Principles of Soft Tissue Surgery

Question 1

Describe Halsteads principles

Answer 1

• Gentle tissue handling
• Strict asepsis
• Haemostasis
• Preservation of the blood supply
• No tension on tissues
• Good approximation of tissues
• Obliteration of dead space (avoids filling with fluid)

Question 2

Describe the duodenal maneuver

Answer 2

Duodenum normally ventrally on right side – retract it across the abdominal cavity, which enables the small and large intestine to be retracted, exposing:
• right urogenital structures
• vena cava and portal system

Question 3

Describe the colonic Maneuver

Answer 3

Retraction of the decending colon provides exposure of the left side of the abdomen

Question 4

Give 5 rules of GI surgery

Answer 4

• Recognise and incorporate the submucosa into the surgical closure
• Gentle tissue handling
• Maintain a good blood supply
• Prevent tension across the suture line
• Avoid spillage of contents – laparotomy swabs

Question 5

What must you remember when suturing up the bowel?

Answer 5

You need to include the submucosal layer - highest collagen level will handle sutures best

Question 6

What is a gastrotomy and when is it used?

Answer 6

• Incision into the stomach and suturing back up

* Often used in foreign body removal and biopsy

Question 7

What suture material and method would you use to suture up the the stomach?

Answer 7

Monofilament 3-0 or 2-0

May stitch up in 2 separate layers (submucosa and mucosa, Muscularis and serosa)

Question 8

Define intussusception and name the parts of it.

Answer 8

Intussusception
• Sections of the intestine “telescoping” into itself
• Intussusceptum  Inner segment of intussusception
• Intussuscipiens  Portion of bowel containing the intussusceptum

Question 9

Give three causes of intussusception

Answer 9

• Causes include  lack of worming in puppies and kittens, GI tumours and post moretem

Question 10

Describe and Enterotomy

Answer 10

Enterotomy

• Formation of a hole in the intestine

Question 11

What suture material and pattern would you use to deal with an enterotomy?

Answer 11

o Polydioxanone (PDS), polyglyconate (Maxon), Glycomer 631 (Biosyn), Poliglecaprone 25 (Monocryl)
o 3/0 or 4/0
o Good early tensile strength (days 5-7)
o Resist absorption for > 21 days
o Simple interrupted appositional sutures
o 2-3mm apart, 2-3mm from edge

Question 12

When would you feed an animal after GI surgery and why?

Answer 12

o Starvation after GI surgery detrimental
o Villous atrophy
o Ulceration
o Breakdown in gut barrier
o Ileus
o Early enteral nutrition indicated in most circumstances

Question 13

Define anastomosis

Answer 13

Formation of a new connection between two body parts that carry fluid (may be required if removing sections of bowel or blood vessels)

Question 14

What three things must you do before closing the abdomen post surgery?

Answer 14

• Check integrity of repair: gut, bladder
• Check for bleeding
• Count swabs

Question 15

What suture material and patterns are best for the Subcutaneous layer in abdominal closure?

Answer 15

Subcutaneous layer

o simple continuous, glyconate, polydioxanone, poliglecaprone

Question 16

What suture material and patterns are best for the Intradermal layer in abdominal closure?

Answer 16

Simple continuous, glyconate, polydioxanone, poliglecaprone

Question 17

What suture material and patterns are best for the Skin sutures in abdominal closure?

Answer 17

o Non-absorbable, usually nylon

o Interrupted or continuous pattern

Question 18

What suture material and patterns are best for the linea alba in abdominal closure?

Answer 18

o Continuous suture patterns preferableo Absorbable monofilament e.g. polydioxanone or polyglyconate
o e.g. commonly either 2-0 or 0 (dogs) or 3-0 or 2-0 (cats

Question 19

Describe post op care for abdominal surgery

Answer 19

• ALWAYS cover wound before leaving theatre – fibrin seal takes several hours to form
• Analgesia – always.
• Antibiotics - rationale??
• Check wound every 24 hours – inspection, gentle palpation – wear gloves!