jjj Flashcards
SKIN
What is the purpose of the scalpel in skin incision?
What blades are commonly used?
Purpose: The scalpel is used to make the initial incision in the skin.
Common Blades:
#10 blade: Most commonly used for skin incisions.
#15 blade: Used for smaller, more delicate incisions.
SKIN
What are Metzenbaum and Mayo scissors used for in skin dissection?
Purpose: Scissors are used to cut through the skin and subcutaneous tissue or trim excess tissue during the procedure.
Metzenbaum scissors: Used for delicate tissue dissection.
Mayo scissors: Used for tougher tissues.
SKIN
What is the function of the needle holder in skin closure?
Purpose: The needle holder is used to hold the needle while suturing the skin after the surgery, ensuring precise control and minimal tissue trauma.
SKIN
What is the role of hemostats in the skin incision phase?
Purpose: Hemostats are used to clamp blood vessels in the skin or subcutaneous tissues to control bleeding.
Types:
- Kelly clamp: Temporarily clamps blood vessels or tissues.
- Pean clamp: Used for larger vessels requiring temporary occlusion.
SKIN
How are Adson forceps used during the skin incision and closure process?
Purpose: Adson forceps grip and hold the skin edges during incision and closure.
With Teeth: Provides a firmer grip on the skin.
Without Teeth: For more delicate handling without causing trauma.
SKIN
When and why are surgical drains used in neurosurgery?
Purpose: Drains are placed under the skin to prevent fluid accumulation, such as seromas or hematomas.
Types:
Jackson-Pratt drain: Typically used for continuous drainage.
Penrose drain: Used for passive drainage.
SKIN
What is the purpose of electrocautery (diathermy) during the skin dissection?
Purpose: Electrocautery (diathermy) is used to coagulate tissue and control bleeding by applying high-frequency electrical currents. It’s particularly useful during dissection to minimise bleeding.
SKIN
What is the function of a delicate needle holder in skin closure?
Purpose: The delicate needle holder is used to control and pass sutures through the skin, ensuring accurate and tight closure.
SKIN
What is the purpose of suture scissors during skin closure?
Purpose: Suture scissors are used to cut the sutures once the skin has been properly closed.
SKIN
What is the role of a skin stapler in skin closure?
Purpose: A skin stapler may be used instead of sutures for faster and more efficient skin closure, especially with larger incisions
SKIN
What is the role of skin preparation before incision in neurosurgery?
Purpose: Skin preparation is done to reduce the risk of infection by removing contaminants and microorganisms from the skin surface.
Techniques:
Use of antiseptic agents (e.g., iodine-based solutions or chlorhexidine) to cleanse the skin.
Ensure sterile draping and proper positioning of the patient to prevent cross-contamination.
SKIN
What factors affect skin tension and healing in neurosurgery?
Factors Affecting Skin Tension:
- Patient’s age and overall health.
- Proper technique in suturing to minimize tension on the skin.
- Alignment of tissue layers to promote effective healing.
Healing Considerations:
- Use of subcuticular stitches or skin staples to ensure optimal skin closure and reduce the risk of wound dehiscence.
SKIN
What are the differences between continuous and interrupted sutures in skin closure?
Continuous Sutures:
- Provides faster closure and evenly distributes tension across the wound.
- May be preferred for long incisions.
Interrupted Sutures:
- Offers better control of tension on each suture, useful in areas with irregular edges.
- Typically used in cases requiring more careful, precise closure.
SKIN
What are the key aspects of post-surgical skin care for neurosurgery?
Dressings:
- A sterile dressing is applied to the incision site to prevent infection, absorb exudates, and protect the wound from external contamination.
- Dressings should be checked regularly for signs of infection (redness, swelling, discharge).
Sterile Coverage:
- Maintaining a sterile dressing until the wound heals sufficiently to avoid infection.
- Changing the dressing as per the surgeon’s protocol.
SKIN
What are common skin incision locations and key considerations in neurosurgery?
Scalp Incisions: Common for brain surgery, often following natural skin lines for aesthetic purposes.
Posterior Cervical Incisions: For spinal surgeries, often made along the hairline or in less visible areas.
SKIN
When is skin stapling preferred over suturing in neurosurgery?
Skin Stapling:
- Faster, especially for long incisions or in cases where time efficiency is critical.
