Surgery Flashcards
Suture with most ST reaction
plain catgut
hemostasis for sickle cell patients
AVOID TOURNIQUETS as much as possible → hypoxia and increased sickling
try local anesthetic (least invasive)
sickle cell risk of complications
sickle cell patients are at higher risk than general population for intra-op and post-op surgical complication
OM cause in sickle cell patients
SALMONELLA
common complication of PIP RESECTION
Flail toe → toe instability and catching on socks or shoes
MC complication following preaxial polydactyly repair
hallux varus
(usually w/ short 1st met)
ankle tourniquets (vs thigh)
- greater NV damage
- (bc of less ST and adipose tissue around NV structures)
- requires shorter duration than thigh tourniquet
ankle tourniquet pressure:
rule of thumb
should be set ~100 mmHg higher than systolic BP;
BUT should NOT exceed 250 in adults, or 150 in a child
thigh tourniquet pressure:
rule of thumb
may be elevated to 300-350 mmHg in adults due to greater ST coverage and larger girth of the limb
maximal stress a material can undergo w/o permanent deformation
elastic limit
process of a solid material to slowly and permanently migrate or deform while mechanical stresses that are below yield strength for the material
creep
production of corrosion resistance by a surface of reaction products (this layer is normally an oxide layer, which is impervious to gas and water)
passivation
amount of deformation that a tensile stress or load will produce
elongation
force that attempts to pull apart or stretch a material
tensile stress
measure of stiffness of a substance along its elastic range;
(stress load / amount of strain or deformation)
modulus elasticity
ratio of change in dimension that takes place in a material under stress
strain
3 phases of wound healing
- inflammatory or substrate
- proliferative or fibroblastic
- remodeling or maturation
vimentin:
what is it and when is it secreted
structural filament protein involved in wound healing (inflammatory phase)
wallerian degeneration:
phase of nerve lesion
an active process of degeneration that results when the nerve fiber is cut or crushed and the part of the axon distal to the injury degenerates
occurs during AXONOTMESIS stage;
best sx for CP patient w/ HAV
1st MPTJ fusion (McKeever);
due to equinus, poor toe clearance during swing; stiff-knee gait 2° to rectus femoris dysfunction → toe drag at initial point of stance
ligation method:
small blood vessels during debridement of SubQ tissue
cauterized by bipolar cautery
ligation method for vessels larger than 2-3 mm
ligated with liga-clips
liga-clips are least reactive foreign body material to accomplish this; if suture is used, should be small diameter monofilament
best method to evaluate for equinus in cerebral palsy (CP) patients
qwith patient under general anesthesia;
(is the best way)
following successful callous distraction w/ an ex-fix,
how long should frame be kept on to ensure complete ossification?
2-4x the time it took to complete the lengthening
patient is encouraged to weight bear to stimulate bone healing, as after the distraction period has been completed, the distraction gap is ossified incompletely
5 modes of plate functions
- compression
- protection
- buttress
- tension band
- bridging
mechanism of variable pitch compression screws
wider pitched threads distally entering the bone faster than the trailing threads →
providing gradual compression as the screw is advanced
MOI: of lateral talar process fracture
(snowboarder’s fracture)
Dorsiflexion and External Rotation
sudden axial force traveling through the foot when the foot is dorsiflexed and externally rotated →
