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Surgical Skills > Dave Practice Q's > Flashcards

Dave Practice Q's Flashcards

1
Q

Superficial Fascia contents

A

cutaneous nerves and superficial venous system

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2
Q

Deep Fascia contents

A

muscles/tendons, arteries, deep veins, and nerves

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3
Q

periosteum (3rd dissection interval)

A

cartilage

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4
Q

Target tissue in surgery is what?

A

Bone (5th surgical layer)

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5
Q

Exception with Digital Anatomy (concerning surgical layers)

A

All neurovascular elements are in the superficial fascia

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6
Q

Target tissue in HAV surgery

A

1st MT head and Proximal phalanx base

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7
Q

Incision for HAV surgery

A

Dorsomedial incision centered over shafts of 1st MT and Hallux proximal phalanx, between medial eminence and EHL tendon

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8
Q

Target tissue in digital procedure

A

Head of the proximal phalanx

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9
Q

Joint capsule closure

A

Absorbable suture, interrupted cruciate 2-0 or 3-0 Vicryl

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10
Q

Which suture technique offers the most eversion of the skin edges?

A

Vertical Mattress interrupted suture

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11
Q

Deep fascia closure

A

2-0 or 3-0 Vicryl cruciate

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12
Q

Superficial fascia closure

A

buried interrupted (3-0 ir 4-0 Vicryl)

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13
Q

What is the hyponychium?

A

distal free edge of the nail

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14
Q

eponychium

A

aka cuticle, proximal skin fold on nail

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15
Q

Nail Matrix Borders

A
  • Distal= lunula
  • proximal= distal portion of the extensor ridge
  • med/lat= lateral condyles of distal phalanx
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16
Q

When would a total nail avulsion procedure be appropriate?

A

nail pathology greater than 50% of the nail

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17
Q

When is phenol contraindicated in nail surgery? what is the alternative?

A

During acute infection, dont use phenol–> do a cold steel matrixectomy (15 blade)

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18
Q

Acisional nail procedures

A
  1. Partial nail avulsion
  2. Bottlecap nail avulsion
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19
Q

Incisional nail procedures

A
  1. Winograd
  2. Frost
  3. Zadik
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20
Q

When is the Winograd procedure used?

A

In pediatric patients or if there is hypergranular tissue

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21
Q

What is the advantage of the Frost procedure?

A

allows visualization of the nail matrix via proximal incision

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22
Q

When is a Zadik procedure appropriate?

A

For better matrix visualization during a permanent total nail avulsion

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23
Q

Post-Op for partial nail avulsion

A

1st day post-op, start soaking in epsom salt and warm water for 20min 3x a day

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24
Q

Post-op for total nail avulsion

A

NO SOAKING! Keep bandage clean/dry/intact

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25
Q

Overdrill

A

same size as the screw thread diameter, thru proximal cortex only Glide Hole

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26
Q

Underdrill

A

Thread Hole smaller than screw diameter, thru the near and far cortices **Use a drill guide to stay coaxial to the glide hole**

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27
Q

Countersinking

A

increases the surface contact area for the screw head, and makes the head less prominent (which would cause soft tissue irritation)

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28
Q

Measure

A

Using a depth gauge to determine screw length for drill hole ALWAYS after countersinking, because that step will remove some bone

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29
Q

Tapping

A

cuts the thread pattern for the screw, use the 2 forward 1 back technique

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30
Q

Screw

A

Always the last step, tighten to 2 finger tightness only

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31
Q

What are the 4 AO principles?

A
  1. Fracture reduction and fixation to restore anatomical relationships
  2. Stability by fixation or splintage, as the personality of the fracture or injury requires
  3. Preservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques
  4. Early and safe mobilization of the part and the patient
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32
Q

Why do we fixate fractures/osteotomies?

A

Lack of motion is osteogenic, not compression!

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33
Q

What are the 2 components of interfragmentary compression?

A
  1. holding the near fragment with the screw head
  2. grabbing and pulling the far fragment with the screw threads
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34
Q

Screw sizes in mini-frag set

A

1.5, 2.0, 2.7

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35
Q

Screw sizes in small frag set

A

3.5 and 4.0

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36
Q

Screw sizes in large frag set

A

4.5 and 6.0

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37
Q

What are the 3 stabilization rules?

