Exam 2: Lecture 14: Case Study: Wounds and Suture knowledge Case Presentation Flashcards
Why should you not use “claims” in a medical record?
-Claims can imply that you do not believe them or are questioning their integrity
When you palpate “Ginger” you notice a hernia and explain to the owner the surgeon needs to be called and “Ginger” will need to go back in too have it repaired, what should you do next before you leave?
-Place a supportive belly wrap on Ginger to keep the hernia reduced, preventing strangulation, and advise the owner to take her to her vet very 1st thing in the morning
Before you can place the bandage, Ginger starts heaving like she needs to vomit, what is your concern?
-Vomiting involves an increase in intra-abdominal pressure so it is putting pressure on an already compromised abdominal wall
Ginger vomits, rips her stitches, and has intestines laying on the kitchen table -> how do you adjust your previous treatment plan of applying a belly wrap?
-Gently replace as much of the intestines as will easily go back in, place a large sterile Telfa pad over the exposed intestines, place a very light wrap around her “tummy” and take her to your practice for emergency surgery
During emergency surgery, you notice the practitioner who performed the ovariohysterectomy used chromic gut suture to close the abdominal wall - is this normal?
-Not anymore (we know better now)
What do you do in surgery to “fix” what’s going on with Ginger?
-Slightly extend her abdominal incision
-Perform copious warm sterile isotonic saline lavage, “freshen” the edges of the incision & reclose the incision
What are the considerations for suture selection?
-Length of time the suture will be required to help strengthen the wound or tissue
-Risk of infection
-Effect of the suture material on wound healing
-Dimension & strength of the suture required
What layers need to be closed during abdominal wall closure?
-Linea alba
-Subcutaneous
-Subcuticular
-Skin
How do you suture the linea alba?
-Sutures placed in External Rectus Sheath
-Simple continuous (does NOT increase risk of dehiscence)
-Interrupted
-Slowly absorbable, monofilament suture, cutting/reverse cutting needle
What would be the benefit to using simple continuous suture pattern?
-Less suture material
-Faster
-Rapid closure
-Secure knots (6 throws = 3 square knots at each end of the suture line)
How do you suture the subcutaneous?
-Simple continuous
-Little to no holding strength
-Leave a small pocket at each end to facilitate burial of the knots at each end of the subcuticular closure
-Monofilament suture, absorbable, taper needle
How do you suture the subcuticular?
-Simple continuous
-Monofilament suture, absorbable, cutting/reverse cutting needle
What could you replace the 3 square-knots with at the end of your simple continuous suture pattern?
-Aberdeen Knot
What are things to consider when making decisions about closing the skin?
-Do you want to close the skin?
-What method do you want to use?
-What suture and pattern do you want to use?
-Patient personality/behavior
-Owner compliance
-Ability to follow-up on the case
-Who will remove what you put in?
What suture should be used to close the skin?
-Monofilament, nonabsorbable, cutting/reverse cutting needle
