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Y3 MOD soft tissue surgery > General surgical principles > Flashcards

General surgical principles Flashcards

1
Q

What is the importance of gentle tissue handling?

A

Reduces surgical trauma, improves outcome and it vital for a successful surgery

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2
Q

What is the importance of meticulous haemostasis?

A

Haemorrhage obscures the surgical field, acts as a medium for bacterial growth, prevents proper meeting of wound edges and causes hypovolaemia
- Stop haemorrhage as quickly, completely and with as little tissue trauma as possible

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3
Q

During surgery, how can blood supply be best preserved?

A

Dissect tissues as little as possible to preserve adequate vascular supply and drainage.
- This requires good knowledge of surgical anatomy

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4
Q

Why should there be minimal tension used during surgery?

A

Wounds under tension will heal more slowly or not at all, leading to wound dehiscence (a surgical complication where the edges of a wound no longer meet)

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5
Q

Why must dead space be obliterated during surgery?

A

It can accumulate blood or tissue fluid and form a haematoma or seroma that increases the risk of wound infection by providing a medium for bacterial growth

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6
Q

Which instrument is the least traumatic for cutting?

A

Scalpel

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7
Q

How should you attach/detach a blade to a scalpel?

A

Using needle holders

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8
Q

Describe the 3 scalpel holding grips

A
  • Pencil: finger moves the blade, used for short, precise incisions
  • Fingertip: arm motion moves the blade, contact is minimised, used for most scalpel incisions >3cm long
  • Palp grip: rarely used
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9
Q

How should cutting with a scalpel be carried out?

A
  • Single pass to make an incision

- multiple strokes of the blade result in more tissue trauma, jagged wound edges and more haemorrhage

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10
Q

What are scissors used for in surgery?

A

Cutting tissues: especially flaccid tissues that cannot be cut efficiently with a scalpel

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11
Q

Give the names of the 2 common scissors used in surgery and when you would use them

A

Metzenbaum: fine dissecting
Mayo: dissecting connective tissue and fascia

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12
Q

What are some points to consider when cutting tissues with scissors?

A
  • Use the tip, rather than the section near the hinge where cutting forces are reduced
  • Avoid complete closure of the jaws
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13
Q

What is the role of electrosurgical instruments?

A

Use a radiofrequency electrical current to heat tissues and destroy cells/coagulate protein, either coagulating or incising the tissue depending on the degree of damping of the current

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14
Q

Why should electrosurgery not be used excessively?

A

It creates a relatively bloodless surgical field but is more traumatic to surrounding tissues

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15
Q

What points needs to be considered when using electrosurgery?

A
  • Only use on anaesthetised patients
  • Don’t use in the presence of volatile gases or liquids
  • The ground plate for monopolar systems must be in complete contact with the animal to avoid burns
  • Keep the power settings as low as possible
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16
Q

Name the two types of toothed forceps

A
  • Adson (interlocking teeth on their tip and are used for general tissue handling)
  • Debakey (finer, atraumatic jaw pattern are recommended for handling delicate tissues)
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17
Q

What is the function of toothed forceps?

A

Allow a surgeon to securely grip tissue with minimal pressure meaning they are less traumatic

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18
Q

When should non-toothed forceps be used?

A
  • For handling inanimate objects e.g. dressings, pathology specimens
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19
Q

Name the tissue forceps designed to occlude the lumen of the bowel?

A

Doyen forceps

- have a space between the curved jaws to avoid crushing the tissue

20
Q

Which tissue forceps can only be used on tissue being excised?

A

Allis tissue forceps

- they have traumatic jaws

21
Q

What are retractors used for?

A

To help expose the surgical field with as little tissue trauma as possible

22
Q

Give some examples of retractors and their uses

A
  • Finger held: used for thin or delicate tissue
  • Hand held: for thicker or more robust tissue
  • Self-retaining
  • Balfour and Gossett: for abdominal wall
  • Gelpi: used in various locations, they have sharp tips
23
Q

What is the importance of wound irrigation?

A

Avoids drying and trauma to tissues

24
Q

What is the most effective way of removing large volumes of fluid from the wound?

