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Surgery > Lecture 4: Surgical Skills > Flashcards

Lecture 4: Surgical Skills Flashcards

1
Q

What is a clean wound and how is it closed?

A
  • Uninfected, no inflammation, no systemic tract (resp/GI)
  • Closed by primary intention and no drainage.
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2
Q

What is a clean contaminated wound?

A
  • Systemic tracts are entered under controlled conditions without contamination
  • Ex: lung surgery, appendix, vaginal
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3
Q

What is a contaminated wound?

A
  • Open traumatic wound
  • Operations with spillage from GI/GUbiliary tracts
  • Break in aseptic technique (open cardiac massage)

Infection can occur within 6 hours of contamination

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4
Q

What is an infected wound?

A
  • Heavily contaminated/infected wound PRIOR to operation
  • Ex: Perforated viscera, abscesses, necrotic tissue
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5
Q

What is primary intention?

A

Optimal closure method with no edge separation and minimal scar formation.

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6
Q

What are the 3 phases of primary intention?

A
  1. Inflammatory (hemostasis => extravasation) + increased tensile strength
  2. Proliferative (day 3, collagen matrix + increasing tensile strength)
  3. Remodeling (lasts for a year+, area turns paler and devascularization)
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7
Q

What determines tensile strength and wound healing in the inflammatory phase of primary intention?

A

How approximated edges are by suture material

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8
Q

What is wound contraction?

A
  • Wound edges pulling together.
  • Good in buttocks/trochanter
  • Bad in hand, neck, or face, which can be reduced via skin grafting.
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9
Q

When is tensile strength greatest in primary intention?

A

10 weeks, at which point it is around 80%

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10
Q

When does secondary intention occur?

A

Wound fails to heal by primary intention

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11
Q

What is the concern with secondary intention?

A

Excessive granulation tissue, which may prevent epithelialization and require additional tx.

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12
Q

When is delayed primary closure used?

A

Contaminated and infected wounds with high tissue loss and risk of infection

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13
Q

How is delayed primary closure achieved?

A
  • Debridement of nonviable tissue
  • Leave wound open with packing/vacuum system
  • Wound approximation within 3-5d of no infection
  • If infection present, leave to secondary intention
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14
Q

Needle shapes image

A
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15
Q

Image of 5 needle points

A
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16
Q

What is the goal when choosing a suture needle and what is generally the MC?

A

Alter tissue to be sutured with as little as possible, usually with tapered/non-cutting needles.

Generally, taper for delicate, reverse for skin/tough

17
Q

When should taper needles NOT be used?

A

Skin, which is dense and may bend the needle.

Otherwise taper is good.

18
Q

What is the preferred cutting needle?

A

Reverse cutting

Good for skin, whereas taper is not.

19
Q

What are the pros/cons of a memory/nylon/PDS suture?

A
  • Pros: Returns to previous shape when deformed.
  • Cons: Difficult to tie and unravel
20
Q

What are the pros/cons of elasticity/monofilament sutures?

A
  • Pros: Returns to original length once stretched
  • Mainly used for edematous tissue
21
Q

What is knot strength?

A

Force required for a knot to slip.

Surgeon’s knots are used when ligating

22
Q

What are the 3 monofilament sutures and their features?

A
  • PDS, Monocryl, Nylon
  • Less traumatic due to less friction
  • Lower rates of infection
  • More likely to slip, requiring 5-6 throws vs 3 for multi
  • Preferred for skin closure
23
Q

What are the 2 multifilament sutures and their features?

A
  • Vicryl and silk
  • Easier to handle and tie, less likely to slip.
24
Q

What are the non-absorbable suture materials?

A
  • Natural: Silk (braided)/cotton/steel
  • Synthetic: Prolene (mono), Ethilon (nylon-mono)

Left in place indefinitely or removed once adequate healing occurs.

25
Q

What are the absorbable suture materials?

A
  • Natural: catgut, collagen-based for 1 week.
  • Natural: chromic catgut: collagen + chromium, take 3 months to breaht down.
  • Synthetic: Vicryl is degraded by water, minimal reaction by tissue compared to catgut.

Catgut used on face commonly.

Monocryl and PDS are also broken down by hydrolysis.

26
Q

Summary of absorbable suture materials

A
27
Q

How is suture size scaled?

A

0 to 12/0

0 is largest, 12 is smallest.

They had to add on numbers as we got better technology, so higher number = smaller suture

28
Q

Suture Removal Timings

A
  • Face: 3-4d
  • Scalp: 5d
  • Trunk: 7d
  • Limb: 7-10d
  • Foot: 10-14d

You need more tensile strength in feet

Surgery (8 decks)

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