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Principles of Surgery Flashcards

1
Q

Define sepsis

A

Presence of pathogens and toxic products in tissues

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2
Q

Define asepsis

A

Absence of pathogenic microbes in tissues

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3
Q

Define antiseptic

A

Chemical agent that kils or inhibits pathogenic microorganisms; ONLY for agents applied to the body

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4
Q

Define disinfectant

A

Chemical that kills microorganisms on inanimate objects

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5
Q

Define disinfection

A

The removal of microorganisms but not necessarily their spores

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6
Q

Define sterilisation

A

Complete elimination of microbial viability by physical/chemical means

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7
Q

What can wound infection lead to?

A

Adverse effect on procedureAdverse effect on general healthIncreased morbidity and moralityFurther treatment neededIncreased costsIncreased hospital stay

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8
Q

What will almost all surgical wounds become?

A

Contaminated but not all infected

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9
Q

What three things are the factors involved in sugical wound infection?

A

BacteriaLocal wound environmentLocal and systemic defence

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10
Q

What bacterial factors affect there ability to cause infection?

A

Presence and growthNumber of bacteriaType and virulence of bacteriaDuration of exposure to bacteriaTiming of exposure to bacteria

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11
Q

When are the host defences at their lowest in relation to surgery?

A

First three hours after wounding

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12
Q

What are the surgical factors affecting the risk of wound infection?

A

Duration of surgeryPatient and surgeon preparationType of surgery

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13
Q

What four things in surgical wounds can increase chances of infection?

A

Dead space and seromaForeign materialBlood clotsDevitalised tissue

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14
Q

What are the patient factors that can increase the risk of wound infection?

A

AgeNutritionDiseasesTherapy

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15
Q

Which ages of dogs are more at yisk of wound infections?

A

Young and old (>8yrs)

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16
Q

Give some examples of diseases that can increase the risk of wound infection

A

DiabetesRenal failureEnocrinopathiesCancerHypoalbuminaemiaTraumaInfectionInflammationImmunodeficiency

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17
Q

What are the four NRC categories of wound classification?

A

CleanClean-contaminatedContaminatedDirty

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18
Q

Describe a clean wound

A

Non-traumaticElective surgery with primary intention healingNo inflammationNo break in aseptic techniqueRespiratory, alimentary or urogenital tract not entered

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19
Q

Describe a clean-contaminated wound

A

GI or respiratory tract entered without spillageUrogenital tract entered in absence of infectionBiliary tract entered in absence of infected bileMinor break in aspetic technique

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20
Q

Describe a contaminated wound

A

Gross spillage from GITEntrance into urogenital or biliary tract with infectionFresh traumatic woundMajor break in aseptic technique

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21
Q

Describe a dirty wound

A

Perforated viscus encounteredAcute bacterial inflammationPus encounteredTraumatic wound greater than 4 hoursTransection of clean tissue

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22
Q

How does the infection rate vary with categories of wound?

A

Increases with increased contamination

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23
Q

What is the decisive period?

A

First 2-3 hours after wound exposure/inoculation

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24
Q

When is there intense activity between bacteria and host in wounds?

A

Decisive period

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25
Q

When is abtibiotic treatment only beneficial?

A

First 3 hours - decisive period

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26
Q

Why should we provide antibiotics 1 hour before surgery or wound inoculation?

A

To allow time for them to reach the necessary concentrations within the body to combat infection

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27
Q

What are the four key areas within aseptic technique?

A

Surgeon preparationSurgical instrumentsPatient preparationOperating theatre

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28
Q

What are the non-sterile barriers we use in aseptic techniques?

A

Scrub suitsCapShoes/shoe coversFace mask

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29
Q

What are the three areas in which the surgeon prepares aseptically?

A

Non-sterile barriersSkin preparation (scrubbing up)Sterile barriers

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30
Q

What are the two sterile barriers that vets use?

A

Gowns and gloves

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31
Q

Describe how scrub suits and shoes should be worn for aseptic techinque

A

Limit transmission of dirt, debris and bacteriaMade from loose weave lint-free fabricA barrier for danderWorn only in theatreTops tucked into trousersTrousers tucked into boots

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32
Q

Describe the key points to be done before scrubbing up

A

Remove all jewelleryNails short and cleanMask on before scrubbingAppropriate antisepticBrush and soap readyWater running at correct speed and temperature

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33
Q

What are the two recognised methods for scrubbing up?

A

Timed scrub - scrub for a set timeCounted brush stroke method - do each scrub a number of times

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34
Q

What are the three requirements for scrubbing up?

