Lecture 3: Surgical principles Flashcards
what are halsteds principles (7)
- Handle tissues gently
- Meticulous hemostatics
- Preserve blood supply
- Observe strict asepsis
- Minimize tissue tension
- Appose tissue accurately
- Eliminate dead space
what is the most appropriate thumb forcep to minimize tissue trauma
Debakey
minimize grabbing __ with thumb forceps
skin
never use scissors to cut __, will crush tissue
skin
what type of scissors do you use for tough tissue vs delicate
tough- mayo
Delicate- metzenbaum
what is the appropriate way to make scalpel cut
cut perpendicular to skin to avoid making multiple jagged slices for proper apposition
what are some complications of hemorrhage/bleeding
- Continued hemorrhage
- Hematoma
- Pain
- Anemia
- Delayed healing
what are ways to control hemorrhage
- Suture, hemp lips
- Manual pressure
- Electrocautery
- Hemostatic agents- gel foam, surgicel
what do you want to monitor to ensure patient isn’t bleeding post-op
- HR, RR, BP
- MM, CRT
- Pulse quality and pressure
- Mentation
- PCV/TS
clinical signs of hypovolemic shock develop only after __% blood volume has been lost
25-30%
what do you do if compromised instrument, gloved hand, etc has already touched your surgical field
lavage
t or f: use of antibodies is replacement for proper aseptic technique
false
what happens if suture too lose
- Dehiscence
- Leakage
- Contamination
what happens if suture too tight
- Dehiscence
- Compromised blood supply
- Patient discomfort/pain
what are some techniques to minimize tissue tension
- Releasing incisions
- Pre-op or perioperative skin stretching
- Walking sutures
- Skin grafts or flaps
- Healing by second intention with bandages
define dead space
tissue cavity that remains after incomplete closure of surgical or traumatic wound, leaving areas in which blood can collect and delay healing
how can your prevent iatrogenic creation of dead space
- Cautious and deliberate tissue dissection
- Only dissect minimum required
- Keep dissection along same tissue plane
proper closure of dead space will decrease risk of __, improve ___ healing, decrease __ and __
serum or hematoma formation, tissue, decrease pain and risk of infection
What are some techniques to eliminate dead space
- Strategic suturing- tacking down of tissue layers
- Closed suction drains
- Bandages
how do you pass hemostats, needle holders and scissors
in ready to use position- closed and give handle to surgeon
what instrument is this and what is it used for. Does this have scissor component
Mayo-Hegar needle driver- used to drive suture
Does not have scissor component
what are these and what are they used for
Mayo scissors- blunt and sharp tissue dissection
For dense fibrous tissue: linea alba, biceps fascia, joint capsule
What are these and what are they used for
Metzenbaum scissors: blunt and sharp tissue dissection for finer more delicate tissue
GI tract, bladder
what are these and what are they used for
general operating scissors used for non-tissue related cutting, drapes, suture
what are these and what are they used for
hemostats- used to clamp tissue pedicles or bleeding blood vessels
what is the smallest and largest hemostat
- Smallest- mosquito
- Largest- Rochester carmalt
What are these and what are they used for
Brown-Adson thumb forceps- skin closure and suturing
what are these and what are they used for
Adson (rat tooth)- grasp fascia
thumb forceps are used in non-dominant or dominant hand
non-dominant
what is most common suture handle used
Bard-Parker Nos. 3
where do you hold suture needle with hemostats
caudal 1/3 near swagged end
Suture needle should be pointed to the __in a right handed surgeon
left
what is a suture throw
twist of suture- simple knot
what is a surgical knot
2 throws
what is a granny knot
two simple throws in same direction- not good
what is a half hitch knot
one stand is pulled at 90 degree angle- not good
granny and half hitch knots are considered __ knots and must be covered with a __ to make them secure
slip knots, square knot
what is a square knot
two opposing/ mirro image simple throws
what type of knot is this
Strangles knot
what is a circumferential ligature used for
lighting small blood vessels, can be used for large vessels/pedicles if another more secure ligature is used
what This
Circumferential ligature
transfixation knot/ligature prevents ___
suture slippage
place transfixation knot/ligature __ to other ligature
distal
how do you do transfixation knot/ligature
- First bite through pedicle or vessel
- Square knot is made
- Suture wrapped around to other side and two square knots are made
how many throws/ square knots are required for simple interrupted
4 throws/ 2 square knots
What type of suture pattern
simple interrupted
How do you do crucitate
bite across incision twice before securing with minimum 4 throws/ 2 sqaures
what is common error for cruciate
too tight
What suture pattern
cruciate
simple continuous is less secure and entire line relies on
secure knot at bond ends and all bites engage proper holding layer
what suture pattern
simple continuous
what is key to intradermal pattern
bury your knots
how do you do intradermal pattern
- Deep to superficial your side
- Superficial to deep far side
- Horizontal bites
- To finish- superficial to deep (far side), deep to superficial your side, save loop then superficial to deep far side and tie 4-5 throws
what suture size used to close large dog body wall
0
what suture Size used to close cat body wall
2-0 to 3-0
what suture filament type will we be using
monofilament
absorbable is used for everything but __then use non-absorbable
skin cruciates
are poliglecaprone 25 (securocyrl) and polydioxanone (securodox) absorbable to not
absorbale
are nylon (securolon) absorbable or not
non-absorbable
what size suture using for pedicles (ovarian, uterine, spermatic) for 0-5kg, 5-10kg, and 10+kg
0-5kg:: 3-0 monocyrl
5-10kg: 3-0 or 2-0 monocryl
10+kg: 2-0 to 0 monocryl
what are you using for body wall for 0-5kg, 5-10kg, and 10kg+
0-5kg: 3-0 PDS
5-10kg: 2-0 or 0 PDS
10+kg: 0 PDS
what suture are you using for skin- intradermal layer for 0-5kg, 5-10kg, and 10+kg
0-5kg: 3-0 or 4-0 monocryl
5-10kg: 3-0 or 4-0 monocryl
10kg+: 3-0 monocryl
what suture are you using for skin-external cruciate layer for 0-5kg, 5-10kg, and 10kg+
0-5kg: 4-0 nylon
5-10kg: 3-0 or 4-0 nylon
10kg+: 3-0 nylon
