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principles of surgery Flashcards

1
Q

define antisepsis

A

prevention of sepsis by destruction or inhibition of microorganisms using an agent that may be safely applied to living tissue

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2
Q

define antiseptic

A

an agent that is applied to living tissue to destroy or inhibit microorganisms

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3
Q

define disinfectant

A

agent that is applied to inanimate objects to kill or inhibit microorganisms

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4
Q

define disinfection

A

removal of microorganisms but not necessarily the spores

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5
Q

define sepsis

A

presence of pathogens or toxic products in tissue of patient

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6
Q

define sterilisation

A

complete elimination of microbial viability including spores

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7
Q

non-sterile barriers on person during surgery

A
  • scrub suit
  • face mask
  • surgical head masks
  • shoes/shoe covers
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8
Q

scrud suit in surgery

A

a permeable barrier to microorganisms that reduces particulate shedding during surgery

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9
Q

surgical head covers

A

reduce shedding of bacteria from the hair

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10
Q

face masks

A

protect the wound from saliva droplets during speaking

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11
Q

3 physical methods of sterilisation

A
  • heat
  • irradiation
  • filtration
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12
Q

heat sterilisation is dependent on

A

time and temperature

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13
Q

3 methods of heat sterilisation

A
  • steam
  • moist heat (boiling)
  • dry heat
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14
Q

most widely used method of heat sterilisation

A

steam

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15
Q

moist boiling cons

A

can only reach 100* which is not sufficient to kill most spores

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16
Q

dry heat sterilisation how to

A

kills microorganisms by oxidative destruction

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17
Q

dry heat sterilisation can be used on

A
  • glassware
  • cutting instruments
  • opthalmic instruments
  • drill bits
  • powders
  • oils
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18
Q

3 methods of irradiation sterilisation

A
  • gamma rays
  • UV light
  • high energy electrons
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19
Q

most effective sterilisation irradiation technique

A

gamma irradiation

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20
Q

filtration sterilisation used on what

A
  • liquids

- gases

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21
Q

3 methods of chemical sterilisation

A
  • ethylene oxide
  • hydrogen peroxide gas plasma
  • cold sterilisation
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22
Q

ethylene oxide can

A

destroy all bacteria, fungi and spores

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23
Q

ethylene oxide action

A

inactives cellular DNA stopping cellular reproduction

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24
Q

ethylene oxide cons

A

toxic, inflammable and irritant to tissues

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25
Q

ethylene oxide sterilisation how to

A
  • soak at room temperature for 12 hours

- aerate and ventilate for 24 hours to allow ethylene oxide dissipation

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26
Q

hydrogen peroxide gas plasma action

A
  • uses UV photons and radicals

- 50* temperature for 45 min

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27
Q

hydrogen peroxide gas plasma pros

A

nontoxic and quick

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28
Q

cold sterilisation cons

A

usually only disinfects

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29
Q

cold sterilisation how to

A

soak in disinfectant for 24 hours

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30
Q

3 ways to indicate sterilisation

A
  • chemical
  • biological
  • temperature and pressure recordings
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31
Q

chemical indicators of sterilisation how

A

colour changes on exposure to a certain temperature or chemical

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32
Q

chemical indicators of sterilisation cons

A

dont show exposure time

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33
Q

biological indicators of sterilisation

A

spores which are more resistant to sterilisation than bacteria are put in as well then cultured to see if killed or not

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34
Q

biological indicators of sterilisation cons

A

take time to show if machine functional or not

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35
Q

temperature/pressure indicator of sterilisation

A

the temps/pressures are plotted on a graph during machine operation to show that requirements are met

