Soft Tissue Surgery (1-19) Flashcards
name the 3 phases of wound healing
- inflammation
- proliferation
- maturation
name the 3 goals of the inflammatory phase of wound healing
- haemorrhage + clot formation
- incr. blood flow
- start control bacterial infection
what is the role of neutrophils in the inflammatory phase of wound healing
phagocytose bacteria & die
name the 3 roles of macrophages in the inflammatory phase of wound healing
- phagocytosis of debris
- produce proteases
- release cytokines
name 2 roles of exudate during the inflammatory phase of wound healing
- sloughing tissue, cells, and bacteria
- debridement phase of wound management
name the 2 parts of the proliferative phase of wound healing
- granulation tissue forms
- epithelialisation
name the 3 steps of granulation tissue formation during the proliferative phase of wound healing
- macrophages promote fibroplasia and angiogenesis
- vessels migrate into fibrin clot
- collagen matrix is laid down
name 3 features of an unhealthy granulation bed during wound healing
- pale
- not progressing
- usually necrotic debris or infection
name 3 features of a healthy granulation bed during wound healing
- highly resistant to infection
- nutrient and oxygen supply
- lattice for scar formation (red, moist, flat)
name 5 factors that promote epithelialisation during the proliferative phase of wound healing
- healthy granulation bed
- absence of infection
- absence of necrotic debris
- oxygen at wound surface (vessels)
- moist wound environment
name the 2 parts of the maturation phase of wound healing
- scar contracts
- collagen remodels (increasing strength)
what is the endpoint goal of initial open wound management
granulation tissue with epithelialisation
name 2 types of factors affecting wound healing
- host factors
- local factors
name 5 host factors that may delay wound healing
- old age
- hypoalbuminaemia
- endocrine disease
- metabolic disease
- medication
name 5 local factors detrimental to wound healing
- foreign material
- infection
- trauma
- desiccation
- hypoxia
name 6 ways to promote wound healing
- removal of non-viable tissue
- control infection
- good tissue oxygenation
- moist surface
- avoid trauma
- control host factors where possible
name 4 wound closure options
- primary closure
- delayed primary closure
- secondary closure
- second intention healing
what type of wound is able to be closed by primary closure
(immediately)
clean or clean-contaminated with aseptic technique
what type of wound is able to be closed by delayed primary closure
(2-5 days)
clean contaminated, contaminated
what type of wound is able to be closed by secondary closure
(>5 days)
contaminated, dirty
name the type of wound closure
closure after bacteria and debris have been eliminated but before granulation starts;
moderate tissue trauma;
grossly contaminated;
caused by dirty objects
delayed primary closure
name the type of wound closure
closure once granulation tissue has formed;
healthy granulation - implies no infection or necrotic debris
secondary closure
name the 3 steps of open wound management
- initial assessment and preparation
- debridement (inflamm. phase)
- granulation (proliferation phase)
name 4 steps to prevent further contamination during hair clipping for preparation of an open wound
- pack wound with sterile K-Y jelly
- clip widely
- gel traps hair
- lavage gel off
name 3 ways to debride an open wound for initial debridement
- sharp dissection
- scraping with blade
- rub with dry swab
name 4 signs of devitalised tissue that should be debrided
- white, green black
- does not bleed when nicked
- loss of skin pliability
- thinning of skin
name 3 options for continued debridement of an open wound
- adhesive dressing (wet-to-dry dressing)
- autolytic
- surgical
how often should a wet-to-dry dressing for debridement be changed
min. 24 h;
usually 12-24h
how long should an adherent dressing be used for continued debridement of an open wound
48-72 h
(during exudative period)
when should you change the debridement method of an open wound to non-adherent?
