisions D) To transect muscle tissue
B) To enter hollow structures under tension
Which technique is effective for excising neoplastic tissues?
A) Electro-surgery B) Blunt dissection C) Slide cutting with a scalpel D) Scissor dissection
C) Slide cutting with a scalpel
What is a significant disadvantage of electrosurgical incisions compared to scalpel incisions?
A) Increased blood loss B) Increased thermal necrosis at wound edges C) Decreased cutting speed D) Poor depth control
B) Increased thermal necrosis at wound edges
What type of suture material is generally preferred for larger vessels during ligation?
A) Non-absorbable sutures B) Absorbable sutures C) Silk sutures D) Monofilament sutures
B) Absorbable sutures
What type of forceps should be applied to surface bleeders?
A) Ochsner forceps B) Mosquito forceps C) Allis forceps D) Carmalt forceps
B) Mosquito forceps
What is a potential outcome of not adequately cleaning the electrosurgical electrode?
A) Enhanced cutting performance B) Increased thermal necrosis C) Reduced need for ligatures D) Improved depth control
B) Increased thermal necrosis
What is the typical material used for needle holder jaws to enhance grip?
A) Titanium B) Stainless steel C) Plastic D) Aluminum
B) Stainless steel
What is the primary function of vascular staples?
A) Ligate large vessels B) Occlude vessels up to 7 mm in diameter C) Repair soft tissue lacerations D) Assist in bone fusion
B) Occlude vessels up to 7 mm in diameter
What is a significant advantage of using the Ligate and Divide Stapler (LD S)?
A) Reduces risk of infection B) Increases blood flow C) Saves time in extensive intestinal resections D) Eliminates the need for sutures
C) Saves time in extensive intestinal resections
When managing lateral wall defects in large vessels, what is recommended?
A) Use of vascular staples B) Suture closure incorporating tunica adventitia and media C) Electrocoagulation D) Cryogenic hemostasis
B) Suture closure incorporating tunica adventitia and media
What type of suture material is typically recommended for suturing large vessel defects?
A) 2-0 to 3-0 B) 4-0 to 6-0 C) 7-0 to 10-0 D) Non-absorbable only
B) 4-0 to 6-0
In a case of vessel laceration parallel to its length, what type of closure is advised?
A) Simple interrupted pattern B) Continuous suture pattern C) Closure perpendicular to the long axis D) Closure with staples
C) Closure perpendicular to the long axis
What should be done for tourniquets used longer than 30 minutes?
A) Fully deflate the cuff B) Partially deflate for 5 minutes C) Leave inflated D) Increase pressure
B) Partially deflate for 5 minutes
Which method of hemostasis uses electrocoagulation?
A) Direct vessel ligation B) Obliterative coagulation C) Chemical application D) Thermal freezing
B) Obliterative coagulation
What is the advantage of coaptive coagulation in vessel sealing?
A) Faster healing B) Better visibility C) Precise electrocoagulation D) Lower cost
C) Precise electrocoagulation
What type of hemostatic technique involves rapid freezing?
A) Electrocoagulation B) Cryogenic hemostasis C) Chemical cauterization D) Tourniquet application
B) Cryogenic hemostasis
What solution concentration of epinephrine is effective for controlling superficial bleeding?
A) 1:10,000 to 1:5,000 B) 1:50,000 to 1:20,000 C) 1:100,000 to 1:20,000 D) 1:200,000 to 1:50,000
C) 1:100,000 to 1:20,000
What is the mechanism of action of buffered formalin in controlling diffuse bleeding?
A) Direct vasoconstriction B) Induction of coagulation on endothelial cells C) Promotion of clotting factor synthesis D) Antibacterial action
B) Induction of coagulation on endothelial cells
What is the purpose of antifibrinolytic lysine analogues like ε-aminocaproic acid?
A) To promote clot breakdown B) To enhance blood flow C) To prevent hemorrhage by inhibiting clot breakdown D) To induce vasodilation
C) To prevent hemorrhage by inhibiting clot breakdown
What are soluble sponge materials primarily used for in hemostasis?
A) Blood volume restoration B) Promoting clot formation C) Immediate wound closure D) Preventing infection
B) Promoting clot formation
How does bone wax control bleeding from bone?
A) Promoting bone healing B) Physically blocking oozing of blood C) Sealing soft tissues D) Inducing coagulation
B) Physically blocking oozing of blood
What is a common complication of prolonged tourniquet application?
A) Reduced visibility B) Nerve damage C) Excessive bleeding D) Increased surgical time
B) Nerve damage
What is the ideal method for achieving hemostasis in small vessels?
A) Direct pressure B) Suture ligation C) Electrocoagulation D) Application of hemostatic agents
C) Electrocoagulation
What type of suture pattern is recommended for large vessel repair?
A) Continuous B) Interrupted C) Simple mattress D) Both continuous and interrupted
D) Both continuous and interrupted
Which hemostatic agent is particularly effective for treating superficial bleeding?
A) Bone wax B) Electrocoagulation C) Epinephrine solution D) Cryogenic materials
C) Epinephrine solution
What is the primary risk associated with using chemical hemostatic agents?
A) Risk of allergic reaction B) Increased blood loss C) Delayed wound healing D) Tissue necrosis
D) Tissue necrosis
What is the key advantage of thermal hemostasis via electrocoagulation?
A) Reduces healing time B) Provides immediate hemostasis C) Requires no suturing D) Is cost-effective
B) Provides immediate hemostasis
What method is used to enhance visibility during surgical procedures?
A) Electrocoagulation B) Suction and irrigation C) Curettage D) Hemostasis
B) Suction and irrigation
What is a common complication of using soluble sponge materials in hemostasis?
A) Immediate hemostasis B) Delayed wound healing C) Enhanced blood flow D) Increased risk of infection
B) Delayed wound healing
How is bleeding from cortical bone typically controlled?
A) Ligatures B) Bone wax C) Electrocoagulation D) Sutures
B) Bone wax
What type of vessels can be effectively sealed with the LigaSure system?
A) Up to 5 mm B) Up to 7 mm C) Up to 10 mm D) Only small capillaries
B) Up to 7 mm
What is the function of the Frazier Ferguson suction tip?
A) Remove large volumes of fluid B) Provide controlled suction in confined areas C) Aid in coagulation D) Deliver medication
B) Provide controlled suction in confined areas
What is the role of the Esmarch bandage during surgery?
A) To close incisions B) To facilitate blood flow C) To occlude blood flow to the limb D) To support tissues
C) To occlude blood flow to the limb
What is a potential complication of using epinephrine for hemostasis?
A) Tissue necrosis B) Increased blood flow C) Enhanced visibility D) Improved healing
A) Tissue necrosis
How does electrothermal vessel sealing work?
A) By applying cold temperatures B) By using heat to fuse tissue C) By ligating vessels D) By applying sutures
B) By using heat to fuse tissue
Figure 12-21. Ligation of large bundles of tissues. (A) Divide and conquer technique. (B and C) Three-forceps technique. The third hemostat has been removed (arrow) and in its place a ligature is applied (B). The bundle is separated between the two remaining hemostats and ligatures are applied at the location of the hemostats or immediately adjacent to them (on the distant hemostat side relative to the division line) (C).
Figure 12-23. (A) An Esmarch bandage (a) and pneumatic tourniquet (b) used for occluding blood flow in a limb. (B) Application of an Esmarch bandage and a pneumatic tourniquet. Gauze rolls are placed over vascular pressure points under the tourniquet (arrow).