A

Suction

25
Q

How can trauma be avoided when using suction?

A

Avoid using excess suction

Cover the suction tip with a surgical swab

26
Q

Name the 3 types of suction tip and their use

A
  • Frazier-Ferguson: fine work and removing haemorrhage
  • Yankauer: removing large volumes of fluid from body cavities
  • Poole: removes fluid from body cavities and it has multiple openings and does not block easily
27
Q

Give examples of complications caused by improper tissue handling

A
  • Tissue ischaemia with delayed healing or necrosis
  • Dead space leading to seroma and abscess formation
  • Wound contamination leading to infection
  • Increased postoperative pain
  • Poor cosmetic results
28
Q

Tensile strength of suture material is proportional to?

A

The diameter of the suture

29
Q

Describe the features of monofilament sutures

A
  • Single strand of material
  • Little tissue drag
  • Withstand contamination
  • Can be prone to damage
  • High degree of memory which can make handling them difficult
  • Not the most reliable knot security
30
Q

Describe the features of multifilament sutures

A
  • Multiple strands of sutures braided or twisted together
  • Increased tissue drag
  • Structure can harbour bacteria
  • More pliable and easy to handle
  • Less memory
  • Better knot security
31
Q

Compare absorbable and non-absorbable sutures

A
  • Absorbable degrade and lose their tensile strength within 60 days
  • Non-absorbable retain their strength for more than 60 days, mainly used in the skin
32
Q

Compare synthetic vs natural sutures

A
  • Synthetic are made from synthetic polymers, broken down by hydrolysis causing minimal tissue reaction
  • Natural are made from animal or plant material and are broken down by enzymatic degradation causing inflammation and tissue reaction
33
Q

Which suture material is best for use in contaminated/infected wounds and why?

A

Synthetic monofilament

  • harbour less bacteria
  • cause less tissue reaction
34
Q

In which tissues are absorbable vs non-absorbable sutures best?

A

Visceral wounds gain tensile strength rapidly (over 14-21 days) = absorbable is best
Connective tissue and fascia heal more slowly = non-absorbable are better

35
Q

Most suture needles are made of …? Why?

A

Stainless steel

  • Strong
  • Withstands corrosion
  • Doesn’t harbour bacteria
36
Q

Name the different designs of suture needle

A
  • Swaged on needles
  • Eyed needles
  • Straight needles
  • Curved needles
  • Round bodied
  • Cutting
37
Q

Which needle is the best to use and why?

A

Swaged on needles

  • attached to suture
  • packed in a sterile wrapper
  • less traumatic to tissues
  • easy to use
38
Q

What are the 3 types of cutting needle?

A
  • Conventional: cutting edge along the inner side of the needle
  • Reverse: cutting edge along the outer side of the needle
  • Taper-cut: combination
39
Q

Name the 2 types of ratchet needle holders

A
  • Mayo-hegar

- Olsen-hagar

40
Q

How are the 2 types of needle holders different?

A

Olsen-hagar have a scissor blade built in

- both have a ratchet built in to allow the instrument to be locked

41
Q

Name the needle holders that don’t have a ratchet

A

Gillies

42
Q

Which suture patterns are best for subcutaneous tissue?

A

Simple continuous

Continuous horizontal mattress

43
Q

Which suture patterns are best for the skin?

A
  • simple interrupted
  • cruciate mattress
  • continuous intradermal
44
Q

Describe when skin staples would be used

A
  • provide rapid and convenient skin closure
  • when the staple is placed it leaves a gap between the skin and staple to allow swelling
  • convenient for re-suturing recent surgical wounds
45
Q

How do tissue adhesives work?

A

Applied to the skin as a liquid and rapidly polymerise in the presence of moisture to glue skin together

46
Q

When are tissue adhesives useful?

A

Repairing small skin wounds particularly when suture removal will be difficult or impossible

47
Q

What are the downsides of tissue adhesives?

A
  • Adhere poorly to moist surfaces so are not suitable for use on mucous membranes, in larger wounds or in those under tension
  • Don’t allow them to enter the wound as they cause chronic inflammation and wound infection

Y3 MOD soft tissue surgery (7 decks)

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