Lecture 7 9/3/24 Flashcards
What should be considered when choosing an incision location?
-location of organs
-tissue to be removed/margins needed
-potential side effects of incision
What are the “tips” for making incisions?
-use an overhand grip for long incisions and a pencil grip for short or irregular incisions
-use non-dominant hand on top of drapes/within surgical field for steadiness
-want a steady stroke with blade edge perpendicular to tissue
What are the steps for subcutaneous vessel ligation prior to transection?
-dissect around the vessel to isolate it
-place two sutures or hemostats on vessel
-transect vessel 3mm from each ligature
What are the hemostasis options for transected subcutaneous vessels that were not previously ligated?
-place pressure with a sponge to slow bleeding before grabbing vessel with hemostats and ligating below the grip
-take a tissue bite around the vessel with the suture needle
-grasp vessel with forceps and clamp with a hemostat until it clots off
What are the steps for disrupting thicker fascial attachments?
-spread tissue in layers with scissors (Metzenbaums) to make them see through
-ligate if the tissue is highly vascular and then transect
-transect sharply with scissors or cautery if tissue has minimal vasculature
What are the ligation options for large blood vessels?
-encircling ligatures
-friction knots
-transfixing-encircling ligatures
What are the indications for a drain?
-remove harmful fluids, air, microbes, or toxins
-prevent seromas and hematomas
-eliminate dead space
-allow infusions
What are the characteristics of passive drains?
-preferably radiopaque, soft, and minimally reactive material
-secured dorsally when possible
-exit ventrally through wide hole
-covered with sterile dressing
-require frequent bandage changes
-left in until fluid volume decreases and character improves (2-5 days)
What is the most common type of passive drain?
penrose drain
What are the characteristics of active drains?
-more expensive than passive drains
-do not require bandage changes
-reduced risk of infection
-wound must be sealed and negative pressure generated
-exit site usually covered with dressing
-left in until fluid production is less than 4.8 ml/kg/day in small animal
What are the characteristics of surgical site closure?
-done in functional layers from deep to superficial
-suture material and pattern chosen based on tissue strength, rate of healing, and situation
-taper or taper-cut needle for all tissues except skin
-absorbable suture for all tissues except skin
-tack SQ tissue down to fascia in non-mobile areas to eliminate dead space
What are the options for managing skin tension?
-elevation of subcutaneous tissues
-multiple layer closures to spread out tension
-skin flaps or releasing incision
-open wound management
What can cause dog ears on an incision line?
-irregular shape of skin incision
-one skin edge longer than the other
-one skin edge under more tension than the other
What are the potential problems that arise from dog ears?
-dead space
-tension
-irritation
-poor cosmetic appearance
What are the steps for closing an irregular wound using the “halves” method?
-place first suture across the center, forming two smaller gaps on either side
-place next sutures across the center of each smaller gap
-place additional sutures across the center of each new gap; repeat until incision is closed
What are the options for correcting dog ears?
-shorten tissue on longer side with a triangle cut
-cut dog ear off at base
-remove overlapping portion on one side with an angled incision
-leave dog ear in place; may shrink over 2-6 months of healing
What is important about creating L, T, Y, and X shaped incisions?
each additional corner increases the likelihood that the wound will fail to heal appropriately
What are the options for skin closure?
-intradermal patterns
-skin glue
-skin sutures
-staples
What factors affect the chosen skin closure method?
-unstable animal
-long, irregular, or uneven incision
-owner compliance
-financial constraints
-location, especially around eye
-expectation of delayed healing
-contaminated surgery