A
  1. Screw fixation
  2. Plate stability
  3. Vassals Rule
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38
Q

Screw fixation

A

Resistance of screws to tear-out depends on screw diameter, length of screw thread gripping bone, and bone strength At least 3 active screw threads are needed to maintain resistance to dislodgment

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39
Q

Plate stability

A

3 or 4 cortical threads in each main fragment distally, and 5-6 cortical threads proximally

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40
Q

Vassal’s Rule

A

Reduce/fixate the dominant fracture first

41
Q

What is the pitch of a cortical screw?

A

1.25 mm

42
Q

What is the pitch on a cancellous screw?

A

1.75 mm

43
Q

AO interfrag technique order

A
  • overdrill
  • underdrill
  • countersink
  • measure
  • tap
  • screw
44
Q

Reasons for post-op bandaging

A
  1. Maintain a sterile OR environment
  2. Protect the surgical site from contamination
  3. Hold reconstructive positioning
  4. Compression against edema and inflammation
  5. Cushioning and protecting bony prominences
  6. Wick moisture and drainage
  7. remind patient that they just had surgery, and to take care of the area
  8. only thing the patient sees post-op, so make it pretty
45
Q

what are the 3 non-adherent bandaging materials?

A
  • Xeroform
  • Adaptic
  • Mepitel
46
Q

Xeroform details

A

occlusive petroleum gauze,

active ingredient is Bismuth

47
Q

Adaptic details

A

knitted cellulose acetate mesh,

impregnated with petrolatum emulsion

48
Q

Hammertoe surgery,

post-op bandaging

A
  • MPJ in PF
  • 1st PIPJ and DIPJ held in neutral/extended positions
49
Q

HAV positioning with bandaging

A
  • 1st MPJ PF and Adducted,
  • IPJ neutral/extended
50
Q

5th digit surgery positioning/bandaging

A

move toe out of varus (nail facing straight up) and level with 4th toe in the sagittal plane

51
Q

Suture for joint capsule closure

A

2-0 or 3-0 Vicryl

52
Q

Suture for Subcutaneous closure

A

3-0 or 4-0 vicryl

53
Q

Skin closure

A

4-0 Nylon or Prolene

54
Q

Surgical instruments are made of what material?

A

Stainless steel

55
Q

what are the components of stainless steel

A
  • Carbon,
  • Chromium,
  • Tungsten carbide,
  • Nickel,
  • Molybdenum
56
Q

what 3 functions do the surgeon’s hands perform when using power instrumentation?

A
  1. Control of power,
  2. Control of direction, and
  3. Stability between the instrument and the surgical site
57
Q

What are the natural-absorbable suture materials?

A

Pig collagen, sheep intestine, cow intestine, and cat gut

58
Q

What are the synthetic-absorbable suture materials?

A

“DPM MV” - “DPM Motor Vehicle”

  • Dexon
  • PDS
  • Maxon
  • Monocril
  • Vicryl
59
Q

Vicryl specifics

(polyglactin 910)

A

braided synthetic absorbable suture
65% strength in 14 days
hydrolyzed in 80-120 days

60
Q

Rapid Vicryl

(polyglactin 910)

A

hydrolyzed in 42 days

61
Q

Vicryl Plus

(polyglactin 910)

A

coated w/ Triclosan, which is a broad-spec antibiotic

62
Q

Dexon

(Polyglycolic acid)

A

braided, synthetic absorbable suture
hydrolyzed in 100-200 days

63
Q

PDS

(Polydiaxonone)

A

monofilament synthetic absorbable suture
70% strength in 14 days,

hydrolyzed in 90 days

64
Q

Maxon

(polyglyconate)

A

monofilament synthetic absorbable suture
Hydrolyzed in 180 days
*LONGEST LASTING SUTURE

65
Q

Monocril

(Poliglecaprone)

A

monofilament synthetic absorbable suture
20-30% strength in 14 days,

hydrolyzed in 90-120 days

66
Q

Non-absorbable suture is for what?

