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CPS > Soft Tissue Surgery > Flashcards

Soft Tissue Surgery Flashcards

1
Q

Name the 7 Halstead’s Principles 1913?

A
  1. Gentle tissue handling
  2. Haemostasis
  3. Strict asepsis
  4. Preservation of blood supply
  5. No tension on tissues
  6. Good approximation of tissues
  7. Obliteration of dead space
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2
Q

Name 8 common abdominal procedures?

A
  1. neutering
  2. cesarean
  3. exploratory laparotomy
  4. cystotomy
  5. splenectomy
  6. Gastrointestinal surgery
  7. Hernia repair
  8. Hepatobilliary surgery
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3
Q

What does ‘otomy’ mean?

A

Making a hole into something

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4
Q

what does ‘ostomy’ mean?

A

Making the hole permanent

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5
Q

What does ‘ectomy’ mean?

A

Removing something

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6
Q

What are the 6 laparotomy approaches?

A
  1. ventral midline
  2. flank
  3. inguinal
  4. parapenile
  5. sublumbar
  6. paracostal (behind the last costal rib)
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7
Q

what is the difference between laparotomy and celiotomy?

A

Nothing, they are the same thing.

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8
Q

When would you use an inguinal incision?

A

Cryptorchid dog

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9
Q

When would you use sublumbar incision?

A

Large animals

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10
Q

Why would use a parapenile approach?

A

In the male dog where the penile sheath gets in the way of a ventral midline incision. Underly the sheath and locate the linea alba.

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11
Q

What is a big problem with cotton drapes?

A

Strike through where the blood comes into contact with the drape and unclipped hair - this is bad contamination.

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12
Q

Which external sheath is the critical layer?

A

Rectus abdominis

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13
Q

When suturing the abdomen, which layer do we put sutures through?

A

Linea alba

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14
Q

What two methods do we use to dissect through the linea alba?

A

Lift and Nick

Push and cut

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15
Q

What does the push and cut cause?

A

May expose the falciform fat.

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16
Q

Where does the falciform fat sit in the dog?

A

Cranial to the umbilicus

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17
Q

What do we have to make sure we do with surgical swabs?

A

Count them in and count them out

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18
Q

What feature makes swabs visible on radiographs?

A

radiopaque markers.

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19
Q

How should we remove the blood using swabs?

A

dab, don’t wipe.

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20
Q

Name three steps to examining the abdomen?

A
  1. Need good expsure e.g. make sure the incision is long enough.
  2. use retractors e.g. Bafours and Gosset
  3. Be methodical, especially with the GIT.
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21
Q

How many points of contact have Balfour retractors?

A

3

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22
Q

How many points of contact have gosset retractors?

A

2

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23
Q

Where can the pancreas be found?

A

Right limb of the pancreas is alongside the duodenum. The left limb is along the greater curvature of the stomach.

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24
Q

What does the duodenal manouvre expose?

A

The right urogenital structures.

The vena cava and portal systems.

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25
Q

What does the colonic manouvre expose?

A

The left side of the abdomen.

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26
Q

Which muscle layer is on the outside of the bowel?

A

Longitudinal with circular inside.

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27
Q

What are the 4 layers of the bowel from the inside out?

A
  1. mucosal layer
  2. Submucosal layer
  3. Smooth muscle (circle, longitudinal)
  4. serosa
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28
Q

Which layer of the bowel holds the sutures?

A

Sub-mucosal layer

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29
Q

What are the 7 rules of GI surgery?

A
  1. Incorporate the submucosa into the sutures
  2. Gentle tissue handling
  3. maintain a good blood supply
  4. Prevent tension across the suture line
  5. avoid spillage of contents - laparotomy swabs
  6. Lavage and suction
  7. peri-operative antibiotics - this is a contaminated surgery
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30
Q

What is the bacterial threat from the stomach?

A

Low bacterial count - acid scald is much more of a problem

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31
Q

What is the bacterial load of the small intestine?

A

high load

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32
Q

What is the bacterial load of the colon?

A

Even higher load - higher than the small intestine

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33
Q

What does suture pattern depend on?

A

Incision location and the reason for surgery.

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34
Q

For luminal structures, why would you use a narrow filament?

A

Not as much drag.

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35
Q

What is Intussusception?

A

This is when the oral end of the bowl folds in on the aborral end. Folds like a teloscope.

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36
Q

When does the bowel intussuscept?

A

When it is disorientated.

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37
Q

What has to happen if the bowel has been intussuscepted for a while?

A

Remove that part of the bowel.

38
Q

What kind of clamps are best to use on the bowel?

A

Use non-crushing clamps therefore fingers are often the best.

39
Q

What is an enterotomy?

A

Biopsy taken from the bowel.

40
Q

What filament should be used for enterotomy?

A

Mono-filament, absorbable.

41
Q

What is a beneficial thing to do following enterotomy?

A

Omentalise the wound e.g. place the omentum around it and protect the wound - blood supply and lymphatic drainage and will heal quicker.

42
Q

What suture pattern would you use to close an enterotomy?

A

Simple continuous

43
Q

Give an example of atruamatic clamps?

A

Doyen (non-crushing) clamps

44
Q

How can you keep the omentum in place over the top of the wound site?

A

Cat tack the omentum in place.

45
Q

What is PDS?

