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Surgery > i dunno > Flashcards

i dunno Flashcards

1
Q

finger grip/ dinner knife scalpel grip used for

A

initial and longer incisions

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2
Q

pencil grip on scalpel used for

A

stab or short incisions

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3
Q

how to incise linea alba

A

-stab while tenting tissues - reverse press cut for stab incision through the linea alba

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4
Q

adson tissue forceps use

A

General tissue handling
* eg. Sub Q and linea alba during closure

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5
Q

adson brown forceps use

A

Stronger grasp of tissues
* e.g. to tent the linea alba during abdominal approach

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6
Q

DeBakey forceps use

A

Least traumatic forceps
* Handle tissues like vessels, bladder and GI wall

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7
Q

olsen hegar vs mayo hegar needle drivers

A

olsens have scissor under driver grip

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8
Q

metzenbaum scissor use

A

not for linea alba - only fat and soft tissues

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9
Q

mayo scissors use

A

strong scissor, perfect for linea alba

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10
Q

scissors to cut sutures with

A

sharp-blunt

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11
Q

carmalt tissue forceps used for:

A

§Used to clamp large pedicles of tissues (e.g. ovarian pedicle during OHE)

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12
Q

carmalt striation description

A

§Carmalts have
longitudinal striations along the entire length -
Perfect to prevent tissue slippage during ovariohysterectomy

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13
Q

kelly or crile forceps are used for

A

smaller vascular pedicles

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14
Q

mosquito forceps are used for

A

§Used to clamp single vessels
>Use the tip of the clamp
§Small vascular pedicles (cat ovarian pedicle)
>Use the body of the clamp

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15
Q

suture is considered absorbable if

A

it loses significant tensile strength within 60 (to 90) days of implantation
§ This does not mean it is completely gone…

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16
Q

non-absorbable suture maitnains:

A

100% of tensile strength for at least 60 days

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17
Q

natural vs synthetic suture mechanism of absorbtion

A

§Hydrolysis vs Enzymatic
§Natural fibers absorbed by enzymatic actions of cellular
proteases and collagenases
§Synthetic absorbable sutures are absorbed through hydrolysis

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18
Q

rate of suture absorption should be proportional to

A

returning of strength of the healing tissue

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19
Q

speed of healing for stomach

A

2 weeks

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20
Q

rate of healing for intestine

A

3 weeks

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21
Q

rate of healing for fascia

A

6-7 weeks

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22
Q

rate of healing for tendons

A

forever

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23
Q

what is knotless, barbed suture used for

A

mostly laparoscopic

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24
Q

why are some sutures coated?

A

§ Coated with a variety of compounds to improve pliability, improve knot formation, reduce drag or to reduce infection
§Antimicrobials such as Triclosan
§PDS Plus®
§Useful in contaminated or infected sites

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25
Q

what is suture elasticity?

A

The degree to which a suture will deform under stress or load and return to its original form when the load is removed

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26
Q

what is suture capillarity?

A

The degree to which a suture will absorb fluid following immersion

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27
Q

multifilament suture pros and cons vs mono

A

+Greater strength and pliability (vs stiffer mono)
+Good knot security (mono considered less but variable) -Greater tissue drag or friction (vs smooth mono)
-Greater capillarity and tendency for bacterial colonization (avoid for infected wounds)

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28
Q

big to small suture sizes

A

2>1>0>2-0>3-0>4-0, etc.

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29
Q

suture strength is related to what? should be considered in relation to what?

A

§Related to size
§Strength should be considered in relation to the tissue where the suture is being placed

30
Q

LARGER SUTURE MEANS THESE 3 THINGS

A

Stronger suture, More foreign body reaction, Less knot security

31
Q

5 common rapidly absorbable sutures

A
  1. catgut
  2. polyglactin 910 (vicryl)
  3. polyglycolic acid (dexon)
  4. poliglacaprone 25 (monocryl)
  5. polyglytone 6211 (caprosyn)
32
Q

catgut suture characteristics - best for what? problems?