A

Nail pickBrushAntiseptic agent

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35
Q

What are the four antiseptics used in scrubbing up?

A

ChlorhexidineIodine (Povidone-iodine)AlcoholSterillium (alcohol again)

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36
Q

What does chlorhexidine kill?

A

Broad spectrum of bacteriaVariable against virusesNo action against spores

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37
Q

How does chlorhexidine kill?

A

Precipitation of cellular contentsAlteration in cell permeability

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38
Q

What are the benefits for chlorhexidine?

A

Rapid initial killPersistent residual activityNot inactivated by organic materialNot generally toxic - only when direct contact

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39
Q

What does iodine kill?

A

BacteriaVirusesFungiNot spores

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40
Q

How does iodine kill?

A

IodinationInhibition of protein synthesis

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41
Q

What decreases the action of iodine?

A

Organic materialHard water

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42
Q

How long a contact time does iodine need to work?

A

2 minutes

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43
Q

Where should iodine be used?

A

Mucosal surfacesNear open wounds

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44
Q

What problems are associated with using iodine?

A

Corrodes instrumentsAcute contact dermatitisAllergic reaction in sensitive people

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45
Q

What does alcohol kill?

A

Broad spectrum of bacteria

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46
Q

How does alcohol kill bacteria?

A

Protein denaturationInhibition of cell division

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47
Q

What does alcohol enhance the action of?

A

ChlorhexidineIodine

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48
Q

Where should alcohol be avoided using?

A

Near open wounds

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49
Q

What does sterillium kill?

A

BacteriaFungiVirusesTB

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50
Q

How does sterillium improve skin health?

A

MoisturisingMaintains skin lipidsNo reported allergiesNo scrubbing

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51
Q

What must you not mix sterillium with?

A

Hand creams or disinfectants

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52
Q

Where should your gown be tied?

A

At the back wrapped around you

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53
Q

What are the two types of gloving?

A

ClosedOpen

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54
Q

What is closed gloving?

A

Most common for surgical proceduresRequires long-sleeved gownGloves must cover cuff of gown

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55
Q

What is open gloving?

A

Gloving for procedures that only require sterile hands

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56
Q

What are the two main methods of sterilising instruments?

A

PhysicalChemical

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57
Q

Where should clipping be carried out?

A

In the prep room

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58
Q

Describe clipping

A

Clip a wide area of the patientAllow for a change in planLengthen incisionAllow for drain placement

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59
Q

Describe aseptic skin preparation on the patient

A

Antiseptics used of all the clipped areaScrub inside to outScrub until no further organic debrisNo less than five minutes contact time

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60
Q

What should be carried out on the patient in the theatre for aseptic preparation?

A

Repeat prep room preparationWipe off excess scrub with alcoholApply final solution

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61
Q

What does draping reduce the risk of?

A

Contamination by surrounding hair or skin

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62
Q

What are the two types of drapes?

A

DisposableReusable

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63
Q

What are the three uses for surgical drapes?

A

Cover whole patientCover whole tableCover instrument trolley

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64
Q

What is primary draping?

A

Single fenestrated drape4 field drapes

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65
Q

What is secondary draping?

A

Skin towelsAdhesive drapes

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66
Q

What are the four areas in the surgical field?

A

Incision siteSterile drapes on the patientInstrument trolleySurgical team

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67
Q

What parts of the surgical team are counted as the surgical field?

A

Front of the bodyBelow the neck and above the waistArms and hands

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68
Q

Describe an operating theatre design

A

End room with a single doorSeparate patient preparation areaSeparate scrubbing areaOnly necessary correctly attired personnel

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69
Q

Describe how the operating theatre should be used

A

Clean operations firstContaminated operations lastDisinfect table between patientsDirty operations in a separate room

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70
Q

What are the five results of inappropriate antimicrobial use?

A

Increased costIdiosyncratic drug reactionsSuppression of normal bacterial floraDevelopment of bacterial drug resistanceIncreased risk of hospital acquired infection

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71
Q

Of the four categories of wound classifications which are antibiotics indicated for?

A

Clean-contaminated - controversially indicatedContaminatedDirty - therapeutic use

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72
Q

When are antimicrobials indicated in clean surgery?

A

Longer surgery (>90 minutes)Implant placedIf infection would be catastrophic to the outcomeImmuno-compromised patients

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73
Q

What are the seven basic principles of surgery?

A

Surgical asepsisGentle tissue handlingAccurate haemostasisPreservation of vascularityCareful approximation of tissuesObliteration of dead spaceNo tension on tissues

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74
Q

What are the four basic steps in surgery?

