Instrumentation Flashcards
Why is slide cutting used?
gives the best control of length, depth and direction
How is the slide cutting technique performed?
Skin incisions should be made full thickness with the blade perpendicular to the skin. The skin is stabilised by the non-dominant hand, being stretched perpendicular to the direction of the blade.
When is the “fingertip” scalpel grip used?
Long incisions
How do you perform the fingertip grip
Place blade length against the skin
When is the “pencil tip” scalpel grip used?
increases precision and depth control and is used for shorter, delicate incisions.
When is the “press cutting” scalpel technique used?
Press cutting and inverse press cutting are used to enter body cavities or fluid-filled organs such as the linea alba or bladder.
When are curved scissors beneficial?
improve visibility during dissection
What is the benefit of straight scissors?
Mechanical advantage
When are long length scissors used? (3)
thoracic and abdominal work, where it is necessary to perform dissection in deep cavities. They are also useful for soft palate surgery.
Which scissors have thin, delicate tips and are used for most surgical dissections?
Metzenbaum scissor
Which scissors have longer, thicker blades and are used for cutting dense tissues?
Mayo
Which scissors should be kept in each kit to be used exclusively for cutting sutures and drapes?
Mayo
Which grip gives the surgeon best control of the forces created when using scissors?
Tripod
Which forces cause the blades to come together?
Closing
How do shearing forces act with scissors?
push the blades flat against each other during closing
Define torque forces
roll the leading edges of the blades inwards to touch each other.
When is push cutting used?
rapidly cut through less dense, areolar tissue.
When is blunt dissection used?
used to undermine skin edges or to break down loose connective tissue.
Why do we want to avoid excessive blunt dissection?
as it increases tissue trauma and dead space.
What are the benefits of tungsten carbide in needle holders? (2)
provide stability while protecting against suture damage.
What is the difference between mayo-hegar and olsen-hegar needle holders?
The Mayo-Hegar is the standard needle holder. The Olsen-Hegar has a cutting blade built into the jaws.
Benefits of tripod grip with needle holders (2)
Easy grasping and release of the needle
Precise needle placement.
What are crushing forceps used for?
Grasping tissue
What are the tips of allis forceps like?
Serrated tips
When are allis tissue forceps used?
used to grasp and manipulate dense tissue and fascia.
What are the tips of babcock forceps like?
Smooth inverted tips
When are babcock forceps used?
They are used to hold delicate visceral tissue and tubular organs such as bowel, their wider, rounded grasping surface being less traumatic.
Which forceps are used to occlude the bowel lumen during gastrointestinal procedures, preventing leakage of bowel contents and providing haemostasis
Doyen intestinal forceps
When are Satinsky clamps used?
To partially or completely occlude blood vessels
When are mosquito forceps applied tips down?
tip clamping of small vessels
When are mosquito forceps applied tips up?
jaw clamping of small vascular pedicles prior to ligature application
Which grip is employed when applying the mosquito forceps?
Tripod
Which grip is employed when removing the mosquito forceps? (2)
Tripod or palmer
What is the palmer grip?
One ring is grasped with the thumb and index finger while pressure is applied to the other ring with the middle and ring fingers.
Which forceps are used for handling delicate tissue, particularly blood vessels and visceral organs. They have long, slightly curved handles, resulting in a shallow A-shape with spring tension that allows the surgeon to control the pressure on the tissue between the tips. The jaws contain two rows of microscopic teeth that fit together on closure resulting in an even distribution of tension and atraumatic tissue handling.
DeBakey
What is the layout of Brown -Adson forceps?
forceps have two parallel rows of very fine teeth.
What is the layout of dressing forceps?
When are they used?
forceps have tips with smooth serrations. They are used for handling swabs.
What is the layout of adson forceps?
forceps have tips with only two fine teeth; these may cause less crushing injury than Brown-Adson forceps.
