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Soft Tissue Surgery > Midterm > Flashcards

Midterm Flashcards

1
Q

Name the stages of wound healing and the associated times

A 
0-5 min Coagulation
0-24h min Inflammation
2-5 days Debridement
4-21 days Proliferation
21 days-2 years Maturation
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2
Q

What is the lag phase of wound healing

A

Debridement

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3
Q

What is the log phase of wound healing

A

Proliferation

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4
Q

In wound healing, what is the hallmark of coagulation

A

Platelet plug (by platelets and vWF)

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5
Q

What time frame indicates Class 1 wound

A

First 6 hours, golden period

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6
Q

What time frame indicates Class 2 wound

A

6h- 12 hours

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7
Q

What time frame indicates Class 3 wound

A

> 12 hours

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8
Q

Describe tissues with accelerated healing times, compare to skin

A

Urinary bladder 100% in 14 days
GI - 75% in 14 days
LI - 50% in 14 days
Skin- 20% in 20 days

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9
Q

Describe a clean surgical wound

A

No break in aseptic technique, no GI or respiratory involvement

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10
Q

Describe a clean-contaminated sx wound

A

Small break in asepsis or entry into GI/respiratory

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11
Q

Describe a contaminated sx wound

A

Major break in asepsis, inflammation without infection, GI gross contamination

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12
Q

Describe a dirty wound

A

Devitalized, necrotic, pus/infection, gross debris

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13
Q

What are the 6 perfusion parameters

A

MM, mentation, CRT, extremity temperature, pulse strength/deficit, BP

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14
Q

What suture should be used for body wall closures

A

40 kg - 1
Horse 3
(or 0-5, 5-25, >25)- 3-0, 2-0, 0

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15
Q

Describe primary closure

A

Immediate closure in less than 6 hours (golden period

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16
Q

Describe delayed primary closure

A

Closure between 6h and 2d, in debridement phase prior to granulation

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17
Q

Describe delayed secondary closure

A

Greater than 2 days, after appearance of granulation tissue

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18
Q

Describe second intention closure

A

Allowing wound to heal on its own, no sx

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19
Q

Describe “skin sutures”

A

Epidermis and dermis

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20
Q

Describe “subcutaneous” sutures

A

Subcutis only

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21
Q

Describe “subcuticular” sutures

A

Subcutis and small amount of dermis

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22
Q

Describe “intradermal” sutures

A

In dermis only

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23
Q

What is the most versatile forceps

A

Brown adson

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24
Q

What direction are serrations on halstead mosquito; What directions are serrations on Carmalt

A

Perpendicular to jaw; parallel to jaw

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25
Q

What grip is like palm but has third finger in ring

A

Thenar eminence

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26
Q

Longer needle holders give more ___, shorter needle holders give more _____

A

Power, precision

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27
Q

What retractors are best for abdomen

A

Balfour (think belly)

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28
Q

What retractors are best for thorax

A

Finochetto (think fino-chest-o)

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29
Q

Which retractors are best for orthopedics

A

Gelpi and hohmann

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30
Q

What should instruments be rinsed in

A

Distilled or tap water

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31
Q

When are eyed needles used

A

First stitch of extracapsular repair

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32
Q

What needle does Dujo recommend for subcuticular tissue and why

A

Reverse cutting (taperpoint can dull)

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33
Q

How do reverse cutting needles open the skin

A

Cut rather than dilate like taperpoint

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34
Q

What needle is used for eye surgery

A

Spatula point

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35
Q

What type of pattern is cruciate

A

appositional, low/mod tension relief

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36
Q

What type of pattern is horizontal mattress

A

everting, tension relieving

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37
Q

What kind of pattern is vertical mattress? Describe the pattern

A

Everting but not as much as horizontal, stronger tension relief than horizontal, far far near near

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38
Q

What pattern is used in intestinal surgery? Why?

