L3: Surgical instruments and suture materials Flashcards
What misuse leads to?
Will dull or break the instruments, each instrument is designed for a particular use
4 categories of instruments
- Cutting instruments
- Grasping instruments
- Retractors
- Miscellaneous instruments
Is there a problem for left-handed surgeon?
Regular instruments might be uncomfortable
Different cutting instruments (3)
- Scalpels
- Scissors
- Bone-cutting instruments (EI TARVII OSATA ERI LUUINSTRUMENTTEJA KOKEESSA!!)
Scalpel blade number used
10 - Most common in small animal surgery
15 - similar, more precise
11 - stab incisions into-fluid filled structures
12 - limited use
No.4 with large dogs
Rules in scalpel handling (4)
- Scalpel perpendicular to the skin when incising
- Goal is full thickness skin incisions attained with a single sweep
- Pencil grip, fingertip grip or palmed grip
- Tissue stabilized with the nondominant hand when incising
4 possible motions with scalpel
- Sliding (precise depth, lenght, control of direction e.g. skin incision)
- Pressing (precise length, direction, depth poorly controlled e.g. stab incision)
- Sawing (allows continuation of a single cut without removal of the blade e.g. transecting a ligated pedicle)
- Scraping (method of separating tissue layers e.g. debridement)
Pencil grip
-Allows shorter, finer and more precise incisions than the other grips
-Reduced cutting edge contact, less useful for long incisions
-Curved incisions
Fingertip grip
-Max length of the blade edge in contact with the tissue
-Movement performed by the whole arm
-Best accuracy and stability for long straight incisions
Palmed grip
-Strongest hold on the scalpel
-Allows exertion of great pressure on the tissue
-Usually unnecessary in surgical situations
Generally about scissors
-Used to cut or dissect tissue and to cut inanimate objects
-Cutting inanimate objects should be limited to specific instruments
-Tripod grip is recommended, provides maximal control
-Using the end of the blade stabilizes tissue more securely and allows more precise cut
-Can be curved or straight, tips sharp or blunt
Difference with curved and straight scissors
Curved have greater maneuverability and visibility, straight have mechanical advantahe for cutting dense tissue
Mayo scissors
For dissecting soft tissue. Thick blades approximately 1/3 of the length
Metzenbaum scissors
Dissecting delicate soft tissue. Thin delicate blades approximately 1/4 of the overall length
Blunt/sharp operating scissors
For inanimate objects (suture material!)
Needle holders generally (5 points)
-Jaws short and frequently have grooves that are cross-hatched on the surface intended to limit twisting and rotation of the needle.
-Should match both, the size and the type of the needle being used.
-Different locking mechanism possible
-Needles placed perpendicular to the needle holder - greatest maneuverability
- Needle is generally grasped near the center!
Different needle holders (4)
- Mayo-Hegar
-Olsen-hegar (also scissors)
-Mathieu
-Castroviejo (pencil grip, very delicate work, eye surgeries!)
Personal preference what you want to use!
Different grasping instruments
Usually designed to inanimate objects OR tissues.
Needle holders
Tissue forceps
Needle holder grips (4)
1.Thenar grip
2.The thumb-ring finger grip
3.Palmed grip
4.Pencil grip
Different tissue forceps (6)
1.Crushing tissue forceps
2.Noncrushing tissue forceps
3.Hemostatic forceps
4.Thumb forceps
5.Towel clamps
6.Bone-holding forceps
Generally about tissue forceps
-Multiple types of forceps of various sizes and shapes
-Variety of tasks
-Configuration of jaw serrations determines their use
-Cross-serrations: tip-clamping
-Longitudinal serrations: jaw-clamping
Crushing tissue forceps and 3 types
Should be used to grasp only tissue slated for excision. Eli jos tarraat näillä kudokseen, niin se osa kudosta pitäisi poistaa!
1.Allis tissue forceps
2.Babcock tissue forceps
3.Ochsner-Kocher forceps
Noncurshing tissue forceps
Doeyn (intestinal) forceps are considered noncrushing, but actually induce tissue trauma (dependent on use duration)
Various peripheral vascular clamps or partial occlusion forceps are also.
Generally about hemostatic forceps (5)
-Crushing instrument used to clamp blood vessels
-Serrations may be transverse, longitudinal, diagonal or combination of these
-Longitudinal are gentler than cross-serrations
-As little tissue as possible should be grasped to minimize tissue trauma
- The least amount and duration of pressure applied by closure of the ratchet on the instrument is the goal
4 types of hemostatic forceps
1.Halsted-mosquito hemostats (very small ones! delicate tissues)
2.Crile hemostats
3.Kelly hemostats
4.Rochester-Carmalt hemostats
General points about thumb forceps (4)
-Tweezer-like, nonlocking instrument used to grasp tissue (and inanimate objects)
-Available in various shapes and sizes; tips can be pointed, flat, round, smooth, serrated, with teeths… (anatominen ja kirurginen!)
