Principles of Operative Surgery

Question 1

ectomy

Answer 1

removal of an organ

Question 2

orraphy

Answer 2

repair of tissues

Question 3

ostomy

Answer 3

artificial communication between hollow viscous and the skin

Question 4

otomy

Answer 4

cutting open

Question 5

plasty

Answer 5

reconstruction

Question 6

pexy

Answer 6

relocation

Question 7

how should hair be removed alongside surgery?

Answer 7

only if necessary as infection increases

Question 8

how to use skin prep/ operative drapes

Answer 8

0.5% chlorhexidine
or 10% povidone iodine with 70% alcohol
disposable, double thickness linen sheets

Question 9

define…

oscopy

Answer 9

examination of hollow viscus

Question 10

what are the 3 tissue layers

Answer 10

epidermis
dermis
hypodermis

Question 11

difference between sharp and blunt dissection

Answer 11

sharp dissection: using scissors, scalpel etc

blunt dissection: cleaving soft tissues apart, eg using mosqiito forceps

Question 12

what is diathermy

Answer 12

a medical and surgical technique involving the production of heat in a part of the body by high-frequency electric currents, to stimulate the circulation, relieve pain, destroy unhealthy tissue, or cause bleeding vessels to clot.

Question 13

types of diathermy, describe each and potential problems

Answer 13

• monopolar (coagulation or cutting): charge in to patient and out through remote plate. BUT stimulates other muscles, nerves in pt at the same time
• bipolar: charge moves from 1 side of forceps to the other. much more common

Question 14

3 main categories of suture and types of each

Answer 14

• absorbable: dexon (polygycolic acid), vicryl (polyglactin)
• slowly absorbed: PDS (polydioxanone)
• non-absorbable: silk, nylon, polypropylene

Question 15

why is silk not often used for sutures

Answer 15

irritant

Question 16

4 common skin closure techniques and when they’re used

Answer 16

• simple uninterrupted: fine sutures on face
• vertical mattress sutures: large wounds, but leave scar
• skin staples
• subcuticular: most commonly used, look the best. secured at each end with a knot or bead

Question 17

3 ways of approximating skin edges

Answer 17

• subcutaneous layer of absorbable suture
• undercutting of skin margins widely to apposition of edges of defect
• excision of wound end to eliminate dog ear when one side of wound is longer than the other

Question 18

excision technique for excision of cyst

Answer 18

• incision beyond end of lesion
• plane of dissection around cyst by blunt dissection
• cyst removed intact with overlying skin

Question 19

5 reasons to dress wounds

Answer 19

• maintain wound in warm moist state
• absorb bleeding/tissue fluid
• protect delicate healing tissue
• apply pressure to prevent haematoma
• conceal wounds from view

Question 20

4 types of skin flaps

Answer 20

• random pattern flaps
• axial flaps (connected to blood vessels)
• myocutaneous flaps
• free flaps (move skin and blood vessels to new site)

Question 21

5 things done in surgery involving infected tissues

Answer 21

• thorough cleaning of all foreign materials
• excision of non-viable tissues
• loose open packing
• inspection of wound under anaesthesia
• delayed primary closure

Question 22

on what areas are skin grafts successful

Answer 22

well-vascularised non-infected tissue

Question 23

where skin grafts often fail

Answer 23

• avascular wounds eg bone without periosteum, tendons with peritoneon, denuded cartilage
• heavy contamination with micro-organisms (infection)
• blood clot (but can survive on plasma)

Question 24

what is a random pattern flap

Answer 24

no specific blood vessel in the pedicle being nourished via dermal plexus
2:1 ratio of length to width of base
can be used to cover local defect eg by rotation, advancement, transposition

Question 25

principle of axial flaps

Answer 25

skin supplied by specific blood vessel and its accompanying venae comitans

Question 26

principle of myocutaneous flaps

Answer 26

skin over muscle will survive if the pedicle to the muscle is not divided

Question 27

when are microvascular free flaps used

Answer 27

autotransplant

tissue must survive on single pedicled blood supply with an artery and draining vein