A

Gambee - reduces mucosal eversion

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39
Q

What layers does gambee go through

A

Mucosa and muscularis

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40
Q

What is the holding layer of the intestines

A

Submucosa

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41
Q

What type of pattern is lembert? what is it used for

A

Inverting continuous, used in stomach, bladder mucosa

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42
Q

What kind of patterns are Connell and Cushing, what is the difference between them

A

Inverting continuous; Connell enters lumen and Cushing does not- only goes to submucosal

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43
Q

What knot is used in extracapsular repair

A

Half hitch

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44
Q

What makes up the epidermis

A

Cuboidal and stratified epithelium

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45
Q

What makes up the dermis

A

Mostly collagen

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46
Q

What makes up the hypodermis

A

Fat and connective tissue

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47
Q

Where is the direct cutaneous artery and vein

A

Hypodermis

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48
Q

What are the clotting factors of the intrinsic pathway

A

12, 11, 9, 8

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49
Q

What are the clotting factors of the extrinsic pathway

A

3, 7

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50
Q

What are the clotting factors of the common pathway

A

10, 5, 2, 1

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51
Q

What is primary coagulation

A

Platelet plug

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52
Q

What is secondary coagulation

A

Fibrin plug from clotting cascade cleaving fibrinogen to fibrin

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53
Q

How long does the inflammation phase of wound healing last

A

0-24 hours

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54
Q

Describe the inflammation phase of wound healing

A

Platelets release cytokines (TGF, TNF, PDGF) to recruit neutrophils

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55
Q

When do macrophages enter the wound?

A

At max 36 hours, during inflammatory phase, after neutrophils are ramping down

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56
Q

What marks the beginning of the debridement phase

A

Macrophages

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57
Q

How do bacteria prolong debridement

A

Metalloproteinase and collagenase, change in pH

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58
Q

How long is the proliferation phase

A

4-21 days

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59
Q

What marks the start of proliferation phase

A

Influx of fibroblasts from cytokine release by macrophages (FGF, TGF, PDGF)

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60
Q

What material provides wound strength in proliferation phase

A

Type 1 collagen

61
Q

When does contact inhibition occur

A

At end of epithelialization phase within proliferation phase when epithelial cells cross basement membrane and touch

62
Q

What is contraction

A

Second intention healing at about 1 week, myofibroblasts produce actin and myosin to contract the wound by pulling ECM at 1mm/day

63
Q

When is the second lag phase

A

21d-2y - Maturation phase

64
Q

What happens in the maturation phase

A

reorganization of fibers, cross linking, linearization

65
Q

T/F tensile strength is increased in Maturation phase

A

False- minimal at best

66
Q

Name intrinsic wound healing factors

A

Hypoproteinemia, DM, malnutrition, anemia, cushings, infection, uremia

67
Q

How does uremia affect wound healing

A

Down-regulates epithelialization and decreases collagen deposition

68
Q

How does hypoproteinemia affect wound healing

A

Less protein for factors, less fibrous tissue deposition

69
Q

How does DM affect wound healing

A

peripheral ischemia

70
Q

What are the extrinsic factors of wound healing

A

Mechanism of injury (crush, shear, laceration), foreign materia, irradiation, antiseptics

71
Q

When in wound healing should abx be used; which kind?

A

Class 2/3, clean-contaminated/dirty; broad penicillins, cephalosporins

72
Q

What should lavage be performed with and at

A

Physiologic 0.9% saline at 6/7-8 psi via pressure cuff at 300mmHg

73
Q

Layers of wet to dry

A

4x4 soaked in physio or hypertonic saline, dry lap sponges, vet wrap

74
Q

When shouldnt wet to dry be used

A

After debridement

75
Q

When are drains indicated

A

Dead space, pocketing, abscess

76
Q

What is the preferred drain type, describe

A

Active (vs passive) - creates vacuum to remove fluid/dead space (butterfly and red top tube)