-Pencil grip preferred
-Can be held in the palm of the nondominant hand when temporarily not in use
4 types of thumb forceps
1.Brown-Adson forceps
2. Debakey forceps
3.Adson forceps
4.Dressing forceps
2 types of towel clamps
- Backhaus towel clamps
- Jones towel clamps
General information about retractors (4)
-Help improve exposure by deflecting tissue away from the area of interest
-Available in hand-held and self-retaining varieties
-Some handled retractors may be bent to conform to the area of the body being retracted
-Moistened towels or pads are frequently placed under self-retaining and selected hand-held retractors to minimize trauma and drying
4 types of self-retaining retractors
1.Gelpi
2. Weitlaner
3. Balfour
4. Finochietto
3 types of hand-held retractors
- Senn
- Malleable
- Hohmann
5 miscellaneous instruments
- Spay hook (esim kissan sterkassa voi kaivella munasarjoja ja kohtua)
- Periostal elevator (separate tissues from bone)
- Curette (usually for bone surgeries)
- Rongeur
- Suction tip (surgery in any fluidfilled organ)
Generally about suture materials (3)
-Appropriate selection of needle type, suture material or other wound-closing strategies is critical
-Strong knowledge of material characteristics combined with an intimate understanding of wound healing will allow for optimal material selection and maximization of wound healing in any patient
-Different recommendations for different tissues
11 Ideal suture material rules!
1.Must not irritate tissues
2.Must not be allergenic
3.Must not be cancerogenic
4.Must have low capillarity (capability to absorb fluids!)
5.Must not have electrolytic properties
6.Must be contrasting (blue or purple, joten eri värinen kuin tissue)
7.Must have minimal knot slippage
8.Must have good handling (jos haluat suoristaa niin se suoristuu, jos haluat taittaa niin se taittuu)
9.Must not be expensive
10.Must be sterile
11.Must have a stable diameter
Measurable suture characteristics
-Flexibility (knot security is better if more flexible)
-Surface characteristics and coating (influence movement through tissues)
-Capillarity
-Monofilament/multifilament (yleensä käytetään monoa, slaidin kuvassa hyvä erottelu!)
-Knot tensile strength
-Relative knot security
-Absorbable/non-absorbable
Comparison between mono- and multifilament suture types
-Mono has low capillarity and less tissue damage
-Multi has good knot security, handling, flexibility and strength
Monofilament should be used unless indicated otherwise
Absorable suture material
Natural - Are absorbed by enzymatic activity of the tissue or by phagocytosis
Synthetic - Are degraded by hydrolysis
Most of the absorbable sutures lose tensile strength in 60 days
Non-absorbable suture material
Will be encapsulated within tissues. Tensile strength lost in several years, but never absorbed. Removed after wound healing.
Tissue adhesives
-Used for clean superficial wounds
-Don’t use if wound is contaminated, deep, inflamed, results from a bite)
-Also not used if subdermal pockets are deeper than 5mm => subcutaneous sutures indicated
-Reaches maximum bonding strength within 2,5 minutes
Needles
-Needles are chosen for appropriate tissue
-Characterized by their ductility, sharpness and strength
-According to geometry needles are divided into traumatic and atraumatic categories
Needle point geometry (6)
- Tapepoint
- Tapercut
- Regular (pulling up, cutting through tissue on top)
- Reverse (no cutting edge on top and under)
- Spatula
- Point
Why use reverse and not regular?
Reverse has no cutting edge on top and under, so when pulling up reverse is not cutting through the tissues on top! Reverse is more used then!
Taperpoint needle
Thin round tip, no cutting edges. Spreads tissues, doesn’t cut. Suturing soft tissues
Tapercut needle
Reverse cutting edge tip and taperpoint body. Dense tough fibrous tissue (fascia, ligaments). Cardiovascular procedures
Regular cutting needle
Three cutting edges, one on the inside. Very sharp, cuts, doesn’t spread. Promotes cut out of tissue
Reverse cutting needle
Three cutting edges, one on the outside. Stronger than regular cutting needle. Reduced amount of tissue cut out.
Spatula needle
Flat on the top and bottom, cutting sides. Ophthalmologic procedures
Blunt needle
Spreads, doesn’t cut. Soft parenchymal tissue (liver or kidneys)