A

Superficial closure (skin)

67
Q

Non-absorbable suture (natural)

A

Silk- low tensile strength
Cotton/Linen= *WEAKEST suture material

68
Q

Non-absorbable synthetic suture types

A
  • Nylon
  • Polypropylene
  • Polyester
  • Fiberwire
  • Stainless steel
69
Q

Nylon suture (Ethilon, Surgilon)

A

monofilament non-absorbable synthetic
*HIGHEST KNOT SLIPPAGE

70
Q

Polypropylene

(Prolene, Surgilene)

A

Monofilament non-absorbable synthetic
Best suture for infected wound
*Least reactive suture material

71
Q

Polyester

(Ethibond, Dacron)

A

braided non-absorbable synthetic
strong suture material, good for tendon repair
can be coated w/ silicone

72
Q

Fiberwire

(polyethylene)

A

multifilament non-absorbable synthetic

polyethylene multifilament core with a braided polyester jacket

Commonly used in orthopedics.

73
Q

Stainless steel suture

(braided is called Flexon)

A

monofilament or braided, non-absorbable synthetic
**STRONGEST suture w/ longest absorption rate

Used for bone fixation and tendon repair, but may corrode bone at stress points

74
Q

How do you prevent thermal necrosis during screw insertion?

A
  • Sharp tip
  • fast advancement (2-3mm/sec)
  • slow drill speed (300-400rpm)
  • firm force (20-25 lbs)
75
Q

What is the weakest portion of a screw?

A

run-out:

or the region where the threads stop and the shank begins

76
Q

where are cortical screws used?

A

hard cortical bone

77
Q

where are cancellous screws used?

A

metaphyseal and epiphyseal bone

78
Q

Surgical layers of dissection

A
  • Skin
  • Superficial fascia
  • Deep fascia
  • Periosteum
  • Bone
79
Q

1st Dissection interval

A

Between superficial fascia and deep fascia
–cutaneous nerve and superficial venous system

80
Q

2nd dissection interval

A

Between deep fascia and periosteum

81
Q

3rd dissection interval

A

between periosteum and bone
- raise the deep fascia and periosteum as a single layer to expose the osseous structure of the head of metatarsal

82
Q

Tips for skin incisions

A
  • Tension on skin on either side of planned incision
  • Vertical incision perpendicular to the skin, w/o skiving
  • Tip-Belly-Tip Technique
83
Q

What is the screw-driver handle made of?

A

PRESSED LINEN

84
Q

tourniquet materials

A
  • 3-5 layers of Webril
  • Tourniquet
  • 10-10 Drape
  • Esmarch –> exsanguination
  • Sterile Blue towel and towel clamp
85
Q

Tourniquet application tips

A
  • make sure tubes pointing proximally
  • pull tight and make sure to tie red ribbon as proximal as possible
  • Next place 10-10 drape over tourniquet
  • Go and Scrub, come back and ask for a towel and clamp
86
Q

What are the potential connections between the medial and central plantar compartments?

A

FHL tendon,

PL tendon,

Adductor Hallucis, and

medial plantar neurovasculature

87
Q

The lateral extensile approach for ORIF of calcaneal fractures should lie at the junction of which 2 angiosomes?

A

Peroneal angiosome and posterior tibial angiosome

88
Q

What knot “locks in tension” when tying the surgeon’s knot?

A

square knot

89
Q

Materials needed for injection, besides needle/syringe:

A
  • 4x4 gauze
  • Band-aid
  • Ethyl Chloride
90
Q

What makes an injection painful?

A
  • substance being injected
  • gauge of the needle
  • size of the syringe (back pressure)
  • rate of injection
  • site of injection
91
Q

What is the consensus in regard to epinephrine use in digital blocks?

A

epinephrine is safe in digital block
Useful in causing vasoconstriction to reduce bleeding, and keep the anesthetic localized to region of injection

92
Q

Lidocaine toxic dose

A

Plain= 300mg
w/ Epi= 500mg

93
Q

Marcaine toxic dose

A

plain= 175mg
w/ epi= 225mg

94
Q

Patient with a history of allergy to amino amides (Lidocaine),

what do you give them?

A

Amino-ester such as Procaine, Tetracaine, etc

95
Q

What gauge needle is used to draw up for an injection?

A

18 gauge

96
Q

Hallux block

A

3-5cc of anesthetic

97
Q

Digital block

A

1-3cc of anesthetic

98
Q

Mayo Block

A

8-10 cc of anesthetic

99
Q

Ankle block

A

10-15cc of anesthetic

Surgical Skills (5 decks)

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