- May be used when there is less tension on the skin and a quicker closure is desired.
Suturing:
- Preferred in areas where precise skin closure is necessary, or when cosmetic appearance is important.
SKULL
What is the purpose of a burr hole drill in skull surgery?
Purpose: A burr hole drill creates small holes in the skull, often the first step in a craniotomy, allowing access to the brain for procedures like removing hematomas or inserting devices (e.g., shunts).
Types: Handheld or powered drills with various sized burrs for controlled bone removal.
SKULL
What is a craniotome used for in neurosurgery?
Purpose: A craniotome is used to cut through the skull during a craniotomy. It helps remove a circular section of the skull to access the brain.
SKULL
What is the purpose of a rongeur in skull surgery?
Purpose: A rongeur is used to remove small pieces of bone after the burr hole has been drilled or to smooth the edges of a craniotomy.
SKULL
When is a bone saw used in skull surgery?
Purpose: A bone saw is used to cut larger sections of the skull during craniotomy procedures.
Types:
- Gigli saw: A flexible wire saw for bone cutting.
- Oscillating saw: An electric saw for cutting through thicker skull bone.
SKULL
What is the function of a cranial elevator?
Purpose: A cranial elevator helps lift or separate the bone flap from the surrounding tissue after it’s been cut, ensuring minimal damage to the brain.
SKULL
How is suction used during skull surgery?
Purpose: Suction is used to clear blood, bone debris, and cerebrospinal fluid (CSF) from the surgical site to maintain visibility.
SKULL
What is bone wax used for in skull surgery?
Purpose: Bone wax is applied to the cut edges of the skull to control bleeding by sealing blood vessels in the bone.
Usage: Applied directly to bone edges after cutting to minimize bleeding.
SKUL
How is the bone flap fixed after a craniotomy?
Fixation Techniques:
- Screws and plates: Titanium plates and screws are commonly used to reattach the bone flap securely.
- Tissue adhesives: May be used in certain cases to further secure the bone flap.
- Sutures: Sometimes sutures are used for finer adjustments, especially when securing the scalp around the bone flap.
What is the purpose of a dura hook in neurosurgery?
A dura hook is used to elevate and expose the dura mater. It gently lifts the dura away from the underlying tissue, providing better access for procedures.
What are dural scissors used for?
Dural scissors are specialized scissors used to make precise incisions into the tough dura mater without damaging the underlying neural tissue.
What is the function of dura forceps? (Adson and bayonet forceps)
Dura forceps are fine, delicate forceps used for gripping, lifting, or repositioning the dura mater without causing excessive trauma.
- Adson forceps: Used for delicate tissue manipulation.
- Bayonet forceps: Useful for deeper or harder-to-reach areas.
What is the purpose of a dura retractor?
A dura retractor gently opens the dura mater to expose the brain or spinal cord beneath, especially when a large opening is needed.
Self-retaining retractors: Hold the dura open on their own.
Manual retractors: Require assistance to maintain the opening.
When are micro scissors used in dura mater procedures?
Micro scissors are fine, sharp scissors used for precise cutting of delicate tissues like the dura mater, typically in smaller, more delicate procedures.
What is the role of a needle holder in dura mater repair?
A needle holder is used to hold the needle while suturing the dura mater, ensuring precise control during closure to prevent leaks.
What type of sutures are used for closing the dura mater?
Purpose: Specialized sutures are used to close the dura mater after incision.
Non-absorbable sutures (e.g., nylon, polypropylene) for longer-term strength.
Absorbable sutures for temporary closures.
When are tissue adhesives used in dura mater surgery?
Tissue adhesives, such as fibrin glue, may be applied to the dura after suturing to create a seal and prevent cerebrospinal fluid (CSF) leaks.
What are the key techniques for closing the dura mater after surgery?
Key Techniques:
Simple interrupted sutures: Commonly used for primary closure of the dura.
Running sutures: May be used for faster closure but with careful tension management to avoid CSF leaks.
Dural patch: In cases of large defects, a patch (e.g., pericranial tissue or synthetic grafts) may be used to cover the dura.
What are dural septa and how are they relevant in neurosurgery?
Dural Septa:
- The dura mater has several fold-like structures called dural septa (e.g., falx cerebri, tentorium cerebelli).