(3 features present)
- all necrotic tissue removed
- exudate reduces
- granulation starts
name 3 surgical options for continued debridement of an open wound
- en bloc
- layered debridement
- combination
name 2 autolytic options for continued debridement of an open wound
- hydrogel
- honey dressing
what are the 3 goals of autolytic debridement
- encourage enzyme activity
- liquefy exudate
- remove exudate
(physiological slough)
name 4 features of honey dressings for an open wound debridement
- autolytic debridement
- osmotic effect
- antibacterial effect
- accelerate wound healing
name 4 visual features of healthy granulation tissue
- red
- uniform
- minimal exudate
- progressing daily
name the 3 layers of a bandage
- primary (contact) layer
- intermediary layer
- tertiary layer
name 3 functions of the intermediary layer of a bandage for an open wound
- hold contact layer in place
- absorb exudate passing through contact layer
- provide padding + support
name the 2 parts of the tertiary layer of a bandage
- conforming layer
- cohesive layer
name the 3 functions of the tertiaru layer of a bandage
- hold intermediary layer in place
- protect environmental contamination
- apply pressure to dressing
name the topical antimicrobial
bactericidal broad spectrum;
apply early to prevent bacterial colonization;
burn therapy
silver sulfadiazine
name the topical antimicrobial
Ag+ ions;
bactericidal;
independent of culture and sensitivity
silver dressings
name the topical antimicrobial
oxidase activity generates H2O2;
acidic pH;
anti-oxidants;
modifies host response;
osmotic effect
honey dressings
name the 4 layers of the skin
- epidermis
- dermis
- hypodermis
- panniculus muscle
name the 4 levels of vasculature in the skin
(superficial to deep)
- papillary/superficial plexus
- middle plexus
- subdermal plexus
- direct cutaneous vessels
name the 7 Halsted Principles
- aseptic technique
- gentle tissue handling
- meticulous haemostasis
- preservation of blood supply
- obliteration of dead space
- accurate apposition of tissue
- minimise tension
what kind of suture material should you use for the skin
synthetic, monofilament, small diameter
what kind of needle should you use for suturing skin
swaged-on reverse cutting needles
what type of forceps are the most traumatic to skin?
plain thumb forceps
(crushing injury)
name 3 surgical techniques for eliminating dead space
- drains
- sutures
- bandages
what is the surgical technique to preserve blood supply if the panniculus is present
dissect below
what is the surgical technique to preserve blood supply if the panniculus is absent?
dissect off underlying fascia
name 3 surgical techniques for meticulous haemostasis
- vessel ligation
- electrosurgical devices
- tourniquets
name 4 ways to reduce tension during surgery closure
- distribute tension evenly through all layers of the wound
- follow tension lines
- tension-relieving suture patterns
- reconstructive techniques
this is the primary holding layer of the wound
subcutaneous layer
should you close wounds parallel to OR perpendicular to tension lines
parallel
name the tension relieving technique
this is the main form of tension relief during surgery;
should be done below the panniculus muscle or below the subcutaneous tissue when the panniculus is absent;
use blunt or sharp technique
undermining
name the tension relieving technique
this follows undermining;
distributes tension throughout wound;
reduces tension at primary suture line;
staggered rows of simple interrupted sutures (absorbable)
walking sutures
name the 4 types of mattress sutures
- cruciate mattress
- vertical mattress
- horizontal mattress
- near-far-far-near
name the tension relieving technique
close one wound by creating a second, adjacent wound;
used to shift wound away from pressure point or into an area where there is more available skin
relaxing incisions
name 3 types of relaxing incisions that can be made to relieve tension
- mesh expansion
- bipedicle advancement flap
- V-Y plasty
name two types of pedicle flaps
- subdermal plexus flap
- axial pattern flap
name the type of pedicle flap
incorporate a large direct cutaneous vessel;
larger flap possible;
anatomical landmarks determined by angiosome
axial pattern flaps
name the 4 most commonly used vessels for axial pattern flaps
- deep circumflex iliac
- caudal superficial epigastric
- thoracodorsal
- omocervical
name the 3 key principles of a free skin graft
(full thickness meshed graft)
- intolerant of movement
- require healthy granulation tissue bed
- must stay in close contact with bed
name the term
removal of part of the upper jaw
usually to remove oral neoplasms
maxillectomy
name the term
removal of part of the lower jaw
mandibulectomy
name the term
removal of part of the toungue;
usually to remove a tumour
glossectomy
name the term
plastic surgery to repair lip defects
cheiloplasty
name 4 important surgical principles for oral surgery
- atraumatic tissue handling
- haemorrhage
- tension-free, supported closure
- appositional suture patterns
name 6 general clinical signs that may be seen with oral disease
- drooling
- oral bleeding
- dysphagia
- anorexia
- pain
- halitosis
name 3 postoperative concerns of oral surgery
- eating
- preventing wound dehiscence
- pain relief
name the 4 major pairs of salivary glands in dogs and cats
- Parotid gland
- Zygomatic gland
- subLingual gland
- Mandibular gland
name the term
submucosal or subcutaneous collection of saliva;
leakage of saliva from gland or duct;
submandibular, cervical, sublingual
sialocoele
(aka salivary mucocoele )
name 3 common locations of sialocoeles (aka salivary mucocoele)
- submandibular
- cervical
- sublingual (ranula)
name 6 possible causes of salocoele
- idiopathic (most common)
- trauma
- inflammation
- neoplasia
- sialolithiasis
- foreign body
what duct is most commonly the cause for a sialocoele
sublingual gland
name 5 clinical signs of a sialocoele
- fluctuating swelling
- dysphagia
- oral bleeding
- hypersalivation
- respiratory obstruction
name 3 features of aspirate from a sialocoele to help with diagnosis
- honey coloured
- viscous
- mucin
what is the treatment for a subcutaneous sialocoele?