A

§Twisted suture material
§Sheep intestinal submucosa or cattle
intestinal serosa

§ Treatment to delay absorption and reduce tissue inflammation
§Still rapid and inconsistent absorption and lots of tissue reaction so not ideal for anything other than vessel ligations (never for body wall or hollow organs like stomach and bladder)

33
Q

polyglactin 910 / vicryl suture characteristcs and use

A

§Multifilament braided suture
> Vicryl Plus (Triclosan coating)
> Vicryl Rapide (irradiated for very rapid absorption)

§Retains about 50% of its original tensile strength at 2 to 3 weeks
§Good option for intradermal

34
Q

poliglecaprone 25 / monocryl characteristics and use

A
  • Rapidly absorbable monofilament suture
    § Monocryl Plus (Triclosan)

§High initial breaking strength
§Will lose approximately 50% of its strength at 1 week
and 70% to 80% at 2 weeks
§Completely absorbed in 90 to 120 days with mild tissue inflammation during the absorption period
§Excellent option for subcutaneous tissues and intradermal, also used for urinary tract

35
Q

common slowly absorbable sutures

A

polydioxanone (PDS II)
polyglyconate (Maxon)
glycomer 631 (biosyn)

36
Q

polydioxanone / PDS II suture characteristics and uses

A

§ Uncoated, (2nd generation monofilament suture made from polydioxanone (PDS Plus (Triclosan))
§Approximately 50% of its initial tensile strength remains at 5 to 6 weeks
§Excellent handling
§Polydioxanone generally has intermediate knot security (less than Maxon®) but pretty good for a monofilament
§Excellent option for the linea alba

37
Q

common non-absorbable sutures

A

polypropylene (prolene)
nylon (ethilon)

38
Q

polypropylene (prolene) suture characterstics and uses

A

§Non absorbable monofilament polyolefin suture
§ Very strong, higher break strength than any suture but less knot
security
§Good handling characteristics
§ Very resistant to degradation because of a lack of hydrolyzable bonds
§Excellent option for skin closure but must be removed after healing

39
Q

nylon suture characteristics and uses

A

§Non absorbable monofilament polyamide-based suture
§ Very strong suture (less than Polypropylene)
§Nylon is susceptible to degradation in specific environments so not ideal for permanent implantation
§Excellent option for skin closure but must be removed once healing has occurred

40
Q

benefits of skin staples, and drawbacks. When to use?

A

§Reduction in surgical time and cost with cosmetic outcomes equivalent to a sutured wound
§Greater resistance to infection
§Difficult to remove – twist within tissues (inert in the tissues)

§Used when time is of the essence
§ Don’t use in difficult patients that will require sedation to remove staples…

41
Q

what material do we use at OVC to close the linea alba and for spay/neuter ligations?

A

§Polydioxanone (PDS®), absorbable

42
Q

What material do we use at OVC for subcutaneous and intradermal skin closure

A

§Polyglecaprone 25 (Monocryl®), absorbable

43
Q

what material do we use to suture the skin at OVC

A

§Polypropylene (Prolene®)

44
Q

what type of suture material should we use for Hollow viscera (intestine, stomach)?

A

§Monofilament synthetic absorbable material such as PDS® (polydioxanone) or Biosyn® (glycomer 631)
§ For urinary bladder consider Monocryl® (PDS is calculogenic)

45
Q

for bladder, what suture material should we use and why? what should we not use?

A

§ For urinary bladder consider Monocryl® (PDS is calculogenic)

46
Q

for fascia such as the linea alba, what suture material should we use

A

§ Synthetic absorbable, typically monofilament such as PDS® or Biosyn® (long tensile strength)
§ Monocryl is not acceptable except to close short cat spay incisions

47
Q

what suture material should we use for ligation?

A

§ Synthetic absorbable such as Monocryl®, Biosyn® or PDS® - Vicryl® (braided) is also an option

48
Q

what type of suture material should we use for subcuticular or subcutaneous applications?