- These structures separate different parts of the brain and provide structural support.
- Surgeons need to be mindful of these structures when planning approaches for surgeries such as tumor resections, to avoid damage to critical brain areas.
What is the vascular supply to the dura mater?
Vascular Supply:
- The dura mater is richly supplied by blood vessels, including branches from the middle meningeal artery, which is the primary source of blood supply.
- Other contributions come from the anterior meningeal artery and posterior meningeal artery.
- Careful management of these vessels is essential during surgery to prevent significant bleeding and complications.
What are arachnoid scissors used for in neurosurgery?
Arachnoid scissors are fine, delicate scissors used to precisely cut through the arachnoid mater without damaging the underlying structures.
Use: Often used for incising the arachnoid layer or dissecting adhesions in the subarachnoid space.
What is the function of arachnoid forceps?
Purpose: Arachnoid forceps are used to grasp, lift, or reposition the arachnoid mater without causing excessive trauma.
Types:
- Adson forceps: For delicate tissue manipulation.
- Bayonet forceps: Useful for deeper or harder-to-reach areas.
What are arachnoid retractors used for?
Arachnoid retractors gently hold or pull back the arachnoid mater during surgery, providing better brain or spinal cord access.
Use: Commonly used in craniotomies or spinal surgeries, particularly when the arachnoid must be separated from underlying structures.
What are micro scissors used for in pia mater surgery?
Micro scissors are fine, delicate scissors used for precise cutting of the pia mater.
Use: Often used to make small incisions or trim excess tissue during surgery, especially when working with delicate neural structures.
What is the function of micro forceps during pia mater surgery?
Micro forceps are used for grasping and manipulating the delicate pia mater.
Use: Helps to hold, lift, or reposition the pia mater with precision during surgery.
Why is a needle holder used for the pia mater?
A needle holder is used to hold the needle when suturing the pia mater.
Use: Ensures precision and control during the suturing process to avoid damage to the delicate tissue.
What are microsurgical instruments used for in pia mater surgery?
Microsurgical instruments, like microscissors, microforceps, and microneedles, are used for precise and controlled manipulation of delicate tissues.
Use: Essential for performing surgeries on small or deep structures in the brain or spinal cord near the pia mater.
What are the common surgical instruments used for making an incision during neurosurgery?
Instruments Used:
- Scalpel: Used for making the initial incision in the skin and sometimes the dura.
- Scissors (Metzenbaum, Mayo): Used for cutting through tissue layers such as skin, subcutaneous tissue, and occasionally dura.
- Needle Holder: Used to secure needles for suturing any of the layers after an incision.
- Electrocautery: Used to coagulate blood vessels and tissue during incision to minimize bleeding.
What retraction techniques are used to expose the different layers during neurosurgery?
Retraction Techniques:
Forceps (e.g., Adson or Bayonet): Used for gentle retraction and stabilization of tissue layers during surgery.
Surgical Retractors: Instruments like dural retractors for dura mater and pia retractors for pia mater are used to carefully hold layers in place for better access to underlying structures.
Hooks (e.g., dura hooks): These are used to gently lift the dura or pia mater without causing damage.
How is bleeding controlled during incision and the dissection of the meninges (skin, skull, dura mater, arachnoid, pia mater)?
Hemostats (e.g., Kelly clamp, Pean clamp):
- Clamps are applied to vessels to control bleeding during the incision and dissection of tissues.
- Electrocautery: High-frequency electrical currents are used to coagulate small blood vessels and minimize bleeding in all layers.
- Bone Wax: Applied to bone surfaces, especially in skull surgeries, to control bleeding from bone cuts.
- Surgical Suction: Used to clear blood or cerebrospinal fluid (CSF) from the surgical field for better visibility.
What suturing techniques are used to close the layers after neurosurgery?
Suturing Techniques:
- Interrupted Sutures: Commonly used to close skin or dura mater, ensuring tight closure without tension.
- Continuous Sutures: Used for quicker closure, often applied to the dura mater or skin.
- Subcuticular Sutures: Applied to the skin layer for cosmetic closure, where minimal scarring is desired.
- Tissue Adhesives (e.g., fibrin glue): Used as an additional sealant, particularly for the dura or pia mater to prevent CSF leaks.