77
Q

Describe passive drain

A

Penrose tubing using gravity

78
Q

How long should drains be left in

A

3-5 days

79
Q

What is the gold standard dx for septic peritonitis

A

Cytology (BG more than 20 difference, lactate

80
Q

Name the causes of perforation

A

Foreign body, intuss, volvulus, abscess, granuloma, trauma, tumor

81
Q

How does perforation affect wound healing

A

Decreased collagen synthesis (elevation in TNFa), collagen destruction by collagenases from bacteria

82
Q

How can obstruction be diagnosed

A

US > rads - SI > 2 times L5 vertebral body

83
Q

Diagnose peritonitis via abdominocentesis cytology

A

> 13000 nucleated cells, intracellular bacteria

84
Q

Describe bilroth I sx

A

Pylorectomy with gastroduodenostomy

85
Q

Describe bilroth II sx

A

Pylorectomy with gastrojejunostomy

86
Q

Complication of bilroth I sx

A

Removal of common bile duct

87
Q

What three things can cause surgical failure

A

Pre-existing peritonitis, foreign body in intestine, albumin less than 2.5 g/dL

88
Q

Compare open vs closed drainage for peritonitis sx

A

Open many bandage changes, needs second sx, but can continually eval; closed less hospitalization, less infection, higher survival, no second surgery

89
Q

What type of drainage does UF prefer

A

Closed

90
Q

When should OVH/E be done to avoid mammary neoplasia

A

before 1st or 2nd heat in dogs, before 6 months in cats

91
Q

What causes pyometra

A

Luteal phase progesterone

92
Q

Vascular pedicle knots

A

Strangle or Miller’s

93
Q

Preferred terminal knot- repro

A

Aberdeen bc smaller, les trauma, less infection

94
Q

Closed vs open castration

A

Open enters vaginal tunic

95
Q

1 complication- castration

A

Hemorrhage (hematoma, hemoabdomen, urerteral or urethral ligation)

96
Q

1 complication- OVE

A

Hemorrhage, ureteral ligation, ORS

97
Q

What is ORS

A

Ovarian remnant syndrome - worse on R side

98
Q

Preferred peritoneal access in laproscopy

A

Modified Hasson (vs veress)

99
Q

Light source- laproscopy

A

Xenon 100-300 watts

100
Q

Telescope size- laproscopy

A

5mm (sometimes 10mm) bigger= wider field of view

101
Q

Ligasure stats

A

vessels up to 7mm, withstand 3x systolic pressure (300mmHg)

102
Q

Sterilize tools- laproscopy

A

Ethylene oxide or gas plasma

103
Q

Cold sterilization of scopes- laproscopy

A

2% glutaraldehyde

104
Q

Contraindications- laproscopy

A

Advanced or exploratory (adrenalectomy, choecystectomy, splenectomy)

105
Q

Physio effects- laproscopy

A

Respiratory pressure, vena cava collapse at 20mmHg

106
Q

Target pressures- laproscopy

A

Dogs-

107
Q

Pain sources- laproscopy

A

Incision, peritoneal CO2 acidosis/irritation, neuropraxia of nerves from pressure)

108
Q

Preferred technique- OVH, OVE laproscopy

A

OVH: 3 ports, on midline (pitcher- scope, instruments at 1st and 3rd);
OVE 2 ports- 1cm caudal to umbilicus (camera), 2-4 cm cranial to umbilicus

109
Q

Closure of ports- laproscopy

A

5mm- Subcutaneous and skin; 10mm- linea, subcutaneous, skin

110
Q

Common complication- gastropexy via scope

A

Seroma, splenic laceration, serosal tearing

111
Q

Body wall closure- holding layers

A

Linea alba and external rectus abdominus sheath/fascia

112
Q

Body wall closure- linea bites

A

Cranial- full thickness through linea; caudal 1/3 wide, partial thickness of ext. rectus fascia

113
Q

Suture peritoneum?

