Introduction to Surgery Flashcards
What are Halsted’s principles?
A Good Surgeon Has Delicious Tasty Coffee Daily
A) Asepsis
G) Gentle tissue handling
S) Supply (preservation of blood supply)
H) Haemostasis
D) Dead space (elimination of dead space)
T) Tension (minimise tissue tension)
C) Closure (accurate)
D) Debridement (of dead tissue)
How do we get strict asepsis?
- Preparation of skin after clipping
- Preparation of instruments
- Surgical scrub and team
What is asepsis?
Absence of pathogenic microbes in living tissue
What three solutions are used in preparation of skin after clipping for asepsis?
- Chlorhexidine surgical scrub (cleanser and antibacterial)
- Alcohol - Antiseptic kills bacteria on skin
- Alcohol/chlorhexidine solution - final prep
How are surgical instruments prepared and made aseptic? (6)
- Steam under pressure (autoclaving)
- Dry heat
- Gas sterilisation
- Radiation
- Chemical sterilisation
- Correct storage
Aims and length of surgical hand scrub:
- To remove as many microorganisms as possible from hands, nails and arms by mechanical washing and antiseptic contact time
- Approximately 5 minutes
What do surgeons need to wear?
- Gloves
- Gown
- Mask
- Head cover
- Enclosed shoes
How is draping of the patient done? (6)
Take care not to contaminate sterile
drapes, gloves or gown
- 1st drape between patient and surgeon
- **2nd and 3rd **head and tail
- 4th drape far side of patient
- Secure drapes in place with towel
clamps
- Fenestrated drape on top
What does rough handling or crushing of tissues during surgery lead to?
Swelling, inflammation and post-operative pain and discomfort for the animal
How is blood supply preserved during surgery?
- By careful dissection
- Be aware of surgical anatomy
- E.g. blood supply to small and large
intestine - Ensure ligated vessels are not
supplying viable tissue
How is adequate haemostasis maintained during surgery?
- Ligation
- Electrocautery
- Haemostatic forceps
- Pressure
What are the risks of NOT maintaining adequate haemostasis during surgery? (5)
- Uncontrolled haemorrhage life threatening
- Blood ideal medium for bacterial contamination
- Blood clots stop the coaptation of wound edges
- Fluid and dead space in the wound area interferes with healing
- Obscures the surgical field
Why do we eliminate “dead space” during surgery?
- Dead space allows the accumulation of fluids and air to disrupt the close
approximation of tissues and delay its healing - Dead space is predisposed to infection
- Elimination of it decreases risk of seroma or hematoma formation
How can we prevent dead space during surgery? (4)
- Good tissue apposition
- Pressure bandages
- Use of sutures to close dead space
- Active and passive drains
Excessive tension during suturing of organs is _____ and sometimes _____
unnecessary; detrimental
How much tension to use during surgery?
- Can’t be too tight – crushing and pressure necrosis could result
- Loose enough to allow for postoperative swelling
- Not too loose – could cause leakage or dehiscence
What are the benefits of accurate closure after surgery?
- Purpose of wound closure is to
bring the edges together to allow
for healing - Careful approximation of tissues
is achieved by appropriate suturing techniques
Necrotic tissue
Dead or devitalised tissue
* Tissue that cannot be salvaged
* Must be removed to allow wound healing to take place
What are the two types of debridement?
Layer and en bloc
What is layer debridement?
- Debride progressively from surface of wound to deeper tissues
- Allows conservation of healthy tissue
What is en bloc debridement?
- Complete excision of wound
leaving healthy tissue - Wound closure can occur
What are some common small animal surgical procedures?
- Female – Ovariohysterectomy (Spay)
- Male – Orchiectomy (Castration)
What are common emergency proceedures?
- Gastric dilation and volvulus (GDV)
- Occurs in large, deep chested breeds
- Acute emergency
- Require immediate surgery
- 10‐25% mortality - C- Section
- Foreign body
What is cautery?
A medical procedure that uses heat, electricity, or chemicals to burn or destroy tissue
What is ligation?
Act of tying or closing off a blood vessel or other tube in the body
What is volvus?
an obstruction caused by twisting of the stomach or intestine
What is necrosis?
Death of body tissues due to irreversible cell damage
What is seroma?
A localised accumulation of serous fluid in a part of the body
What is hematoma?
A localised collection of blood outside of blood vessels