A

Incision and excision of tissueHaemostaissHandling and care of tissuesClosing with sutures

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75
Q

What are four ways we can incise into tissues?

A

ScissorsScalpelElectrosurgeryLaser

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76
Q

What is usually used to incise through skin?

A

Scalpels

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77
Q

Which scalpel blade is used for most small animal surgery?

A

10 scalpel blade

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78
Q

What is a #11 scalpel blade used for?

A

Stab incisions and opening up organs

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79
Q

What tissues is a scalpel used for?

A

Tough tissueFor tissues held under tension

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80
Q

Describe the action of using a scalpel

A

Single, bold incisionCorrect length and depth

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81
Q

How should a scalpel be held normally?

A

Pencil grip

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82
Q

What can scissors be used for?

A

IncisionsCutting of tissue

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83
Q

What are the three most common types of scissors used?

A

Suture removal scissorsMayo scissorsMetzenbaum scissors

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84
Q

What are mayo scissors used for?

A

Bigger tissues

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85
Q

What are metzenbaum tissues used for?

A

Smaller tissues that require a gentler handling

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86
Q

What are the advantages and disadvantages of using scissors?

A

Advantages: controlled cutting and good for flaccid tissuesDisadvantages: shearing tissue trauma

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87
Q

What are the three things scissors can be used for?

A

Cutting tissue below the skinBlunt dissectionUndermining tissue

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88
Q

How should scissors be held?

A

Thumb and ring-finger grip

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89
Q

What are the advantages of using other cutting instruments (laser etc.)

A

Improved haemostasisDecreased need for ligaturesReduced operating timeImproved accessNo-touch technique

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90
Q

What are the disadvantages to using other cutting instruments e.g. laser?

A

Tissue trauma causedExpensiveRisk of burns and fires

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91
Q

Why is haemostasis important?

A

Severe blood loss results in hypovolaemiaObscures the surgical fieldStains tissues redBlood irritates tissuesIncreases wound infectionAvoids surgical panic

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92
Q

What four ways can we use preventive haemostasis?

A

Plan the approachIdentify blood vessels in surgical fieldLigate vessels before transectionGentle dissection

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93
Q

What 9 things can be used as haemostasis?

A

PressurePackingWound closureHaemostatic forcepsDiathermyLigaturesTopical agentsTourniquetVascular clips and staples

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94
Q

What is the maximum time a tourniquet should be left on for?

A

Twenty minutes

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95
Q

What five things determine the choice of haemostasis used?

A

Least traumaticLeast foreign materialLeast necrotic tissueQuickestDepends on tissue a vessel

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96
Q

What are the two actions of haemostats?

A

PressureCrushing

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97
Q

How are haemostats used on small superficial vessels?

A

Use tip of the forcepsApply tip down

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98
Q

How are haemostats used for large tissue pedicles?

A

Use the jawPerpendicular to blood vessel

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99
Q

What is the most secure method of haemostasis?

A

Ligatures

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100
Q

What is the main disadvantage of ligatures?

A

Leave foreign material in the wound

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101
Q

WHere should a ligature be placed in relation to your clamps?

A

1.5 to 2 cm below them (in opposite direction to blood flow)

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102
Q

What are the three basic grips for scalpels?

A

Pencil gripFingertip gripPalm grip

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103
Q

What are the three types of surgical haemorrhage?

A

Primary - immediate bleedingDelayed intermediate - bleeding within 24 hoursDelayed secondary - bleeding more than 24 hours later

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104
Q

Describe the correct use of swabs

A

Use woven cotton swabsUse swabs with a radio-opaque markerUse singlyOpen swab out if performing delicate manoeuvresUse large laparotomy swabs in body cavitiesBlot tissue - don’t wipe

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105
Q

What are the four main types of haemostatic forceps?

A

HalstedKellyCarmaltKocher

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106
Q

What are the five knots that surgeons should be aware of?

A

Simple knot: 1 single throwSquare knot: 1 single throw then another in the opposite directionSurgeon’s knot: 1 double throw then a single throw in the opposite directionHalf-hitch: 1 single throw, then another but tightened by slidingGranny knot: 1 single knot, followed by another in the same orientation

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107
Q

What are the six ligature methods?

A

Simple encirclingDouble ligationHalsted’s transfixing ligatureModified transfixing ligatureTissue ligatureStick ties

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108
Q

What do stick ties incorporate?

A

Organ vessels are attached to

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109
Q

What are the four ligatures for vascular pedicles?

