Surgical Instruments and Suture Materials Flashcards
Surgical instruments can be divided in categories: (4)
- Cutting instruments
- Grasping instruments
- Retractors
- Miscellaneous instruments
Name the parts
Tips
Jaws
Box lock pin
Box lock
Shank
Ratchet
Ring handle
Cutting instruments can be 1 of 3:
- Scalpels
- Scissors
- Bone-cutting instruments
Name the Bone-cutting instruments
- Bone chisel (A)
- Osteotome (B)
- Gouge (C)
- Gigli saw (D) (most frequent in large animal) pronounced jeelee
- Bone-cutting forceps (E)
- Trephine (F) (for hole boring)
Primary tissue cutting instrument
Scalpel
Handle #3 can hold blades 10-15
Handle #4 can hold blades 20-23 (often large animal)
- No. 10 – most common in small animal surgery
- No. 15 – similar, more precise
- No. 11 – stab incisions into-fluid filled structures
- No. 12 – limited use
Scalpel position to aim for while incising
Scalpel perpendicular to the skin when incising.
Tissues stabilized with the nondominant hand when incising.
Scalpel grip (3)
Can be held with a pencil grip, a fingertip grip (or a palmed grip).
Tissues stabilized with the nondominant hand when incising.
Four scalpel motions can be used:
- Sliding (precise depth, length, control of direction; e.g., skin incision)
- Pressing (precise length, direction, but depth poorly controlled; e.g., stab incision)
- Sawing (allows continuation of a single cut without removal of the blade; e.g.,
transecting a ligated pedicle) - Scraping (method of separating tissue layers; e.g., debridement)
Describe image depiction.
Image depicts press cut incision technique.
- A – reverse press cut incision into the peritoneal cavity
- B – press cut incision into a fluid-filled structure
Describe image depiction. (3)
Pencil grip:
* Allows shorter, finer, and more precise incisions than the other grips. Hand is also in contact with patient.
- Reduced cutting edge contact – less useful for long incisions
- Curved incisions
Describe image depiction. (3)
Fingertip grip
* Maximum length of the blade edge in contact with the tissue
- Movement performed by the whole arm
- Best accuracy and stability for long
straight incisions
Describe image depiction. (3)
Palmed grip
* Strongest hold on the scalpel
- Allows exertion of great pressure on the tissue
- Usually unnecessary in surgical situations
If you have a choice, which should you favor: scalpel or scissors?
scalpel
less tissue damage and more precision
Curved vs straight scissors.
- Curved scissors – greater maneuverability and visibility
- Straight scissors – mechanical advantage for cutting dense tissue
Describe image depiction.
Tripod (thumb–ring finger) grip is recommended for maximal control.
Identify instrument and describe its use.
Mayo scissors
- For dissecting soft tissue
- Thick blades approximately one-third of the length.
Identify instrument and describe its use.
Metzenbaum scissors
- Dissecting delicate soft tissue
- Thin delicate blades approximately
one-fourth of the overall length.
Identify instrument and describe its use.
Blunt/sharp operating (utility) scissors
- Often reserved for use on inanimate objects (e.g., suture material).
“suture scissors”, lankasakset
Identify instrument and describe its use.
Suture scissors for suture removal.
tikkisakset
Identify instrument and describe its use.
Bandage scissors for cutting bandages and tape.
Identify instrument and describe its use.
Tenotomy scissors for cutting through tendons.
Frequently limited to ophthalmology and neurosurgery.
Grasping instruments can be either: (2)
- Needle holders or
- Tissue forceps
Types of Tissue forceps (6)
- Crushing tissue forceps
- Non-crushing tissue forceps
- Hemostatic forceps
- Thumb forceps
- Towel clamps
- Bone-holding forceps
Guidelines etc. for needle holders: (5)
- Needles placed perpendicular to the needle holder – greatest maneuverability.
- Needle is generally grasped near its center.
- Jaw grooves cross-hatched on the surface intended to limit twisting and rotation of the needle.
- Holder should match both the size and the type of the needle being used.
- Different locking mechanisms possible.
Identify instrument
Mayo-Hegar needle holders
Identify instrument
Olsen-Hegar needle holders
Identify instrument
Mathieu needle holders
Identify instrument
Castroviejo needle holders
used in a pencil grip, ophthalmology
Needle holders - grips
Thenar grip
Needle holders - grips
The thumb-ring finger grip
Needle holders - grips
Palmed grip
Needle holders - grips
Pencil grip
Tissue forceps are Used for
a variety of tasks
Multiple types of forceps of various sizes and shapes available.
