Exam 2 Labs

Question 1

True or false: Extra ties add strength to a suture knot.

Answer 1

FALSE - however, more throws are needed with larger sized suture

Question 2

What is the minimum amount of throws needed for a secure knot?

Answer 2

4 throws (2 knots)

Question 3

How should tissue be apposed?

Answer 3

only appose like tissue - if unlike tissues are apposed, there will be a delay in healing +/- dishiscence

Question 4

Why is it important to close dead space?

Answer 4

minimizes the risk of seroma formation

Question 5

Why aren’t sutures placed too tight?

Answer 5

there is bound to be incision edge swelling after surgery

Question 6

What is a square knot?

Answer 6

2 simple throws applied in opposite directions using even tension on both strands of suture while tightening each throw
- secure = 2 square knots (4 throws)

Question 7

When is a surgeons knot used? How does it compare to the square knot? How is it done?

Answer 7

when there is tension on tissues

greater knot security (still not bulky) with an increased friction to keep it from slipping
- extra suture material can make it harder to tighten

double twist on first throw (suture wrapped around jaws of needle driver twice) followed by 2-3 square knots

Question 8

Where should the first and last bites be taken with respect to the incision?

Answer 8

3-5 mm away from edge of incision

Question 9

What are psychomotor skills?

Answer 9

movement tasks that require both cognitive and motor processes —> learned motor skills that are performed without conscious thought

Question 10

How are ringed instruments handled? Why?

Answer 10

wide-base tripod grip with thumb and ring finger in the rings up to the first knuckle and pointer finger along the shank

• increases stability
• balances instrument
• atraumatic tissue handling
• efficient suturing and securing knots

Question 11

Ringed instrument anatomy:

Answer 11

Question 12

How should suture needles be held by the needle drivers?

Answer 12

2/3 from point
1/3 from swagged end

Question 13

How should thumb forceps be handled?

Answer 13

pencil grip between thumb and pointer finger (+/- middle finger)

Question 14

How are thumb forceps help in the resting position?

Answer 14

“finger guns”

Question 15

What are the 2 ways to hold scalpel blade holders?

Answer 15

1. pencil grip - fine, short, precise incisions
2. fingertip/slide grip - long incisions

Question 16

How are scalpel handles armed?

Answer 16

Question 17

How are scalpel blades unarmed?

Answer 17

Question 18

What 4 things affect knot security?

Answer 18

1. size and suture material
2. length of cut ends (ears/tags)
3. quality of knot
4. knot and suture patter chosen

Question 19

Is a simple knot (1 throw) by itself secure?

Answer 19

NO - incomplete basic unit

Question 20

Surgical knot:

Answer 20

Question 21

What makes a secured knot?

Answer 21

placing a minimum of 2 additional simple throws on top of the initial knot (4 total throws)

Question 22

Why are hand ties important? What is a disadvantage compared to instrument tying?

Answer 22

useful in confined spaces where surgical tools cannot fit

uses more suture material

Question 23

How do 1 hand ties and 2 hand ties compare?

Answer 23

1 - useful in deep cavities and confined spaces

2 - allows for good control and accuracy, but can be difficult in confined spaces

Question 24

What is a half hitch knot?

Answer 24

AKA: slip knot

occurs when there is UNEVEN tension on suture strands when tightening the knot or when upward tension is applied to one strand

Question 25

What is a granny knot?

Answer 25

type of slip knot where a second throw is tightened in the same direction as the first throw resulting in poor knot security

Question 26

What are 2 possible causes of knot failure?

Answer 26

1. knots slip - poorly ties
2. suture breakage

(sutures tend to fail at the knot unless suture has been damaged)

Question 27

What are ligatures? In what 3 situations is this common?

Answer 27

suture is used to tie off (ligate) an anatomical structure to aid in hemostasis

1. ovarian pedicle (spay)
2. testicular pedicle (neuter)
3. ligation of blood vessels

Question 28

How does chance of ligature failing compare to the volume of tissue it encloses?

Answer 28

proportionally
- more tissue = higher chance to fail or slip

Question 29

What is the circumferential ligature? Where is it placed? When is it often performed?

Answer 29

suture is wrapped around vessel/pedicle and secured by tying a square or surgeons knot

placed PROXIMALLY on the pedicle (closest to the body)

in the “crush” of a clamp

Question 30

When is the transfixation/transfixing ligature used? Where is it typically placed?

Answer 30

larger vessels or pedicles - 2 steps, 2 knots

placed DISTALLY on the pedicle and DISTAL to circumferential ligature (further away from the body)

Question 31

Testicular ligation:

Answer 31

Question 32

In what 2 situations are friction knots helpful for ligatures? Why are they so commonly used? What are the main 2 examples?

Answer 32

1. fatty pedicles (spay) or pedicles under tension
2. vascular ligation (spay/neuter)

greater knot security compared to circumferential and transfixing ligatures

Miller’s and modified Miller’s knots

Question 33

Miller’s knot:

Answer 33

Question 34

Modified Miller’s knot:

Answer 34

AKA strangle knot

Question 35

What is a crush?

Answer 35

hemostat is placed on pedicle or vessel and used to crush tissue, then removed and replaced by ligature

Question 36

What is flashing?

Answer 36

hemostat is placed on a pedicle or vessel and then loosened while the first 2 thors of ligature are placed