Prac Class Review Questions

Question 1

When may it be appropriate to use a slip knot with a monofilament suture rather than the traditional surgeon’s or square knot throw?

Answer 1

To secure the first throws of a suture line into a deep space and for tight ligatures

Question 2

List 2 advantages of monofilament suture over multifilament suture material?

Answer 2

1. The smooth edge of the monofilament suture is less traumatic to tissue than multifiulament when pulled through. 2. Monofilament material doesn’t wick bacteria / fluid into the wound

Question 3

Between the locking loop and three loop pulley patterns, which is the preferable tendon suture pattern and why?

Answer 3

The three loop pulley pattern because it is more resistant to gap formation during tensile loading and is quicker to place.

Question 4

What else must you do to ensure a tendon will heal after suturing the ends together?

Answer 4

The sutured tendon ends must be protected from tension for 3-4 weeks.

Question 5

When closing a midline approach to the abdomen, which tissue layer must be included to ensure a strong closure?

Answer 5

The external rectus sheath

Question 6

Inclusion of the peritoneal layer during abdominal closure is no longer recommended. What reasons support this?

Answer 6

1. Increased closure time 2. No added strength 3. Inclusion may increase risk of adhesions 4. Inclusion may increase post-operative pain

Question 7

When will you commence enteral nutrition of a patient having undergone a gastrotomy?

Answer 7

For the first 12 hrs give water - allow time for fibrin seal to form before stomach use. Then give small amounts of soft, high energy food every 4 hours to nourish the gut enterocytes. Reintroduce normal food very gradually over the next 10 days.

Question 8

When is it appropriate to bury a knot?

Answer 8

The subcutaneous layer so the knot does not poke out through the skin and encourage wicking of bacteria.

Question 9

When is it not appropriate to bury the knot?

Answer 9

Linea alba - may cause peritonitis. Joint capsule.

Question 10

Friday night 11pm: you are presented with an unstable closed mid shaft fracture of the radius and ulna of a 5 month old kelpie. Surgery will not be able to be performed until after the week end. What can you do?

Answer 10

Robert Jones bandage, lateral splint or carpal spoon splint and cage rest over weekend.

Question 11

You have successfully reduced a fresh coxofemoral luxation and are happy that it feels stable. What else might you do to improve the chances of maintaining this reduction?

Answer 11

An Ehmar sling for 2-3 weeks (if you’re lucky)

Question 12

You are presented with a 6 week old pup with a fracture to the spine of the scapula. You wish to stabilise this fracture until such time as you can gather further advice on treatment.

Answer 12

Apply a velpeau sling or a spica splint

Question 13

This photo represents the carpus of a kelpie. The dog went missing for 24 hours and came home with this wound. Dot point your management of this case. Focus on wound only, presume dog otherwise healthy.

Answer 13

• Prevent further contamination - apply KY jelly.
• Lavage with Heartmans
• Hydrogel / Intrasite
• Melolin
• Softban
• Vet wrap
• Check up tomorrow

Question 14

You have just sutured a severe laceration to the pad of the front foot of a very active dog. You want to make sure that no extra tension is placed on this wound until it heals. How might you support this repair?

Answer 14

Velpeau sling to avoid dog walking on newly sutured footpad OR a heavily padded foot bandage and protective booty

Question 15

Discuss your choice of suture patterns to close a gastrotomy site:

Answer 15

Mucosa-submucosa layer - simple continuous pattern for good apposition, faster healing and increased strength. Serosa-muscularis layer - use an inverting pattern (cushing or utrech) to invert the dirty edges and reduce the risk of adhesion.

Question 16

Discuss your choice of suture patterns to close the enterotomy site:

Answer 16

Full thickness simple interrupted sutures - appositional, faster return to tensile strength. Cannot use an inverting pattern with the small lumen as this may lead to intestinal strictures.

Question 17

Discuss some of the techniques or procedures you will use to minimize trauma to tissues:

Answer 17

Use a scalpel rather than scissors to cut tissue (where appropriate) as scissors crush. Use stay sutures Use instruments such as Debaky’s or Adson-Brown forceps for holding tissue Avoid wiping or rubbing tissue Keep tissue moist Perform the surgery as quickly as possible - “Time is Trauma” Minimise foreign material

Question 18

What additional procedure(s) can you do, after completion of a gastrotomy or enterotomy, to help protect the site against leakage?

Answer 18

Omentalisation or serosal patch

Question 19

A soft fluctuant non-painful swelling on the side of this dogs face. A FNA reveals that this is a seroma. You plan to drain the serous fluid. How will you manage the dead space?

Answer 19

1. Clean the skin with surgical prep. 2. Identify the most ventral point and make a 1cm incision with a scalpel. 3. Flush out the swelling and dead space with lactated ringers and then again with diluted iodine. 4. Insert penrose drain into the swelling and suture in place - do not fenestrate. Leave drain in fro 3-5 days.

Question 20

This lump has been diagnosed as a Mast Cell Tumour and you plan to remove it with 3cm margins and one deep fascial plane. How will you manage the resultant dead space?

Answer 20

• Try to make an elliptical incision
• Consider using tacking / walking sutures
• Leave the ventral portion of incision open
• Place a pressure bandage

*Do not insert a drain - seeds the tumour site!

Question 21

This wound is the result of a dog attack 3 hours ago. There are large loose pockets under skin all around the obvious skin wound. How will you manage the dead space?

Answer 21

• Pressure bandage
• Leave the wounds open until they have passed the debridement stage, then you may be able to attempt closure
• Place a penrose drain once the wounds are ‘clean’

Question 22

List methods that you could use to hold the nerves aside as you work on the vessels near by:

Answer 22

1. Hold aside with a sterile penrose drain
2. Hold aside with a sterile gauze swab
3. Use nerve hooks (atraumatic)
4. Ask an assistant to gently hold aside with finger