Which forceps cause less crushing injury 0 Adson or brown-adson
Adson
Choose six items that might be used to assemble a kit of long instruments.
Needle holders
Metzenbaum scissors
Adson forceps
DeBakey forceps
Dressing forceps
Right angled forceps
Name crushing forceps (3)
Halstead
Allis
Babcock
Name non crushing forceps (2)
Doyen
Satinksy
Name thumb forceps (2)
DeBakey
Adson
What do senn retractors look like?
small, double-ended retractors, one end having three prongs and the other a right-angled blade.
When are senn retractors used?
Retract superficial tissue
What do langenbeck retractors look like?
flat, right-angled blades
When are langenbeck retractors used? (2)
deeper tissues and muscle bellies.
What do malleable retractors look like?
flat and flexible
What are malleable retractors used for?
retract organs such as liver lobes or lung lobes within body cavities.
What do hohmann retractors look like?
flat blade and a beak.
How are hohmann retractors used?
The beak is inserted under bone or fracture fragments while the blade depresses and protects the adjacent soft tissues.
Name 4 hand held retractors?
Senn
Langenbeck
Malleable
Hohmann
What do gelpi retractors look like?
two arms, ring handles and a ratchet lock.
When are gelpi retractors used?
How to optimise use?
These are ideal for retracting skin edges, subcutaneous tissues and muscles. Exposure is optimised when two Gelpi retractors are placed at right angles to each other.
What is the benefit of travers over gelpi retractors?
Travers retractors have the same function as Gelpi retractors. However, their multiple prongs allow better tissue purchasing and force distribution.
What do balfour retractors look like?
two moveable arms mounted on parallel slide bars
When are balfour retractors used?
retraction of the abdominal wall during celiotomy procedures.
Which retractors: have two broad, outward-curved blades mounted on a ratcheted bar?
Finochietto retractors
When are Finochietto retractors used?
Spreading the ribs or sternum during thoracotomy procedures.
When are self retaining retractors used?
Name 4
- Long term exposure
- Gelpi
Travers
Baflour
Finochietto
Which suction tips (2) allow precise suctioning of small volumes of fluid?
Adson
Frazier
Which suction tip allows suctioning of large volumes of fluid?
Yankqauer
When are poole suction tips used?
How does the structure benefit this use?
Suction fluid from body cavities
The outer fenestrated tube contains an inner pin point suction tube and prevents occlusion by ody tissue
When are thumb controlled flexible suction tip used?
Fluid from upper airway + trachea (e.g. brachy)
How do radiofrequency devices work?
Radiofrequency devices deliver a high frequency alternating electrical current to tissues to generate heat energy. This heat results in collagen denaturation and tissue shrinkage;
How does monopolar radiofrequency work?
the current is applied to the patient via a handpiece (the active electrode). This travels back to the generator via an inactive electrode attached to the patient. This return electrode (sometimes referred to as a grounding pad or dispersive pad) ensures that low-density current passes back to the radiofrequency generator (electrosurgical unit), preventing patient burns
What are monopolar units used for? (2)
dissection and haemostasis.
What are the risks of monopolar?
thermal damage to tissues and delayed wound healing
(If the ground plate is in contact with only a small area)
When is bipolar advantageous over monopolar?
can be used in a wet surgical field. This is advantageous if there is active haemorrhage.
What wavelength do harmonic devices deliver at?
How do they work?
Harmonic devices deliver ultrasound waves at 55.5 KHz. These ultrasonic vibrations generate heat and coagulate tissues.
Why are harmonic devices more beneficial than radiofrequency?
In contrast to the obliterative coagulation of radiofrequency units which occurs at much higher temperatures resulting in the burning of tissues, coaptive coagulation minimises collateral tissue damage and prevents charring of tissue.
What physical effect do medical lasers have?
What are the functions? (5)
photothermal effect, that is they cut, cauterise, coagulate, vaporise or weld tissue
