Part two - operative Flashcards
Small bowel resection
Small bowel run DJF to TI Identify limits of resection Ligation and division of blood vessels Resect diseased segment Anastomosis Closure of mesenteric defect Washout Closure
Vicryl (Ethicon)
Polyglactin = copolymer of lactide and glycolide
Coated with polyglactin 370 and calcium sterate
Synthetic
Braided usually but can get monofilament variant
Violet / undyed
Strength retention 75% at 2 weeks, 25% at four weeks
Absorption 63 days, minimal until day 40
Hydrolysis
Good strength retention
Minimal memory
Good knot security
Minimal tissue reaction
Rapide variant - undyed, absorbed 42 days, 0 strength at 14 days, 50% at 5 days
Monocryl (Ethicon)
Poliglecaprone 25 Synthetic Monofilament Undyed / violet 60% at one week, 30% at two weeks 100 days Hydrolysis
Pilability
Smooth passage
Slight tissue reaction
Undyed is weaker by 10&
PDS* II (Ethicon)
Polydioxanone Synthetic Monofilament Violet / clear 70%, 50%, 30% at 2, 4, 6 weeks 200 days, minimal before 90 days Slow hydrolysis
Longest lasting absorbable synthetic suture
Maxon (Tyco)
Polyglyconate from glycol acid and trimethylene carbonate Synthetic Monofilament Green 80%, 50% at one week and one month 180 days, minimal before day 60
0 Maxon on taper point 5/8 needle
Ethibond EXCEL (Ethicon)
Polyester / dacron Synthetic Coated with polybutilate Braided Green / white Non-absorbable Indefinite retention of strength
Ethilon (Ethicon)
Nylon 6 Synthetic Monofilament Black / blue / clear Losses 20% strength / year Non-absorbable
Prolene (Ethicon)
Polypropylene Synthetic Monofilament Blue / clear Non-absorbable Indefinite retention of strength
Superior strength
Unsurpassed smoothness reduces suture chattering
What type of needle is used for cutting?
Reverse cutting with flat edge forwards such that less likely to cut out.
Suture size
6/0 - 0.076 mm 5/0 - 0.102 mm 4/0 - 0.152 mm 3/0 - 0.203 mm 2/0 - 0.254 mm 0 - 0.33 mm 1 - 0.41 mm
Principles of pilonidal surgery
Drain infections acutely Excise all the disease Closure off the midline Flatten the natal cleft Meticulous hygiene and regular shaving of hair
Contrast agent for IOC
Omnipaque 300mg iodine per ml
50ml contrast with 50ml saline
Contains iodine -> hypersensitivty, thyrotoxicosis, etc
Lactation - pump and dump for 24 hours
Pregnancy - ok in animal studies so OK in humans if very good reason
Distal gastrectomy
- Incision and exposure
- Exploration
- Enter lesser sac
- Proximal transection
- Take right gastric & gastroepiploic vessels
- Distal transection
- Reconstruction
- Drain(s) & close
Risk factors for anastomotic leak
Patient factors
- Malnutrition
- Smoking
- Alcohol abuse
- COPD
- Radiation
- Steroids
Disease factors
- Peritonitis
- Obstruction
- Blood transfusions
Technical
- Operative time > 4-6 hours
- Operative contamination
- Tension
- Blood supply
- Alignment
What is patent blue dye?
Patent blue V dye is a synthetic dye from the triarylmethan group of dyes. It is used in medical practice and less commonly as a blue food dye.