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36
Q

prep of surgical site 3 steps

A
  • hair removal
  • prep of skin
  • draping of patient
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37
Q

hair removal in patient prep is to

A

reduce bacterial contamination

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38
Q

sterile areas of the gown

A
  • from chest to table height

- from above elbow to cuff

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39
Q

wounds are classified as

A
  • clean
  • clean-contaminated
  • contaminated
  • dirty
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40
Q

clean contaminated wound example

A

going into GIT without significant spillage

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41
Q

contaminated wound example

A
  • major break in aseptic technique or major GIT spillage
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42
Q

dirty wound example

A

foreign body

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43
Q

3 grips for holding a scalpel

A
  • pencil grip
  • fingertip grip
  • palm grip
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44
Q

mayo scissors

A

used for dense collagen rich tissue

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45
Q

metzenbaum scissors

A

used for delicate dissection

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46
Q

surgical haemorrhage can be

A
  • primary
  • delayed intermediate
  • delayed secondary
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47
Q

primary surgical haemorrhage

A

bleeding starts immediately

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48
Q

delayed intermediate haemorrhage

A

bleeding within 24 hours of surgery, e.g ligature slipped

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49
Q

delayed secondary haemorrhage

A

bleeding after 24 hours post surgery. can be due to necrosis of blood vessles

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50
Q

4 types of haemostatic forceps

A
  • halsted mosquito (small)
  • kelly (medium)
  • carmalt (large)
  • kocher (large with rat tooth tip)
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51
Q

define electrosurgery

A
  • diathermy

- electric current passed through tissue produces heat due to the tissue resistance

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52
Q

2 types of diathermy

A
  • bipolar

- monopolar

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53
Q

monopolar diathermy

A

current flows between handpiece to the ground plate

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54
Q

bipolar diathermy

A

current flows between 2 bipolar forceps

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55
Q

monopolar diathermy pros

A
  • can cut through tissue as well as coagulation

- can attach to a metal instrument

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56
Q

bipolar diathermy pros

A
  • use less current
  • reduced local tissue trauma
  • reduced incidence of distant tissue trauma
  • can be used in a wet surgical field
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57
Q

half hitch ligature

A

do 1 throw then another (square knot) tightened by sliding

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58
Q

natural fibre suture material con

A
  • more likely to get an inflammatory reaction

- variable absorption

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59
Q

synthetic suture material pros

A
  • less reaction

- predictable absorption

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60
Q

multifilament suture material pros

A

better handling and knot security

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61
Q

multifilament suture material cons

A

capillary action for bacteria

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62
Q

monofilament suture material pros

A

less tissue drag

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63
Q

monofilament suture material cons

A

weakens when crushed

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64
Q

example of synthetic absorbable multifilament suture material

A

vicryl

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65
Q

vicryl is made from

A

polyglactin 90

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66
Q

when synthetic multifilament suture material absorbed by

A

day 60-90

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67
Q

when does vicryl loose strength

A
  • day 7 33%
  • day 14 80%
  • day 21 100%
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68
Q

2 examples of synthetic absorbable monofilament

A
  • monocryl

- PDS 2

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69
Q

monocryl is made of

A

polyglecapron

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70
Q

monocryl absorbed at

A

90-120 days

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71
Q

monocryl strength lost days

A
  • 7 days 50%
  • 14 days 60%
  • 21 days 100%
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72
Q

PDS 2 is different from monocryl as it has a

A

longer duration

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73
Q

PDS 2 adsorbed at

A

day 110-210

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74
Q

strength lost PDS2 when

A
  • day 14 26%
  • day 28 40%
  • day 42 75%
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75
Q

synthetic nonabsorbable monofilament 3 examples

A
  • prolene
  • ethilon
  • flexon
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76
Q

nylon % strength lost at 2 years

A

25%

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77
Q

nylon memory

A

high

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78
Q

high memory means (knot)