Configuration of jaw serrations determines their use.
* Cross-serrations – tip-clamping
* Longitudinal serrations – jaw-clamping
Purpose of tissue forceps with:
* Cross-serrations
* Longitudinal serrations
- Cross-serrations – tip-clamping
- Longitudinal serrations – jaw-clamping
Crushing tissue forceps Should be used to
grasp only tissue slated for excision.
(cause you don’t want to crush tissue that will remain in the body cavity)
Identify instrument
Allis tissue forceps
Identify instrument
Babcock tissue forceps
Identify instrument
Ochsner-Kocher forceps
Note they have a tooth at the tip.
Non-crushing tissue forceps include: (3)
- Various peripheral vascular clamps
- Partial occlusion forceps
- Doyen forceps are considered non-crushing, but actually induce tissue trauma (dependent on use duration).
Identify
Doyen intestinal forceps
Crushing instruments used to clamp blood vessels are called
hemostatic forceps.
- Serrations on the jaws may be transverse, longitudinal, diagonal, or a combination of these.
- Longitudinal serrations are generally gentler to tissue than cross serrations.
- As little tissue as possible should be grasped to minimize trauma.
- The goal is to use the least amount and duration of pressure applied on closure of the ratchet of the instrument.
What instrument would you use to hold bowel that requires resecting?
Doyen intestinal forceps
You do not want to crush the tissue that you must reconnect thus use doyen’s which are less traumatic.
Identify
Halsted-mosquito hemostats,
Hemostatic forceps
Used on more delicate tissues (cause they is smol).
Identify
Crile hemostats,
Hemostatic forceps
Identify
Kelly hemostats,
Hemostatic forceps
Identify
Rochester-Carmalt hemostats,
Hemostatic forceps
Tweezer-like, nonlocking instruments used to grasp tissue (and inanimate objects) are called
Thumb forceps (atulat)
- Available in various shapes and sizes; tips may be pointed, flat, round, smooth, or serrated with small or large teeth.
- Pencil grip preferred.
- Can be held in the palm of the nondominant hand when temporarily
not in use.
Brown-Adson forceps,
Thumb forceps
Debakey forceps,
Thumb forceps
Adson forceps,
Thumb forceps
Dressing forceps,
Thumb forceps
Grip for thumb forceps?
Thumb forceps - pencil and palmed grip
Towel clamp types: (2)
Backhaus towel clamps
Jones towel clamps
Backhaus towel clamp
Jones towel clamp
Lane bone holding forceps,
Bone-holding forceps
Bone holding forceps with speedlock,
Bone-holding forceps
Instruments that Help improve exposure by deflecting tissue away from the area of
interest are called?
Retractors
- Available in hand-held and self-retaining varieties.
- Some handheld retractors may be bent to conform to the area of the body being retracted.
- Moistened towels or pads are frequently placed under self-retaining and selected hand-held retractors to minimize trauma and drying.
Senn retractor,
Hand-held retractors
Malleable retractor,
Hand-held retractors
Hohmann retractor (ortho),
Hand-held retractors
Gelpi retractor,
Self-retaining retractors
(pronounced with a hard G)
Weitlaner retractor,
Self-retaining retractors
Balfour retractor,
Self-retaining retractors
Finochietto retractor,
Self-retaining retractors
Periosteal elevator (dental)
are mainly used to lift full thickness soft tissue flaps.
surgical Curette
designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure.
Rongeur (ortho)
heavy-duty surgical instrument with a sharp-edged, scoop-shaped tip, used for gouging out bone.
Suction tip
Ideal suture material must not… (1.-11.)
These will be on the exam!
- Must not irritate tissues
- Must not be allergenic
- Must not be carcinogenic
- Must have low capillarity (non-absorbability)
- Must not have electrolytic properties
- Must be contrasting (visibility)
- Must have minimal knot slippage
- Must have good handling
- Must not be expensive
- Must be sterile
- Must have a stable diameter
Suture Flexibility is determined by
torsional stiffness and diameter.
The more flexible the suture, the better your knot should hold.
A suture’s surface characteristics and coating influence what?
movement through tissues.
