Lecture 7: Principles of Tissue Handling

Question 1

Why is good surgical tech important

Answer 1

Affects the outcome

Question 2

Define heuristics

Answer 2

Elements of a skill

Question 3

What are the 3 types of heuristics in surgery

Answer 3

• Cognitive
• Perceptual
• Motor

Question 4

Define Cognitive heuristics

Answer 4

Planning movements

Question 5

Define perceptual heuristics

Answer 5

Recognizing tissues

Question 6

Define motor heuristics

Answer 6

Handling tissues

Question 7

There is a trade off btw/ what when discussing surgical movements

Answer 7

Speed & accuracy

Question 8

How do good surgeons perform

Answer 8

Less repetition & fewer mistakes than the novice

Question 9

What surgical principles are attributed to Halsted

Answer 9

• Handle tissue gently
• Control hemorrhage meticulously
• Observe strict aseptic tech
• Preserve blood supply to tissue
• Eliminate dead space
• Appose tissues accurately w/ min tension

Question 10

What surgical skills are need for safe, efficient, & reproducible surgical tech

Answer 10

• Instrument Handling
• Tissue dissection & manipulation
• Suturing
• Knot tying
• Hemostasis
• Wound closure

Question 11

What do we need to protect tissues from

Answer 11

• Crushing
• Drying
• Heat loss
• Hemorrhage
• Loss of vascular supply

Question 12

List the four motions of the scalpel

Answer 12

• Sliding
• Pressing
• Sawing
• Scraping

Question 13

List the use of scissors

Answer 13

• Cut or dissect tissues
• Cut inanimate objects
• Should be used only for their intended

Question 14

Pros of curved scissors

Answer 14

Greater maneuverability & visibility

Question 15

Pros of straight scissors

Answer 15

Greater mechanical advantage for cutting dense tissue

Question 16

inefficient use of needle holders accounts for what

Answer 16

More wasted time than poor tech w/ any other surgical instrument

Question 17

What should not be used on tissue slated to remain in the px

Answer 17

Allis & Babcock forceps

Question 18

What can hemostatic forceps be used for

Answer 18

• Isolation of bleeder
• Blunt dissection

Question 19

What should be considered by towel clamps

Answer 19

• Know what you are penetrating under the drape
• May be used to assist in closing wounds under tension
• Consider substituting nonpenetrating clamps in the overdrape

Question 20

What should be avoided when using retractors

Answer 20

• Avoid sensitive structures (vessels & nerves)
• Avoid excessive opening

Question 21

What suction tip is used for body cavities

Answer 21

Poole tip

Question 22

What suction tip is used for oral cavities

Answer 22

Yankauer tip

Question 23

What suction is used for neurosurgery & bulla osteotomy

Answer 23

Frazier tip

Question 24

What precautions are there with tissue dissection & manipulation

Answer 24

• Cautious & deliberate dissection
• Dissect along tissue planes (sharp or blunt)
• Pay attention to lines of tension
• Limit tissue manipulation
• Know when to use fingers instead of instruments
• Use the right instruments
• Consider stay sutures instead of forceps
• Keep tissues moist & patient warm!

Question 25

What needs to be done for proper suturing

Answer 25

• Use the right suture pattern
• Use the right needle
• Correct needle placement is critical
• Minimize tissue handling when placing sutures
• Do not over tighten (achieve apposition & avoid ischemia)

Question 26

What needs to occur for proper knot tying

Answer 26

• Secure knots
• Appropriatley buried
• Absorbable suture is only absorbable when it is buried in tissue
• On abdominal closures leave some space btw/ the knots & the skin
• Continuous closures are faster

Question 27

Describe the Aberdeen knot

Answer 27

• Alternative to the square knot @ the end of a continuous line, when the surgeon is left w/ a loop & a free end
• Knot volume is 32 to 56 per cent of traditional square knots
• Knot holding capacity is 24 per cent greater than traditional square knots