A

low knot security

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79
Q

synthetic nonabsorbable multifilament example 2

A
  • catgut

- collagen

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80
Q

absobed time natural absorbable mutlifilament suture material

A

60-70 days

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81
Q

absorption of natural absorbable multifilament materials is sped up by

A

infection

82
Q

strength lost of natural absorbable multifilament material

A

day 7 33%

day 14 67%

83
Q

example of natural nonabsorbable multifilament

A

silk

84
Q

absorption time of silk

A

2 years

85
Q

suture material size for dog

A

3 metric

86
Q

suture material size for cat

A

2 metric

87
Q

define simple suture

A

material goes over and under wound edges

88
Q

define mattress suture

A

material either just goes under wound or above wound

89
Q

continuous suture pros

A
  • quicker
  • use less material
  • even distribution of tension
90
Q

continuous suture cons

A

have to be sure of knot security

91
Q

appositional suture pros

A
  • quicker healing

- less scar tissue

92
Q

inverting suture pros

A

stronger bursting strength

93
Q

inverting suture cons

A
  • necrosis of inverted tissue

- narrow lumen

94
Q

everting suture pros

A

strong tensile strength

95
Q

everting suture cons

A
  • prolonged inflammation
  • vascular compromise
  • narrow lumen
96
Q

partial thickness suture pros

A

not entering lumen so no wicking

97
Q

full thickness suture pros

A
  • better apposition

- ensures submucosa is engaged

98
Q

1 layer closure pros

A
  • quick

- less suture material

99
Q

2 layer closure pros

A
  • better apposition

- more water tight seal

100
Q

simple interupted suture pattern type

A

appositional though inverts if too tight

101
Q

modified gambee cons

A

difficult to place

102
Q

modified gambee how to

A
  • place material full thickness
  • come back up partial thickness on smae side
  • across wound and into other side
  • down into lumen partial thickness
  • up same side full thickness
  • tie off
  • should have a bubble writing n shape
103
Q

cruciate mattress pros

A
  • quicker than simple interupted

- stronger than simple interupted

104
Q

horizontal mattress suture type

A

appositional/everting depending on tension

105
Q

half buried horizontal mattress suture

A

used in complicated skin surgery

106
Q

vertical mattress pattern how to

A

far-far-near-near

107
Q

simple interupted echelon suture appearance

A
  • alternating sizes of simple interupted
  • wide bite for tension
  • narrow bite for apposition
108
Q

2 things used to spread tension when suturing

A
  • quills

- stents

109
Q

mesengenesis define

A

undifferentiated multipotent cells differntiate into a range of cells

110
Q

3 classic stages of wound healing

A
  • inflammation
  • new tissue formation/proliferation
  • remodelling
111
Q

inflammation in wound healing is seen (time)

A

first 48 hours

112
Q

environment of wound healing in inflammation

A

hypoxic with fibrin clot

113
Q

cells of inflammation wound healing

A
  • bacteria
  • neutrophils
  • platelets
114
Q

new tissue formation wound healing (time)

A

2-10 days

115
Q

new tissue formation wound healing appearance

A
  • scab on surface
  • angiogenesis
  • fibroplasia
116
Q

macrophages in wound healing

A
  • remove wound debris
  • produce collagenases and elastases
  • produce growth factors
  • coordinate angiogenesis
117
Q

how macrophages coordinate angiogenesis

A

secrete vascular endothelial growth factor

118
Q

keratinocytes role in wound healing

A
  • migrate under fibrin clot
  • reconstitute wound margin
  • ECM production
  • angiogenesis
119
Q

define pericytes

A
  • cells that sit around blood vessels

- have a role in angiogenesis

120
Q

fibroblast and wound healing

A

days 3-5 migrate into wound and produce ECM

- differentiate into myofibroblast

121
Q

myofibroblast and wound healing

A

make contractile proteins to help wound closure

122
Q

exmarchs 5 principles of wound management

A
  • non-introduction of anything harmful
  • tissue rest
  • wound drainage
  • avoidance of venous stasis
  • cleanliness
123
Q

swelling at incision site 6 ddx

A
  • acute haemorrhage/haematoma
  • incisional swellin/oedema
  • acute infection
  • seroma
  • abcess
  • dehiscence of underlying body wall
124
Q

tx of acute haemorrhage of wound post surgery

A

pressure dressing

125
Q

2 causes of wound dehiscence

A
  • excessive force on incision

- poor wound holding strength

126
Q

3 reasons for excessive force on incission

A
  • activity level
  • skin tension
  • trauma
127
Q

5 resons for poor wound holding strength

A
  • suture selection
  • knot security
  • wound edge compromised
  • wound infection
  • neoplastic tissue in wound or around wound edge
128
Q

tx wound infection

A

manage as an open wound. therefore remove sutures, debribe devitalised tissue, lavage and drain

