Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery literally enochs + stuff that I can't remember > Lecture 4: Surgical Skills > Flashcards

Lecture 4: Surgical Skills Flashcards

1
Q

What is a clean wound and how is it closed?

A
  • Uninfected operative wound, no inflammation, no systemic tract is entered (resp/GI)
  • Closed by primary intention and no drainage.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a clean contaminated wound?

A
  • Operative wound where systemic tracts are entered under controlled conditions without contamination
  • Ex: lung surgery, appendix, vaginal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a contaminated wound?

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

Infection can occur within 6 hours of contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an infected wound?

A
  • Heavily contaminated/infected wound PRIOR to operation
  • Ex: Perforated viscera, abscesses, necrotic tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is primary intention?

A

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

Takes place in 3 phases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the inflammatory phase of primary intention healing

A

Begins immediately and completed by day 3-7
* hemostasis occurs
* extravasation of tissue fluid, cell, and fibroblasts
* increasing blood supply to wound
* debridement of tissue debris by proteolytic enzymes

inc. in tensile strength of tissue and wound healing is dependent on approximation of edges by closure material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

How approximated edges are by suture material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the proliverative stage of primary intension healing?

A

Starts from day 3
* fibroblasts form a collagen matrix
* this matrix determines the tensile strength and plability of the healing wound
* Becomes vascular, supplying the nutrients and oxygen necessary for wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is wound contraction?

A
  • Wound edges pulling together. If successful, results in smaller wound with less need for repair by scar formation
  • Good in buttocks/trochanter
  • Bad in hand, neck, or face, which can be reduced via skin grafting.

Part of proliverative stage in primary intention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the remodeling part of primary intention

A

may continue for a year +
* following completion of collagen deposition vascularity decreases and any surface scar becomes paler.

resultant scar size is dependent on initial volme of granulation tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is tensile strength greatest in primary intention?

A

10 weeks, at which point it is around 80%

20% @ 2 weeks
50% @ 5 weeks
80% @ 10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is primary intention wound closure performed with?

A

sutures
staples
tape/glue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When does secondary intention occur?

A

Wound fails to heal by primary intention

d/t infection, excessive trauma, tissue loss, imprecise approximation of tissue (dead space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the concern with secondary intention?

A

Excessive granulation tissue, which contains myofibroblasts leading to gradual but marked wound contraction
may protrude above wound surface, prevent epithelialization and require additional tx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is delayed primary closure used?

A

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

trauma, penetrating injury

17
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
18
Q

Do you hold the forceps or the driver in your dominant hand? What fingers are used?

OK THIS WONT BE A QUESTION BUT I AM PARANOID

A

Forceps with non dominant, hold in the first 3 fingers (like a pen)
Needle-holder in dominant hand, partially insert the thumb and ring finger in the loops of the handle

just 5 this

19
Q

Needle shapes image

A
20
Q

Image of 5 needle points

A
21
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 damage as possible, usually with tapered/reverse non-cutting needles.

Generally, taper for delicate, reverse for skin/tough

22
Q

When is the conventional cutting used?

A

skin, sternum

23
Q

When is the reverse cutting needle used?

A

fascia, ligament, nasal cavity, mucosa, pharnxy, skin, tendon sheath

preferred for skin and tougher tissues

24
Q

When is the taper needle used?

A

aponeurosis, biliary tract, dura, fascia, GI tract, laparoscopy, muslce, myocardium, nerve, peritoneum, pleura, subcutaneous fat, urogenital tract, vessels, valve…..pass

preferred for delicate tissues

when in doubt, choose taper for everythign except skin sutures

25
Q

When should taper needles NOT be used?

A

Skin, which is dense and may bend the needle.

Otherwise taper is good.

26
Q

What is the preferred cutting needle?

A

Reverse cutting

Good for skin, whereas taper is not.

decreases likelihood of sutures pulling through soft tissue

27
Q

Where is the cutting edge for the traditional cutting needle?
what about for the reverse cutting needle?

A

traditional cutting needle: inside of the curve (concave surface)
reverse cutting needle: outter surface of the curve (convex surface)

28
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
29
Q

What are the pros of elasticity/monofilament sutures? what tissue should it be used on?

A
  • Pros: Returns to original length after it’s stretched
  • Mainly used for edematous tissue
30
Q

What is knot strength?

A

Force required for a knot to slip.

important to consider when ligating arteries

31
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 d/t better cosmetic result
32
Q

What are the 2 multifilament sutures and their features?

A
  • Vicryl and silk
  • Easier to handle and tie, less likely to slip.
33
Q

What are the non-absorbable suture materials?

natural and synthetic

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

Left in place indefinitely or removed once adequate healing occurs.

34
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 small kids face

Monocryl and PDS are also broken down by hydrolysis.

35
Q

Summary of absorbable suture materials

A
36
Q

How is suture size scaled?

A

0 to 12/0

0 is largest, 12/0 is smallest.

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

37
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 literally enochs + stuff that I can't remember (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions