General surgical principles

Question 1

What are Halstead’s principles of surgery?

Answer 1

Gentle tissue handling
Strict asepsis
Meticulous haemostasis
Preservation of blood supply
Obliteration of dead space
Accurate tissue apposition 
Minimal tension

Question 2

How should an incision be made?

Answer 2

One single line

Using a scalpel with disposable blades

Question 3

When using scissors for surgery, should you use the entire blade?

Answer 3

No - use tips only

Question 4

Scissors can be Mayo or Metzenbaum and straight or curved. When would you used straight and curved scissors?

Answer 4

Straight - cut

Curved - dissect, finer cutting

Question 5

Are electrosurgical instruments less or more traumatic than scalpels/scissors?

Answer 5

More traumatic - only on anaesthetised patients

Question 6

How should you use an electrosurgical instrument?

Answer 6

Ensure good plate contact
Don't coil up handpiece lead
Keep electrode clean
Use with care around delicate tissues
Lowest power possible

Question 7

Why do electrosurgical incisions take a long time to heal?

Answer 7

Can burn skin

Question 8

When are electrosurgical instruments useful?

Answer 8

For fat tissues

Reducing risk of haemorrhage

Question 9

Should you use tissue forceps on tissues?

Answer 9

No - only dressing forceps

Unless removing the tissue being handled

Question 10

What are retractors?

Answer 10

Instruments either manual or self-retaining

Allow to expose surgical field with least trauma possible

Question 11

What should be used for wound irrigation?

Answer 11

Saline

E.g. if washing abdomen after intestinal spill

Question 12

After flushing a body cavity with saline, what should you do?

Answer 12

Remove the saline with suction

Question 13

What are some complications of improper tissue handling?

Answer 13

Incisional hernias
Seroma/abscess formation 
Infection (due to contamination)
Increased post-op pain 
Poor cosmetic results

Question 14

What happens if dead space is left after surgery? (Halstead’s principles - dead space should be obliterated)

Answer 14

Forms seroma or abscess

Question 15

What factors influence what suture material is used?

Answer 15

Tensile strength (should be equal strength to tissue)
Structure of suture - mono or multifilament, adsorbable, non-adsorbable, synthetic or natural
Local wound conditions
Healing rate
(Cost and surgeons preference)

Question 16

How is suture diameter measured?

Answer 16

Metric = in 1/10 of a mm
USP = arbitrary units (1/1000 of an inch)

Question 17

What is the difference between monofilament and multifilament sutures?

Answer 17

Mono = a single strand of suture 
Multi = multiple strands braided/twisted

Question 18

What are the advantages of monofilament sutures?

Answer 18

Little drag

Withstand contamination better

Question 19

What are the disadvantages of monofilament sutures?

Answer 19

High degree of memory =
Difficult handling
Worse knot security

Question 20

What are the advantages of multifilament sutures?

Answer 20

Easier to handle
More pliable as less memory
Higher surface area = better knot security

Question 21

What are the disadvantage of multifilament sutures?

Answer 21

More drag

Harbour bacteria

Question 22

All sutures cause some reaction within tissues. Which causes more reactions - synthetic or natural suture material?

Answer 22

Synthetic - less reactions (hydrolysis)

Natural - more reactions (enzymatic)

Question 23

Give examples of when non-adsorbable sutures may be used

Answer 23

Skin
Securing implants
Hernia repairs

Question 24

What are the advantages/disadvantages of using a swaged on needle?

Answer 24

Less traumatic as new sharp needle each time

Expensive

Question 25

What are the advantages/disadvantages of using an eyed needle?

Answer 25

Cheap
Require threading
More traumatic

Question 26

When would you use a straight needle?

Answer 26

Only for skin (when with no needle holders)

Question 27

Suture needles can be round bodied or cutting. When would you use each type?

Answer 27

Round bodied - fat, viscera, muscles

Cutting - skin, tendons, fascia (tough tissues)

Question 28

What reaction causes adsorbable synthetic sutures to degrade? What is the advantage of this?

Answer 28

Hydrolysis

Minimal tissue reaction

Question 29

What reaction causes natural suture material to degrade? What are the disadvantages of this?

Answer 29

Enzymes from neutrophils/macrophages

Provoke a more intense FB reaction than synthetic material

Question 30

When suturing an infected area, what suture material should ideally be used?

Answer 30

Monofilament

As little material as possible

Question 31

Suturing should use enough tensile strength to support the tissue. How fast do skin, connective tissue and viscera heal relatively?

Answer 31

Skin and viscera = fast healing

CT = slower

Question 32

Give examples of suture pattern

Answer 32

Appositional 
Inverting 
Everting 
Interrupted
Continuous

Question 33

What are advantages/disadvantages of surgical skin staples compared to sutures?

Answer 33

Faster than suturing
More expensive
Cannot be used for irregular wounds or wounds under tension

Question 34

When may linear/circular staplers be used?

Answer 34

Bowel anastomoses

Question 35

Give an example of a family of tissue adhesives

Answer 35

Cyanoacrylates

Question 36

Where can cyanoacrylates (surgical glue) be used?

Answer 36

SKIN ONLY

Question 37

What are complications of using tissue adhesives?

Answer 37

Granulomas
Potentiate infection
Delay healing
Poor adhesion if skin wet