129
Q

define sinus

A

blind ending tract from an epithelial surface

130
Q

define fistula

A

communicating tract from one epithelial surface to another

131
Q

4 reasons impaired granulation tissue formation

A
  • necrosis/devitalised tissue
  • wound infection
  • ischaemia
  • movement
132
Q

2 reasons for inadequate wound contraction

A
  • peripheral countertension due to lack of loose skin around the edge
  • restrictive fibrosis
133
Q

8 reasons for failure of tissue epithelialisation

A
  • necrotic tissue
  • wound infection
  • fibrotic scar tissue
  • poor quality chronic granulation tissue
  • repeated trauma to wound surface
  • loose bandages that abrade the wound
  • tissue desiccation
  • movement of wound site
134
Q

indolent pocket wounds define

A

where the skin is elevated around the granulation tissue creating a pit. so will not close

135
Q

steps on how indolent pocket wounds form

A
  • surrounding tissue becomes elevated and does not adhere to margins of defect
  • epithelial cells migrate to line the dermal surface
  • no skin edge advancement but instead it curls under
136
Q

3 places where indolent pocket wounds form

A
  • inguinal region
  • axillary region
  • flank region
137
Q

tx of indolent pocket wounds

A
  • excise scar border and restrictive dermal scar
  • close wound and attach to underlying granulation tissue
  • manage dead space with drains
138
Q

4 aims of wound management

A
  • achieve a healed wound
  • minimise scar formation
  • preserve function
  • prevent infection
139
Q

initial wound management steps

A

cover with a sterile dressing

140
Q

assessment of patient in wound managment

A
  • ABC

- throrough physical exam and history

141
Q

during assesment of wound establish

A
  • aetiology (cause)
  • location
  • nature
  • extent and degree of contamination
142
Q

antibiotic therapy is not needed in wound management once

A

a healthy bed of granulation tissue forms

143
Q

7 steps to promote a healthy bed of granulation tissue

A

1) protect from dessication and contamination
2) preparation and clipping
3) debride necrotic tissue
4) lavage to remove foreign material and contaminants
5) provide adequate wound drainage
6) promote a viable vascular bed
7) select appropriate method of closure

144
Q

wound prep and clipping in wound management 4 steps

A
  • wound protection
  • tissue handling
  • clipping of hair
  • surgical prep
145
Q

wound protection can be with (3)

A
  • KJ jelly
  • saline soaked swabs
  • temporary closure of wound with sutures or towel clips
146
Q

tissue handling in the prep stage of wound management should be

A
  • atraumatic
  • do not probe or replace bone fragments
  • stabilize with a splint if necessary
147
Q

clipping hair is easier with (3)

A
  • sharp blades
  • moist hair
  • wet blades
148
Q

surgical prep of wound (2)

A
  • prepared aseptically

- do not get antiseptic in the wound

149
Q

3 things to do in debridement of necrotic skin/fascia

A
  • excise liberally
  • back to bleeding tissue
  • preserve vessles
150
Q

2 debridement techniques

A
  • en bloc

- layered

151
Q

layered debridement define

A

begin at wound edges and work down through the tissue layers

152
Q

layered debridement pros

A

can assess each individual tissue layer in a wound

153
Q

layered debridement cons

A

all of the necrotic tissue may not be removed

154
Q

en bloc debridement define

A

complete excision of wound with no entry into the wound

155
Q

en bloc debridement cons

A

larger wound, and may damage the surrounding structures

156
Q

en bloc debridement pros

A

make it into a clean wound

157
Q

in lavage use

A

sterile isotonic fluid

158
Q

lavage of wounds is performed when

A

daily after changing dressing

159
Q

6 reasons for closing a wound

A
  • can convert to a clean wwound
  • no skin tension
  • wound is not a crush wound
  • wound is not infected
  • granulating wound
  • wound wont heal by second intention
160
Q

4 reasons for not closing a wound

A
  • puncture wound
  • cant debride or lavage
  • infected wound
  • tension on closure
161
Q