A

Polydioxanone

46
Q

What is Maxon?

A

Polyglyconate

47
Q

What is Biosyn?

A

Glycomer 631

48
Q

What is Monocryl?

A

Poligrecaprone 25

49
Q

What is a good size suture material to use for soft tissue surgery?

A

3/0 or 4/0

50
Q

Name 2 reasons why these suture materials are good to use for soft tissue surgery e.g. GIT?

A

> Good tensile strength 5-7 days

> resist absorption >21 days

51
Q

What kind of suture would you use to close the lumen?

A

Simple interrupted 2-3mm apart and 2-3 mm from edge/

52
Q

Why would you not use an eye needle during bowel surgery?

A

Because this is traumatic and would cause damage at the site of the eye.

53
Q

What type of needle would you chose for bowel surgery?

A

4.30 has sharp-cutting edge.

Use swaged needle.

54
Q

How do you test that the site is not going to leak?

A

Inject saline fluid into lumen and hold other end with finger and see if leaks

55
Q

How tight should the sutures be?

A

Just so that the sutures are appositional

56
Q

Name 3 three things that starvation after gastrointestinal surgery will cause?

A
  1. villus atrophy
  2. Ulceration
  3. Breakdown of the gut barrier
57
Q

What happens in dogs and cats if we don’t feed them after surgery? More common in dogs and cats than horses.

A

We see ileus where the bowel stops moving and there is a blockage.

58
Q

Name three things that the omentum supplies to the wound?

A
  1. vascular supply
  2. fibrosis
  3. Phagocytosis
59
Q

What do you do if there is no omentum?

A

Attach neighbouring piece of intestine to the site.

60
Q

What is it called when a piece of health bowel is attached to the site of the wound to aid healing?

A

Serosal patching

61
Q

Name 3 reasons why you would carry out bladder surgery?

A
  1. calculi e.g.bladder stones
  2. Tumour
  3. Biopsy
62
Q

With bladder surgery, why do we need to avoid rough handling?

A

To avoid oedema

63
Q

Where do we place a stay suture in the bladder? and why?

A

In the apex - to secure the bladder and draw it back cranially so that we have good access.

64
Q

What do we need to avoid incising in the bladder?

A

THE TRIGONE

65
Q

How would we normally close the bladder?

A

Single layer, full thickness, simple continuous or interrupted.

66
Q

Why do we want to avoid non-absorbable sutures in the bladder?

A

Site for nidus and urolith formation

67
Q

Within how many days does the bladder regain 100% strength again?

A

14-21 days

68
Q

Which type of suture material is best in the bladder?

A

PDS

69
Q

What causes a more rapid breakdown in strenght of sutures holding the bladder?

A

in contact with urine.

70
Q

What else can you do to aid bladder healing?

A

Omentalise!

71
Q

Is it better to do single layer or two layer closure of the bladder?

A

Classically, two layer closure

generally, 1 layer closure.

72
Q

Name 5 things that you should do before closing the abdomen?

A
  1. check the integrity of repair (gut and bladder)
  2. check for bleeding
  3. count swabs
  4. lavage and suction
  5. change gloves? change instruments?
  • depends on contamination
73
Q

Which is the critical layer when closing the bladder?

A

the External rectus sheath

74
Q

Where is it easiest to locate the linea alba?

A

Cranial to the umbilicus

75
Q

How do you want to close the linea alba?

A

> even distribution of tension along length of closure
more rapid closure
less bacterial load therefore less suture maaterial
6 throws at each end

76
Q

Which absorbable monofilament suture material could be used to close the abdomen?

A

PDS (3-3.5)

77
Q

Will the linea alba ever regain full strength?

A

No, will only ever regain about 80% strength.

78
Q

How many layers are there to closing the abdomen and what are they?

A
  1. subcutaneous layer
  2. intradermal layer
  3. skin layer
79
Q

What pattern and suture material should be used for the SC tissues?

A

Simple continuous pattern, PDS or monocryl

80
Q

What pattern and suture material should be used for intradermal sutures?

A

Simple continuous and PDS, or monocryl

81
Q

What pattern and suture material should be used for skin sutures?

A

Non-absorbable, maybe nylon?

Use simple continuous or simple interrupted

82
Q

What do we do to allow some swelling in the sutures?

A

Don’t pull them too tight.

83
Q

When are the most bacteria going to enter the wound?

A

Within the first 12-24 hours. Want to stop the risk of SSI.

84
Q

Why do we ALWAYS want to cover the wound before leaving theatre?

A

Because fibrin seal takes several hours to form.

85
Q

Do we give analgesia post-operatively?

A

ALWAYS

86
Q

How often do we check the wound?

A

Check the wound every 24 hours - inspection and gentle palpation with gloves.

87
Q

What are 5 signs of uroabdomen or peritonitis?

A
  1. Pyrexia
  2. lethargy
  3. Needs fluids
  4. might go into shock
  5. Looks pale
88
Q

How could we determine if there is an infection or uroabdomen?

A

Clinical signs, peritoneal tap, radiology, abdominal ultrasound.

89
Q

What 3 things might we need to do following complications?

A
  1. revision surgery
  2. copious lavage and drain
  3. peritoneal drainage
90
Q

If you suspect peritonitis, what should you not do?

A

send the dog home - need to act QUICKLY!

CPS (21 decks)

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