sialoadenectomy
(removal of the salivary gland)
what is the treatment for a ranula (caused by a sialocoele)
marsupialisation
+/- sialoadenectomy
name the term
abnormal communication between the oral and nasal cavity
oronasal fistula
name 4 clinical signs of an oronasal fistula
- chronic rhinitis
- nasal regurgitation of food
- aspiration pneumonia
- malnutrition
name 3 possible causes of an oronasal fistula
- dental disease
- trauma
- neoplasia
name 3 features of acute presentation of penetrating oropharyngeal injuries
- oral signs (dysphagia, blood-tinged saliva, pain)
- pyrexia
- pyothorax + mediastinitis
name 2 features of chronic presentation of penetrating oropharyngeal injuries
- swelling/abscess
- sinus tract
name the term
any incision into abdominal cavity
coeliotomy
name the term
incision through muscle into abdomen;
flank incision or paracostal approach
laparotomy
name the term
sudden onset abdominal pain;
catastrophic abdominal pathology
acute abdomen
name 5 possible characteristics of acute abdomen
- acute severe abdominal pain
- shock
- +/- abdo distension
- +/- vomiting
- +/- diarrhea
name the term
fibrous band running from xiphoid to prepubic tendon;
located between paired rectus abdominus
linea alba
the aponeuroses of what muscles forms the linea alba
- external oblique
- internal oblique
- transversus abdominus
this is the primary holding layer for abdominal closure
external rectus sheath
which 3 muscles contribute to the external rectus sheath
- external abdominal oblique
- internal abdominal oblique
- transversus abdominus
name the 3 possible approaches to abdominal surgery
- ventral midline coeliotomy
- flank laparotomy
- paracostal laparotomy
name two advantages of an organ centered approach for ventral midline coeliotomy
- quicker
- lower morbidity
name three advantages of a full exploratory approach for ventral midline coeliotomy
- better exposure
- evaluate entire abdomen
- easier to deal with complications
how should an animal be clipped for an abdominal surgery
for full abdomen approach
(mid-sternum to beyond pubis + up to flank folds)
what two additional structures must be transected/ligated in a male doge for full ventral midline coeliotomy
- cranial preputial muscle
- preputial branches of caudal and superficial epigastric artery and vein
name 2 surgical approaches to maximize exposure during ventral midline coeliotomy
- excise falciform fat
- use abdominal retractors
name 2 types of abdominal retractors
- Balfour
- Gosset
name 2 surgical approaches to prevent tissues from desiccating during abdominal surgical
- moistened swabs
- saline lavage + suction
what 4 organs should be looked at in the cranial quadrant of the abdomen
- diaphragm
- liver
- gall bladder
- stomach
what 7 structures should be inspected in the right gutter of the abdomen
- R limb pancreas
- kidney
- adrenal
- portal vein
- vena cava
- ureter
- ovary
what maneuver must be done in order to see into the R gutter of the abdomen
mesoduodenal sling
what maneuver must be done in order to see the left gutter of the abdomen
mesocolic sling
what 4 structures should be looked at in the left gutter of the abdomen
- kidney
- ureter
- ovary
- adrenal
what 3 structures should be looked at in the central abdomen quandrant
- omentum
- spleen
- left limb of pancreas
what 6 structures should be inspected in the caudal quadrant of the abdomen
- colon
- repro tract
- bladder
- urethra
- prostate
- inguinal rings
what suture type should be used to close the first layer from a coeliotomy, the linea alba (external rectus sheath)
monofilament, synthetic absorbable suture material
what suture pattern should be used to close the first layer from a coeliotomy, the linea alba (external rectus sheath)
simple interrupted or continuous patterns
if using PDS for closure of the ecternal rectus sheath, how many throws should be at the start and finish of the continuous pattern
7 throws start + finish
what type of suture should be used for coeliotomy closure of the second layer, the subcutaneous tissue
monofilament, absorbable suture
what type of suture should be used for intradermal skin apposition
monofilament, absorbable suture
what type of suture should be used for external skin apposition
non-absorbable
name the 3 layers that must be sutured for coeliotomy closure in a dog
- linea alba (external rectus sheath)
- subcutaneous tissue
- skin apposition
name the term
enlargement of the stomch associated with rotation on its mesenteric axis
gastric dilation-volvulus (GDV)
name the term
stomach that is engorged with air or froth but not malpositioned
simple dilatation
name 3 types of fluid that may fill the dilated stomach in GDV
- food + gastric secretions
- transudate from mural venous congestion
- blood + mucosal slough as stomach necrosis develops
what direction will the stomach typically rotate in a GDV
clockwise rotation
where will the spleen be displaced to with GDV
right dorsal
(via gastrosplenic ligament)
name 4 possible cardiovascular effects of GDV
- reduced venous return to heart
- reduced circulating blood volume
- cardiac arrhythmias
- shock (endotoxic + septic)
how can GDV cause respiratory compromise?