A

Triple clamp techniqueModified Miller’s knotTransfixing ligatureDivision of pedicle

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110
Q

Describe a triple clamp technique

A

Three clamps put into place and ligature tied into crushed area left by proximal clamp

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111
Q

What are the two types of diathermy?

A

Monopolar and bipolar

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112
Q

What are the advantages of monopolar diathermy?

A

Cut tissues as well as coagulate themApply current ot instruments in contact with patients

113
Q

What are the advantages of bipolar diathermy?

A

Lower current so reduced local tissue traumaReduced incidence of distant tissue traumaBurns unlikelyCan be used in wet surgical field

114
Q

What is the main difference between monopolar and bipolar diathermy?

A

Monopolar can be used to cut as well as coagulateBipolar is just coagulation

115
Q

What are the three main types of topical haemostatic agents?

A

VasoconstrictorsClotting promotersProvide a physical barrier

116
Q

What are the two physical barriers used as haemostatic agents?

A

Bone wax and glue

117
Q

What are some examples of haemostatic agents causing vasoconstriction?

A

Ice salinePhyenylephrineAdrenaline

118
Q

What are some examples of haemostatic agents that promote clotting?

A

FibrinCollagenCelluloseGelatinPolysaccharides

119
Q

What should be used if repeated manipulation of tissues is needed?

A

Stay sutures

120
Q

What are some examples of excessive trauma in handling tissue?

A

Inadequate excision lengthExcessive retractionDull surgical instrumentsExcessive undermining of tissueSwab traumaFailure to dissect along tissue planesAllowing tissue to dry out

121
Q

What four things can help reduce operative tissue trauma?

A

Gentle handlingGentle retractionKeep tissues moistSuction rather than swabs

122
Q

What are used most often to manipulate tissues?

A

Thumb forceps (Adson-Browns

123
Q

Which thumb forceps are used for more delicate tissues?

A

DeBakey forceps

124
Q

How are tissue forceps held?

A

Pencil grip

125
Q

Which tissue forceps are used to stabilise and retract tissues?

A

Allis (with teeth)Babcock (without teeth)

126
Q

What tissue forceps are used to dissect neurovascular structures from other tissues?

A

MixterLahey

127
Q

What tissue forceps are used for occlusion of hollow organs?

A

Doyens (intestine)Rochester-Carmalt (uterus)

128
Q

What tissue forceps are used to occlude blood vessels after incision?

A

CooleySantinsky

129
Q

What is the major disadvantage to using retractors?

A

Tissue trauma or ischaemia at point of contact

130
Q

What are some commonly used hand-held retractors?

A

SennLangenbeckArmy-NavyMalleable retractors

131
Q

What are some commonly used self-retaining retractors?

A

Gelpi (general)Weitlaner (general)Finochietto (thorax)Gosset (abdomen)Balfour (abdomen)

132
Q

What are the two types of towel clamp?

A

BackhausCross-action

133
Q

What are the six major benefits of wound lavage?

A

Removes bacteria and foreign materialDilutes toxinsReduces wound infectionHydration of tissuesImproved visibilityWarms the patient

134
Q

What is an ideal lavage agent?

A

Sterile, isotonic, non-toxic and normothermic solution

135
Q

What are the three types of suction tip used to remove fluid?

A

Frazier (fine)Yankauer (wide bore)Poole (multiple holes)

136
Q

What must be done if lavage is used?

A

Fluid must be completely removed

137
Q

What are the five different types of needle holders?

A

Mayo (ratchet)Mayo-Hegar (ratchet)Olsen-Hegar (ratchet and scissors)Gillies (scissors)Castroviejo (fine ratchets)

138
Q

What are the three ways that surgeons should be aware of when tying knots?

A

One-hand tieTwo-hand tieInstrument tie

139
Q

What are the principles of successful suture use? (6)

A

Knot security is inversely proportional to suture diameterTighten each throw separately with even tension on both handsUse absorbable multifilament suture for ligaturesPlace the minimum number of throws to reduce knot bulkCut the ends short to minimise foreign material in the woundAvoid including frayed or damaged suture in the loop

140
Q

Why is an elective ovariohysterectomy technically a clean-contaminated surgery?

A

Genital tract is entered at the junction of uterus and cervixRisk of contamination is low as surgery is usually short

141
Q

With a foreign body removal surgery in the small intestine why is prophylactic antimicrobial use recommended?

A

Do not know whether there will be subsequent spillage of intestinal contentsAt start surgery is clean-contaminated for which antimicrobial use is controversial

142
Q

Why is surgery in the perineal region associated with a higher rate of infection?