Suture Capillarity means that high capillarity increases
likelihood of infection.
Capillarity refers to the ability of the suture material to absorb fluids. You do not want your suture material to be highly absorbent.
Image depicts what?
Monofilament vs multifilament
Monofilament is a bit more beneficial so it tends to be more common in practical use.
Suture Knot tensile strength refers to?
the ability of the suture knot to withstand forces
Explain this table.
(most important is USP)
USP = Suture sizes are described most commonly using the USP (United States Pharmacopeia) denotation. Using this system, sutures diameter is described from 11-0 (smallest) to 7 (largest).
Suture size followed with a -0: the bigger the number the smaller the suture material.
Mono-numbers: The bigger the number the larger the suture material.
The table shows equivalencies between different systems of suture size denotation.
Smallest safe size should be used.
Name 8 Suture characteristics:
- Flexibility – determined by torsional stiffness and diameter.
- Surface characteristics and coating – influence movement through tissues.
- Capillarity – high capillarity increases likelihood of infection.
- Monofilament/multifilament
- Absorbable/non-absorbable
- Knot tensile strength
- Relative knot security
- Knot holding capability
Pros and cons between mono- and multifilament suture materials.
Monofilament
* Low capillarity
* Less tissue damage
Multifilament
* Knot security
* Handling
* Flexibility
* Strength
However, monofilament should be preferred unless indicated otherwise.
Review this table.
Absorbable suture material can be either
natural or synthetic.
- Natural – are absorbed by enzymatic activity of the tissue or by phagocytosis.
- Synthetic – are degraded by hydrolysis.
Most of the absorbable sutures lose tensile strength in 60 days.
Mechanism behind how absorbable suture material is absorbed in the body.
Degraded by either hydrolysis or by enzymes.
Remember absorbable material can be natural or synthetic.
Natural – are absorbed by enzymatic activity of the tissue or by phagocytosis.
Synthetic – are degraded by hydrolysis.
Describe Non-absorbable suture material.
- Will be encapsulated within tissues eventually.
- Tensile strength lost in several years, but never absorbed. (Nylon 30% keeps its strength 2 years, Silk 30% 14 days, 50% 1 year)
- Usually meant to be temporary and therefore removed after wound healing.
Some exceptions for using as permanent fixtures e.g. tendons and hernias.
Describe Tissue adhesives
Used for clean superficial wounds.
Not to be used in case the wound is:
* Contaminated
* Deep
* Inflamed
* Resulting from a bite
Also not used if subdermal pockets are deeper than 5mm (Subcutaneous sutures indicated).
Reaches maximum bonding strength within 2,5 minutes (Equivalent in strength to healed tissue at 7 days after repair).
Relevant information generally on the suture package
- size (gauge of suture and length)
- product name
- needle name and point type (conventional cutting)
- needle code: shape and size
- production information, batch number
- description of suture (undyed braided)
Needles are chosen for
the appropriate tissue.
- They are characterized by their ductility,
sharpness and strength. - According to geometry, needles are divided
into traumatic and atraumatic categories.
(Needles without built in suture material.)
Name the 6 main types of suture material needle.
taper point
taper cut
regular cutting
reverse cutting
spatula point
blunt point
- Thin round tip, no cutting edges
* Spreads tissues, does not cut
* Suturing soft tissues e.g. GI tract tissues
What type of needle is described?
taperpoint
- Reverse cutting edge tip and taper point body
* For dense, tough fibrous tissue (fascia, ligaments)
* Cardiovascular procedures
What type of needle is described?
tapercut
- Three cutting edges, one on the inside
* Very sharp
* Cuts, does not spread
* Promotes “cut out” of tissue aka can cut tissues as drawn up, so not used as typically.
What type of needle is described?
regular cutting
- Three cutting edges, one on the outside
* Stronger than regular cutting needle
* Reduced amount of tissue cut out
What type of needle is described?
reverse cutting
- Flat on the top and bottom, cutting sides
* Ophthalmologic procedures
What type of needle is described?
spatula point
- Blunt point
* Spreads, does not cut
* Soft, parenchymal tissue (liver, kidneys, spleen etc.)
What type of needle is described?
bunt point
Needle holders - 4 grips
- Crushing instruments used to clamp blood vessels
Crile has cross serrations all along the jaws whereas Kelly as cross serrations but not all the way along the jaws.