A

No! Increases adhesion risks, mesothelial cells close on own in three days

114
Q

Body wall closure- pattern

A

Continuous, 5 throws at start, 7 throws at end

115
Q

Body wall closure- suture SA

A

PDS (or maxon polyglyconate) ( monofil absorbable

116
Q

Body wall closure- suture LA

A

Vicryl #3 horses

117
Q

Body wall closure- bite sizes/position

A

0.5-1cm from incision, apart

118
Q

Suture material- most tensile strength

A

PDS, maxon (aka polydioxanone, polyglyconate)

119
Q

How should you incise the skin

A

Parallel to Langers lines of tension

120
Q

What is undermining

A

Removing subcu from skin

121
Q

Skin closure- typical closure combination

A

Subcutaneous (or intradermal to avoid licking complications) and skin with continuous pattern (5-10mm between bites)

122
Q

Subcutaneous skin closure- material, size, pattern

A

Non-reactive monofil absorbable PDS, vicryl, Maxon, monocryl; interrupted or continuous; 1-2 sizes smaller than linea (0- 4-0)

123
Q

T/F subcutaneous is a holding layer

A

FALSE, need additional layer above

124
Q

Cutaneous- material, pattern

A

(skin suture) Nylon mono NO BRAIDED, abs or non, Cruciate or simple interrupted

125
Q

Intradermal- material, pattern

A

Absorb monofilament (vicryl, PDS, monocryl), 3-0 to 4-0; Deep-sup- sup-deep; 4 throws in knots

126
Q

Brand name polydioxanone

A

PDS

127
Q

Brand name polyglyconate

A

Maxon

128
Q

Brand name polyglactin 910

A

Vicryl #3

129
Q

Brand name polyglecaprone

A

Monocryl

130
Q

Intradermal cons and pros

A

Difficult, slow, no dead space elimination, low tension only- cosmetic, no suture removal

131
Q

Laparotomy (GI explore) advantages

A

Full biopsy, excision, address hemorrhage, intervention

132
Q

Indications for laparotomy- diagnostic

A

PLE, hepatopathy (MVD, copper storage), neoplasia

133
Q

Indications for laparotomy- therapeutic

A

Rads (free gas, dilated SI, foreign, herniation, GDV); abdominocentesis (high PCV, clots=acute hemorrhage, urine (creat/K >in fluid than serum), cylotoly( neutrophils, intracell bacteria), bile pigment

134
Q

What is the holding layer for abdominal wall

A

External rectus fascia

135
Q

Peri-op Abx

A

Cefazolin

136
Q

Laparotomy prep- scrub skin

A

Clorhex gluconate 10 min, then 5 min in OR

137
Q

Visualization in abdomen, L and R side help

A

L- mesocolon; R mesoduodenum

138
Q

Where is the portal vein

A

Epiploic foramen under duodenum and ventral

139
Q

Peritoneal lavage amount in contamination

A

50mL/kg

140
Q

LA- most common sx complications- anesthesia

A

myopathy, neuropathy

141
Q

LA- most common sx complications- sx

A

hemorrhage, airway obstruction

142
Q

LA- most common sx complications- post op

A

Infection, dehiscence, colic, laminitis

143
Q

Reduce anesthesia complications

A

MAP >60mmHg, pCO2 45-65, pO2 >60

144
Q

pO2 saturation at 90%

A

Dog- 57/58mmHg; Horse 54mmHg

145
Q

PCV/TP min- LA sx

A

20%, 3.5g/dL

146
Q

How much blood in a 500kg horse

A

40L (8% body) (25L plasma)

147
Q

Acute blood loss max horse

A

20-25% shock, 50% death - transfuse >10L lost

148
Q

Safe amount blood from donor

A

20% blood total (1.6% BW kg)

149
Q

Transfusion formula

A

(PCVdesired-PCVactual)/PCVdonated x patient blood volume (8% BW)

Soft Tissue Surgery (2 decks)

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