diaphragmatic compression
name 3 intrinsic factors that may incr. risk for GDV
- breed (deep-chested)
- conformation
- genetics
name 3 diets that may be risk factors for GDV
- single source diet
- one daily feeding
- processed dry (cereal or soya based)
name 6 recommendations to try and prevent GDV for high-risk dogs
- several small meals rather than 1 large
- avoid stress during feeding
- restrict exercise before and after meals
- no elevated feed bowl
- don’t breed dogs with first-degree relative with GDV history
- consider prophylactic gastropexy
how to confirm GDV diagnosis
radiography:
1. compartmentalisation
2. cannot identify pylorus on R lateral
what 2 things for patient stabilisation must start immediately for a dog with GDV
- fluid resuscitation
- gastric decompression
what 2 veins should you use for IV fluid resuscitation for a dog with GDV (one of the 2)
- Jugular
- Cephalic
what type of fluid and at what rate should be given to a dog with GDV for fluid resuscitation
crystalloids
90+ mL/kg per hour
(squeeze a full bag into them)
name 3 reasons for decompressing a patient with GDV
- prevents necrosis
- stabilize systemically/cardiovascularly
- easier to de-rotate
name 2 methods for decompression of a patient with GDV
- orogastric intubation
- percutaneous decompression
where should the large bore tube be premeasured to for orogastric intubation for decompression of GDV
to last rib
name 3 goals of GDV surgery
- decompress and reposition stomach
- assess stomach and spleen for necrosis
- prevent recurrence
what is the most common site for necrosis from a GDV
greater curvature
name 3 indications for a splenectomy from GDV
- persistent congestion aftr 10 min of repositioning
- avulsion or infarction of vessels
- gross necrosis
(rarely necessary)
name 4 gastropexy techniques
- incisional
- belt loop
- circumcostal
- tube
name the gastropexy technique
strong;
technically easiest;
adhesion formation between pyloric antrum and R body wall just behind last rib
incisional
where do you put the stomach tube for GDV tube gastropexy
tube in pylorus
where do you put the stomach tube for feeding
in fundus
what is the minimum time a gastrostomy tube must be maintained/kept in
7 days
name 3 possible early post op complication of a GDV surgery
- cardiac arrhythmias
- gastric wall necrosis
- peritonitis
name 2 possible longer term post op complications of a GDV surgery
- gastric hypomotility
- recurrence 5 to 10%
name the term
incision into the intestine
enterotomy
name the term
removal of a segment of intestine
enterectomy
name the term
eneterostomy with reestablishment of continuity between the divided ends
intestinal resection and anastomosis
name the term
surgical fixation of one intestinal segment to another
enteroplication
name 2 ways to reduce contamination during intestinal surgery
- isolate intestine
- lavage and suction
name 2 ways to minimize tissue trauma during intestinal surgery
- gentle handling
- use correct instruments
what is the holding layer of the intestines that MUST be engaged in EVERY suture or staple
submucosa
what is the best choice of forceps to handle the intestines with during surgery
Debakey forceps
what type of forceps should NEVER be used with the intestines during surgery
rat-toothed forceps
name 3 clinical signs of an intestinal foreign body
- vomiting
- loss of appetite
- abdominal discomfort
(+/- diarrhea +/- melaena)
name 3 possible systemic effects of an intestinal foreign body
- dehydration
- electrolyte loss
- weight loss (chronic)
name 3 possible local effects of an intestinal foreign body
- pressure necrosis
- perforation
- peritonitis
name the 2 surgical options for an intestinal foreign body
- enterotomy
- enterectomy
where should the incision be made for an enterotomy for an intestinal foreign body
distally (healthy bowel) to foreign body on antimesenteric surface