General surgical principles Flashcards
What is the importance of gentle tissue handling?
Reduces surgical trauma, improves outcome and it vital for a successful surgery
What is the importance of meticulous haemostasis?
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
During surgery, how can blood supply be best preserved?
Dissect tissues as little as possible to preserve adequate vascular supply and drainage.
- This requires good knowledge of surgical anatomy
Why should there be minimal tension used during surgery?
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)
Why must dead space be obliterated during surgery?
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
Which instrument is the least traumatic for cutting?
Scalpel
How should you attach/detach a blade to a scalpel?
Using needle holders
Describe the 3 scalpel holding grips
- 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
How should cutting with a scalpel be carried out?
- Single pass to make an incision
- multiple strokes of the blade result in more tissue trauma, jagged wound edges and more haemorrhage
What are scissors used for in surgery?
Cutting tissues: especially flaccid tissues that cannot be cut efficiently with a scalpel
Give the names of the 2 common scissors used in surgery and when you would use them
Metzenbaum: fine dissecting
Mayo: dissecting connective tissue and fascia
What are some points to consider when cutting tissues with scissors?
- Use the tip, rather than the section near the hinge where cutting forces are reduced
- Avoid complete closure of the jaws
What is the role of electrosurgical instruments?
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
Why should electrosurgery not be used excessively?
It creates a relatively bloodless surgical field but is more traumatic to surrounding tissues
What points needs to be considered when using electrosurgery?
- 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
Name the two types of toothed forceps
- Adson (interlocking teeth on their tip and are used for general tissue handling)
- Debakey (finer, atraumatic jaw pattern are recommended for handling delicate tissues)
What is the function of toothed forceps?
Allow a surgeon to securely grip tissue with minimal pressure meaning they are less traumatic
When should non-toothed forceps be used?
- For handling inanimate objects e.g. dressings, pathology specimens
Name the tissue forceps designed to occlude the lumen of the bowel?
Doyen forceps
- have a space between the curved jaws to avoid crushing the tissue
Which tissue forceps can only be used on tissue being excised?
Allis tissue forceps
- they have traumatic jaws
What are retractors used for?
To help expose the surgical field with as little tissue trauma as possible
Give some examples of retractors and their uses
- 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
What is the importance of wound irrigation?
Avoids drying and trauma to tissues
What is the most effective way of removing large volumes of fluid from the wound?
Suction