A

Proximity of anus and faecal bacteria

143
Q

Why is surgery involving an abscess dirty?

A

Means established infection already present

144
Q

When is the placement of a tube to drain the bladder a contaminated procedure?

A

If the animal has a urinary tract infection

145
Q

When is an open traumatic wound regarded as dirty?

A

If it has been more than 4-6 hours before treatment

146
Q

Why are wound infections rare in the oral cavity?

A

Excellent blood supplyAntibacterial effects of salivaWarmth of oral cavity

147
Q

What are the four functions of suture material?

A

Wound closure Ligation Attachment of tubes Stay sutures

148
Q

How should the ideal suture material interact with the tissue?

A

Maintain strength until wound strength develops Rapid resorption when no longer required Encapsulated without post-op complications Easily removed Minimal tissue reaction Doesn’t favour bacterial growth Minimal drag Suitable for all wounds

149
Q

How should the ideal suture material interact with the surgeon?

A

Easy to handle Good knot security

150
Q

What are the material properties of the ideal suture material?

A

Easy to sterilise Non-capillary Non-electrolytic Non-corrosive Non-allergenic Non-carcinogenic

151
Q

What are the three practical considerations for the ideal suture material?

A

Inexpensive Readily available Available in a range of sizes

152
Q

What are the six classifications of suture material?

A

Natural Synthetic Absorbable Non-absorbable Multifilament Monofilament

153
Q

What are the differences between natural and synthetic fibre suture materials?

A

Natural - tissue inflammatory reaction, variable absorption Synthetic - less reaction, predictable absorption

154
Q

How do absorbable suture materials differ to non-absorbable?

A

Absorbable - provide temporary wound support, loss of strength under 60 days Non-absorbable - elicits tissue reaction leading to encapsulation, strength persists after 60 days

155
Q

What are the interaction differences between multifilament and monofilament suture materials?

A

Multifilament - easier to handle, better knot security, increased capillarity Monofilament - less tissue drag, can weaken when crushed

156
Q

How can coating suture material help in surgery?

A

Improves handling Reduces tissue drag

157
Q

What does dying suture material help with during surgery?

A

Visibility

158
Q

What are the two ways suture materials are packaged?

A

Cassette Individual packet

159
Q

What are the four materials used for synthetic absorbable multifilament suture materials?

A

Vicryl - polyglactin 910 Dexon - polyglycolic acid Polysorb - lactomer 9-1 Panacryl - Poly(L-lactide/glycolide)

160
Q

How does synthetic absorbable multifilament suture material interact with tissue?

A

Absorbed completely at 60-90 days Speed: Polysorb>Vicryl>Dexon

161
Q

Describe how tensile strength is lost over time with synthetic absorbable multifilament suture materials

A

Loss - 33% at 7 days, 80% at 14 days, 100% at 21 days Strength: Polysorb>Vicryl>Dexon

162
Q

Describe handling and knotting of synthetic absorbable multifilament suture materials

A

Good handling/knotting Tissue drag improved by coating

163
Q

What is synthetic absorbable multifilament suture material used for?

A

Vessel ligation General soft tissue closure

164
Q

What materials are used for short duration synthetic absorbable monofilament suture material?

A

Monocryl - polyglecaprone Caprosyn - polyglytone

165
Q

How does short duration synthetic absorbable monofilament suture material interact with tissue?

A

Complete absorption at 90-120 days Speed: Caprosyn>Monocryl

166
Q

Describe the loss of tensile strength of short duration synthetic absorbable monofilament suture material

A

High tensile strength Loss - 50% at 7 days, 60% at 14 days, 100% at 21 days

167
Q

Describe the handling and knotting of short duration synthetic absorbable monofilament suture material

A

Monocryl - soft and pliable with low memory Caprosyn - more sticky than monocryl

168
Q

What is short duration synthetic absorbable monofilament suture material generally used for?

A

General soft tissue closure Visceral closure - monocryl

169
Q

What materials are used for long duration synthetic absorbable monofilament suture material?

A

PDS II - polydioxanone Maxon - polyglyconate Biosyn - glycomer 631

170
Q

How does long duration synthetic absorbable monofilament suture material interact with tissue?

A

Completely absorbed at 110-210 days

171
Q

Describe the loss of tensile strength of long duration synthetic absorbable monofilament suture material

A

Strong materials Loss - 26% at 14 days, 40% at 28 days, 75% at 42 days Strength: PDS II>Maxon>Biosyn

172
Q

How does PDS tend to handle and knot?

A

Memory Tendency to coil 7 knots

173
Q

What is long duration synthetic absorbable monofilament suture material generally used for?