A

§Braided or monofilament synthetic absorbable
> Vicryl® (polyglactin 910)
> Monocryl® (polyglecaprone 25)
> Caprosyn® (polyglytone 6211)

49
Q

what type of suture material should we use for skin?

A

§Monofilament synthetic non-absorbable such as Prolene® (polypropylene), nylon or staples

50
Q

what should we do when we open new suture to reduce memory

A

stretch slightly by holding suture, not the needle

51
Q

when do we use apposing suture patterns?

A

for eg. skin, intestine

52
Q

when do we use inverting suture patterns?

A

for eg. stomach bladder

53
Q

advantages of interuppted suture patterns, and disadvantages

A

§More precise wound margin apposition
§More selective adjustments to the wound edges (apposition)
§Improved closure security vs continuous*

§More time required for closure
§More suture and knots so more tissue reaction

54
Q

types of interrupted suture patterns

A

§ Simple interrupted (linea alba, GI)

§ Mattress patterns
§ Cruciate (skin)
§ Horizontal mattress § Verticalmattress

55
Q

what suture pattern should we use on the linea alba?

A

simple interrupted, or continuous

56
Q

advantages of continuous suture patterns

A

§ Faster to insert
§ More even distribution of tension
§ More water and air-tight closure (seal)

57
Q

when do we use continuous suture patterns?

A

§ *Not often used for the skin in small animals

§ Viscera (bladder, stomach, intestine)
§ Linea alba
§ Subcutaneous
§ Intradermal (subcuticular)

58
Q

is interrupted safer than continouous suture pattern?

A

§Interrupted is considered ‘safer’ than continuous (relies heavily on the start and end knots) especially in the hands of a novice surgeon but interrupted is not actually safer if a continuous is performed correctly on the linea alba …

59
Q

is it better to use interrupted or continuous suture patterns for abdominal wall closure?

A

§‘Use of a single-layer, simple continuous suture pattern to close abdominal body wall incisions has been shown to be comparable with use of a simple interrupted pattern in strength and complication rate and is quicker and easier to perform’

60
Q

advantages of continuous suture patterns

A

-fast
-uses less material
>less foreign body rxn, cost
-more even distrbution of forces

61
Q

advantages of interrupted suture patterns

A

-more secure, better apposition of tissue edges

62
Q

6 types of continuous suture patterns

A

§Simple continuous
§Ford Interlocking (continuous lock)
§Cushing
§Lembert
§Connell
§Purse string

63
Q

§A simple interrupted suture requires a minimum of ___* throws to form a secure knot (*depends on the suture material)

A

4 to 5

64
Q

why and when to use a surgeons knot

A

§Provides friction and maintains position until second throw is placed = surgeon’s throw

§Use when there is tension on the tissues to appose**
>Closing linea alba
>Placing a ligature on fatty ovarian pedicle
>Not good for small vessels without fat since the extra suture results in a larger loop (isn’t as tight)

§Not actually safer once the knot is completed

65
Q

how many throws should our knots have in a continuous suture line? does this rule always apply?

A

the starting knot should have one extra throw (5-6 throws total) and the final knot should have two extra throws (6-7 throws total) for added security (because of tying a loop to a single strand)

§ This rule is important for the linea alba but is typically not observed for a buried SQ knot due to lack of space!

66
Q

how long should suture tags be

A

2-4mm

67
Q

how many knots in suture for PDS II?

A

5 throws for an interrupted suture and
6 at start and 7 at end of continuous
with 2 to 4 mm suture tags

68
Q

how do we hold the needle with needle holders?

A

Hold the suture needle with the tip of the needle holder and at about 1/3 of the needle

69
Q

how long should we cut suture ends with synthetic suture? for skin closure?

A

§3 mm tags for synthetic suture
§I leave them a bit longer (4-5 mm) on the linea alba when doing a continuous closure

§6-10mm tags for skin sutures (have to remove them!)

70
Q

advtangae of a muller knot/ clove hitch knot for ligature

A

§’locked double loop’
§More likely to prevent slippage
off of the pedicle cut end compared to simple circumferential

Surgery (8 decks)

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