EXAM I Basic Surgical Principles Flashcards
developing a surgical diagnosis is a culmination of what 6 diagnostic steps?
- signs
- symptoms
- relevant history
- patient data
- scientific data
- logical reasoning and experience
you should never accept a diagnosis in which 3 cases?
- diagnosis made by another individual
- diganosis made using poor radiographs
- diagnosis made with inaccurate information
what are 7 basic necessities for surgery?
- adequate lighting
- adequate access
- adequate visibility
- appropriate patient positioning
- assistance
- surgical field free from blood
- aseptic technique
when making an incision, what kind of stroke should you use?
firm, continuous stroke, with the blade held perpendicular to the epithelial surface
when making an incision, what should you avoid?
injuring vital strucures, such as nerves, vessels, lips, adjacent tissues, etc.
what are halstead’s principles (7)?
- gentle handling of tissue
- meticulous hemostasis
- preservation of blood supply
- strict aseptic technique
- minimum tension on tissues
- accurate tissue apposition
- obliteration of dead-space
to avoid flap necrosis, the apex of the flap should never be ___ than the base. what are the exceptions?
- wider
- unless a major artery or other major structure is present
a flap should always converge from the ___ to the ___, or parallel if required due to ___
- base to the apex
- major structures
to prevent flap necrosis, the ___ should be no more than twice the ___ of the base
length, width
ideally, the base is greater than the lengh
is axial blood at the apex or the base of the flap?
base
because axial blood supply is at the base of the flap, the base should be handled with care to avoid what?
twisting, stretching, or injury to the blood supply
what is a possible complication with button hole flaps?
you can get an area of necrosis coronal to the flap, in the area where blood supply has been cut off by the button hole
to avoid flap dehiscence, incisions must be made over ___
intact bone
to avoid flap dehiscence, if the pathological condition has eroded the buccocortical plate, the incision must be ___mm away from it
6-8
to avoid flap dehiscence, the incision must be ___mm away from the bony defect created by surgery
6-8mm
gentle handling of flap edges and avoiding placing flap under tension can help avoid flap ___
dehiscence
to avoid flap dehiscence, you should never cross ___ if possible
bony prominences (like the canine eminence)
T or F:
short incisions heal faster than long incisions
false
if properly repaired, a long incision will heal just as quickly as a short one
what can you do at the beginning of surgery to avoid flap tearing?
create a flap at the onset of the surgery that is large enough for the surgeon to avoid tearing it or interrupting surgery to lengthen it
what are the 3 main types of mucoperiosteal flaps?
- envelope/sulcular incision
- envelope with one releasing incision (3-corner flap)
- envelope with two releasing incisions (4-corner flap)
in creating a standard envelope flap with no releasing incisions, how many teeth should be anterior and posterior to the tooth being worked on? where is it placed in an edentulous arch?
- 1 tooth posterior and 2 teeth anterior to the one being worked on
- in an edentulous arch, it should be placed at the crest of the ridge
in creating an envelope flap with 1 vertical releasing incision, how many teeth should be anterior and posterior to the tooth being worked on?
1 tooth anterior and 1 posterior
in creating an envelope flap with 2 releasing incisions, how many teeth should be anterior and posterior to the tooth being worked on?
1 anterior and 1 posterior
it is important to handle tissue carefully during surgical procedures. what are some things that can damage tissues?
excessive pulling, crushing, extremes of temperature, desiccation, or chemicals
what type of tissue forceps are good for delicate manipulation of tissues?
toothed forceps or tissue hooks
to avoid tissue damage, you should use copious irrigation when ___
cutting bone
patients whose tissue has been handled gently and physiologically will experience wounds that heal with less frequenty ___
complications
what are some issues caused by uncontrolled bleeding?
- decreased visibility
- hematomas
- decreased vascularity
- wound dehiscence
- infection
what are some things you can do to promote wound hemostasis?
- natural hemostatic methods
- gauze (dab) and pressure
- heat
- electrocautery
- suture ligation
- hemostatic agents
- vasoconstrictive substance
what is a concern with dead space?
it will usually fill with blood, resulting in a hematoma
what are some ways to prevent dead space?
- suture tissue planes together
- direct pressure
- packing the surgical site
- drains
when assessing a patient for oral surgery, what are some important general health concerns that can affect the surgery?
- conditions that establish a catabolic state of metabolism, that impeded oxygen or nutrient delivery to tissues, or that require administration of drugs or physical agents that interfere with immunologic or wound-healing cells
- uncontrolled diabetes
- end-stage renal or hepatic disease
- malignant diseases
- severe COPD
- poorly compensated congestive heart failure
- drug addictions such as ethanolism (alcoholism)
- medications
- long-term corticosteroid therapy, malignancies, cytotoxic agents, and irradiation