A

Soft tissues needing long support Muscle Fascia Linea alba Viscera

174
Q

What materials are used to make synthetic non-absorbable monofilament suture materials?

A

Prolene/SurgiPro - polypropylene Ethilon/Monosof - polyamide Flexon -steel

175
Q

How does synthetic non-absorbable monofilament suture materials interact with tissue?

A

Minimal reaction Inert

176
Q

Describe the tensile strength of synthetic non-absorbable monofilament suture materials

A

Strong 25% lost after 2 years

177
Q

How does synthetic non-absorbable monofilament suture material handle and knot?

A

Memory Good knot security

178
Q

What are synthetic non-absorbable monofilament suture materials generally used for?

A

Inert - skin, stoma and vessels Prolonged support - hernia and tendon

179
Q

What materials are used for synthetic non-absorbable multifilament suture materials?

A

Mersilene/Ethibond - polyester Novafil - polybutester Supramid - caprolactam

180
Q

How do synthetic non-absorbable multifilament suture materials interact with tissue?

A

Cause moderate inflammation

181
Q

Describe the tensile strength of synthetic non-absorbable multifilament suture material

A

Stronger than nylon Very little loss of strength

182
Q

How does synthetic non-absorbable multifilament suture material handle and knot?

A

Fair handling Slight elasticity Sheath cracks on knotting

183
Q

What are synthetic non-absorbable multifilament suture materials generally used for?

A

Ligament prosthesis Skin closure (occasionally)

184
Q

What materials are used to make natural absorbable multifilament suture materials?

A

Catgut - plain or chromic Collagen

185
Q

How do natural absorbable multifilament suture materials interact with tissue?

A

Completely absorbed at 60-70 days Marked tissue reaction Faster absorption in infected, vascular or acidic wounds Unpredictable absorption

186
Q

Describe the loss of tensile strength in natural absorbable multifilament suture materials

A

33% loss at 7 days 67% lost at 14 days

187
Q

How do natural absorbable multifilament suture materials handle and knot?

A

Knots become weaker when wet Poor knot security so leave ends long Good handling

188
Q

What are natural absorbable multifilament suture materials generally used for?

A

Vessel ligation Ophthalmic surgery

189
Q

What material is used to make natural non-absorbable multifilament suture material?

A

Mersilk, PermaHand - Silk

190
Q

How does natural non-absorbable multifilament suture material interact with tissues?

A

Moderate-marked inflammation Encapsulated in fibrous tissue

191
Q

Describe the tensile strength of natural non-absorbable multifilament suture material

A

Weak - will break! Very slow absorption (2 years)

192
Q

How does natural non-absorbable multifilament suture material handle?

193
Q

What are natural non-absorbable multifilament suture materials used for generally?

A

Large vessel ligation NOT in viscera

194
Q

What should tensile strength match when selecting suture materials?

A

Strength of the tissue - depends on collagen

195
Q

What should the rate of loss of strength of the suture material match?

A

Gain in wound strength - match with rate of healing (viscera>skin>fascia)

196
Q

What four ways can sutures alter biological healing?

A

Reaction with tissues Potentiation of infection Formation of sinuses Potentiation of calculi, thrombi and ulcers

197
Q

What are the seven general rules to avoid complications with suture materials?

A

Avoid multifilament material in contaminated wounds Avoid non-absorbable sutures in hollow organs Use inert material in the skin Avoid reactive material for stoma creation Use slowly/non-absorbable material in fascia/tendons Avoid burying any suture from a multi-use cassette Avoid catgut in inflamed, infected or acidic wounds

198
Q

What is the size of suture material measured in?

A

1/10ths of a mm in the metric system

199
Q

What size of suture material should be chosen and why?

A

Smallest size possible - less tissue trauma, less suture material volume, smaller knots, greater knot security and encourages gentle handling

200
Q

Generally what size of suture material should be used in dogs?

201
Q

Generally what size of suture material should be used in cats?

202
Q

How much should the size of suture material generally be reduced by for delicate tissue?

A

Reduce by 1 to 2 metric

203
Q

How much should the size of suture material generally be increased by for tough tissue?

A

Increase by 0.5 to 1 metric

204
Q

What are the advantages of swaged-on needles?

A

Immediate use Unlikely to detach from material Less handling of material Less fraying of material Less tissue trauma Likely to be sharper Guaranteed sterile Greater range of needles available

205
Q

What are the 5 shapes of surgical needles?

A

Straight Curved Curved on straight Compound curve J-shape

206
Q

What are the two points of non-cutting surgical needles?