4 options for wound closure

A
  • primary closure
  • delayed primary closure
  • secondary closure
  • second intention healing
162
Q

primary wound closure define

A

direct apposition of wound edges if clean

163
Q

delayed primary wound closure define

A

apposition of wound edges 2-5 days post wounding

164
Q

when delayed primary wound closure is used

A
  • when wound is contaminated

- if judgment on wound cannot be made straight away

165
Q

define secondary wound closure

A

wound closure in presence of granulation tissue 5 -10 days post wounding

166
Q

2 methods of secondary wound closure

A
  • direct apposition of granulating surfaces

- excision of granulation tissue then primary closure

167
Q

secondary wound closure indications

A

when there is superficial contamination or invasive infection

168
Q

indication for secondary intention wound healing

A

large wounds that have a lack of adjacent skin

169
Q

layered debridement define

A

begin at wound edges and work down through the tissue layers

170
Q

layered debridement pros

A

can assess each individual tissue layer in a wound

171
Q

layered debridement cons

A

all of the necrotic tissue may not be removed

172
Q

en bloc debridement define

A

complete excision of wound with no entry into the wound

173
Q

en bloc debridement cons

A

larger wound, and may damage the surrounding structures

174
Q

en bloc debridement pros

A

make it into a clean wound

175
Q

in lavage use

A

sterile isotonic fluid

176
Q

lavage of wounds is performed when

A

daily after changing dressing

177
Q

6 reasons for closing a wound

A
  • can convert to a clean wwound
  • no skin tension
  • wound is not a crush wound
  • wound is not infected
  • granulating wound
  • wound wont heal by second intention
178
Q

4 reasons for not closing a wound

A
  • puncture wound
  • cant debride or lavage
  • infected wound
  • tension on closure
179
Q

4 options for wound closure

A
  • primary closure
  • delayed primary closure
  • secondary closure
  • second intention healing
180
Q

primary wound closure define

A

direct apposition of wound edges if clean

181
Q

delayed primary wound closure define

A

apposition of wound edges 2-5 days post wounding

182
Q

when delayed primary wound closure is used

A
  • when wound is contaminated

- if judgment on wound cannot be made straight away

183
Q

define secondary wound closure

A

wound closure in presence of granulation tissue 5 -10 days post wounding

184
Q

2 methods of secondary wound closure

A
  • direct apposition of granulating surfaces

- excision of granulation tissue then primary closure

185
Q

secondary wound closure indications

A

when there is superficial contamination or invasive infection

186
Q

indication for secondary intention wound healing

A

large wounds that have a lack of adjacent skin

187
Q

3 types of wound

A
  • elective incisional
  • elective excisional
  • traumatic
188
Q

6 things to consider in wound reconstruction

A
  • evaluate tissue elasticity
  • identify skin tension lines and likely effect
  • position and importance of local structures
  • location of adjacent direct cutaneous arteries
  • previous surgical or traumatic wounds in region
  • evaluation of viability and vascularity of local skin
189
Q

mobilise local skin to wound edge by

A

undermining skin edges

190
Q

3 ways to increase local skin by skin stretching

A
  • pre-suturing
  • skin stretchers
  • skin expanders
191
Q

pre-suturing skin expanding how to

A

vertical mattress tension sutures used to stretch the skin

192
Q

pre-sutuing skin stretching cons

A
  • requires 2 surgical procedures

- skin stretch is focal and not adjustable

193
Q

skin stretchers action

A

external device that stretches the skin

194
Q

skin stretchers pros

A

adjustable

can use over large areas

195
Q

skin expanders for skin stretching define

A

an expandable implant placed under skin

196
Q

a way to releive tension on a wound

A

relaxing incision

197
Q

define relaxing incision

A

skin incision adjacent and parallel to primary wound to relieve tension

198
Q

4 basic skin flaps

A
  • advancement flap
  • transposition flap
  • rotating flap
  • flank folds
199
Q

adjacent flaps in wound reconstruction define

A

use loose skin near wound and advance it over wound

200
Q

transposition flap wound reconstruction define

A

rectangular flap within a 90* angle of the long axis of defect

POS (13 decks)

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