A

Round bodied Taper point

207
Q

What are the four points of cutting surgical needles?

A

Taper cut Standard cutting Reverse cutting Side-cutting (spatula)

208
Q

What are the advantages of using reverse cutting needles compared to cutting needles?

A

Generally stronger Danger of tissue cutout is reduced Hole left by needle leaves wall of tissue against which suture can be tied

209
Q

What are the four requirements for surgical needles?

A

Sharp enough to pass through tissue No change to tissue architecture Needle resists bending/breakage Needle hole just big enough for suture

210
Q

What are the five rules for wound closure?

A

Close tissue in same number of layers as incised Appositional pattern unless good reason not to Choose simplest pattern Avoid closure under tension Careful suturing more important than pattern choice

211
Q

What type of suture is this?

A

Simple suture

212
Q

What type of suture is this?

A

Mattress suture

213
Q

What are the advantages for interrupted and continuous suture patterns?

A

Interrupted

  • If 1 knot fails then whole line won’t fail
  • More accurate approximation
  • Adjust tension at each suture

Continuous

  • Quicker
  • Less suture material in wound
  • More even distribution of tension
  • More air-tight and water-tight
  • Cheaper
214
Q

Describe the benefits of appositional suturing?

A

Easy to perform

Accurate alignment of wall layers

Quicker regeneration of mucosa

Less inflammation and fibrous scar tissue

215
Q

What are the advantages and disadvantages of inverting suturing?

A

Advantages

  • Similar tensile strength
  • Reduced risk of adhesions

Disadvantages

  • Greater bursting strength
  • Necrosis of tissue cuff can occur
  • Luminal compromise possible
216
Q

What are the advantages and disadvantages of everting sutures?

A

Advantages

  • Increased tensile strength
  • Endothelial contact reduces thrombosis
  • Easy to place

Disadvantages

  • Prolonged inflammation and vascular compromise
  • Increased incidence of adhesions
  • Increased risk of stenosis
  • Increased risk of leakage
217
Q

What are the advantages of both partial thickness and full thickness sutures?

A

Partial thickness

  • Not exposed to luminal contents
  • Reduces wicking from lumen

Full thickness

  • Better apposition
  • Suture holding layer engaged
218
Q

What are the advantages of one layer and two layer closures?

A

One layer

  • Simple
  • Quick
  • Less suture material

Two layer

  • More accurate apposition
  • Easier in some tissues
  • More watertight?
  • Stronger?
219
Q

What are the main features of a simple interrupted suture pattern?

A

Secure anatomical closure

Precise adjustment of tension possible

Easily applied

Can cause inversion if tight

220
Q

What tissues would you generally use a simple interrupted pattern in?

A

Skin

GI tract

Fascia

221
Q

What type of suture pattern is this?

A

Simple interrupted

222
Q

What are the features of an intradermal/subcuticular suture?

A

Upside down simple interrupted - buried knot

223
Q

What type of suture pattern is this?

A

Intradermal/subcuticular

224
Q

What are the features of a cruciate mattress suture pattern?

A

Stronger than simple interrupted

Resists tension

Prevents eversion

Quicker than simple interrupted

Poorer apposition

225
Q

Where would you generally use a cruciate mattress suture pattern?

A

Skin

Tail

Digit amputation

226
Q

What type of suture pattern is this?

A

Cruciate mattress suture

227
Q

What are the features of a horizontal mattress suture?

A

Apposotional to everting

Strangulate tissue

Edge ischaemia

228
Q

What tissues would you generally use a horizontal mattress suture in?

A

Skin

Muscle

Tendon

229
Q

What suture pattern is this?

A

Horizontal mattress suture

230
Q

What are the features of a half-buried horizontal mattress?

A

Composite of horizontal mattress and subdermal/subcuticular

Avoids trauma to tip of flap

231
Q

When would you generally use a half-buried horizontal mattress?

A

Skin closure

232
Q

What type of suture is this?

A

Half-buried horizontal mattress

233
Q

What are the features of a vertical mattress suture?

A

Appositional to everting

Resists tension

234
Q

When do you generally use a vertical mattress suture?

A

For tension relieving sutures in the skin

235
Q

What type of suture is this?

A

Vertical mattress

236
Q

What are the features of a Mayo mattress suture?

A

Overlap tissue planes

Tighten tissue planes

237
Q

When would you generally use a Mayo mattress suture?

A

Imbrication of fascia lata

Hernia closure

238
Q

What type of suture is this?

A

Mayo mattress suture

239
Q

What are the features of a simple continuous suture pattern?

A

Series of linked interrupted sutures

Suture line advances on one side of the wound

Good for areas under low tension

240
Q

When would you generally use a simple continuous suture pattern?

A

Subcutis

Fascia

Vessels

GI tract

241
Q

What type of suture pattern is this?

A

Simple continuous

242
Q

What are the features of a running suture (baseball stitch)?

A

Series of linked interrupted sutures

Suture line advances on both sides of the wound

Rapid closure

Less accurate approximation

243
Q

What type of suture pattern is this?

A

Running suture (baseball stitch)

244
Q

What is the difference between subcutaneous and subcuticular continuous suture patterns?

A

Subcutaneous

  • Simple continuous
  • Perpendicular

Subcuticular

  • Continuous horizontal mattress
  • Parallel
245
Q

What are the features of a Ford interlocking suture?

A

Greater security than simple continuous

Better apposition than simple continuous

More difficult to place and finish

246
Q

When would you generally use a Ford interlocking suture pattern?

A

On the skin

247
Q

What type of suture pattern is this?

A

Ford interlocking suture

248
Q

What are the seven inverting suture patterns?

A

Cushing

Connell

Lembert

Halsted

Czerny

Parker-Kerr

Purse-string

249
Q

Which suture pattern is used for everting?

A

Horizontal mattress

250
Q

What are the features of the Lembert suture pattern?

A

Variation of vertical mattress

Tissue bites perpendicular to wound edge

Can be interrupted or continuous

251
Q

Which tissues do you generally use a Lembert suture pattern for?

A

Tissues with a hollow viscus

252
Q

What type of suture pattern is this?

A

Interrupted Lembert suture pattern

253
Q

What type of suture pattern is this?

A

Continuous Lembert suture pattern

254
Q

What are the features of a Halsted suture pattern?

A

Modification of the Lembert

Two interrupted Lemberts as a mattress suture

255
Q

What type of suture pattern is this?

A

Halsted suture pattern

256
Q

What are the features of a Cushing suture pattern?

A

Variation of the continuous horizontal mattress

Tissue bites parallel to wound edge

Penetrates submucosa but not lumen

Less inversion

257
Q

What type of suture pattern is this?

A

Cushing suture pattern

258
Q

What are the features of a Connell suture pattern?

A

Like a Cushing

Penetrates lumen

259
Q

What type of suture pattern is this?

A

Connell suture pattern

260
Q

What are the features of a Czerny suture pattern?

A

Generally: simple continuous partial thickness

1st layer:

  • Appositional: simple continuous, running
  • Inverting: Cushing or Connell

2nd layer: Lembert

261
Q

What type of suture pattern is this?

A

Czerny suture pattern

262
Q

What are the features of the Parker-Kerr oversew?

A

1st layer: Cushing

2nd layer: Lembert

263
Q

What would a Parker-Kerr oversew generally be used for?

A

Closure of a visceral stump

264
Q

What type of suture pattern is this?

A

Parker-Kerr oversew

265
Q

What are the features of a Purse-string suture pattern?

A

Circular Lembert

266
Q

What are purse-string suture patterns generally used for?

A

Stump inversion

Feeding tubes

267
Q

What type of suture pattern is this?

A

Purse-string pattern

268
Q

What are the features of a continuous horizontal mattress suture pattern?

A

Causes appositional to everting

269
Q

When would you generally use a continuous horizontal mattress suture?

A

Cardiac surgery

You would generally oversew with simple continuous

270
Q

What type of suture pattern is this?

A

Continuous horizontal mattress suture

271
Q

What are the two solutions to resolving tension in sutures?

A

Remove tension

Fight tension

272
Q

What are the six tension-relieving suture patterns?

A

Vertical mattress

Horizontal mattress

Far-far-near-near

Far-near-near-far

Echelon structures

Quills, bolsters, stents and pledgets

273
Q

What type of suture pattern is this?

A

Far-near-near-far

274
Q

What type of suture pattern is this?

A

Far-far-near-near

275
Q

What are the features of a simple interrupted echelon suture?

A

Alternating simple interrupted sutures

  • Narrow bite - apposition
  • Wide bite - tension

Can use with quills/stents

276
Q

What type of suture pattern is this?

A

Simple interrupted echelon suture

277
Q

What are the features of quills with a horizontal mattress?

A

Quills or bolsters

Distributes tension

Everting

278
Q

What type of suture pattern is this?

A

Quill with horizontal mattress

279
Q

What type of suture pattern is this?

A

Quills with vertical mattress suture

Principles of Science (9 decks)

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