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Surgery I > Surgical Instruments and Suture Materials > Flashcards

Surgical Instruments and Suture Materials Flashcards

1
Q

Surgical instruments can be divided in categories: (4)

A
  • Cutting instruments
  • Grasping instruments
  • Retractors
  • Miscellaneous instruments
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2
Q

Name the parts

A

Tips
Jaws
Box lock pin
Box lock
Shank
Ratchet
Ring handle

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3
Q

Cutting instruments can be 1 of 3:

A
  • Scalpels
  • Scissors
  • Bone-cutting instruments
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4
Q

Name the Bone-cutting instruments

A
  • 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)
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5
Q

Primary tissue cutting instrument

A

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
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6
Q

Scalpel position to aim for while incising

A

Scalpel perpendicular to the skin when incising.

Tissues stabilized with the nondominant hand when incising.

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7
Q

Scalpel grip (3)

A

Can be held with a pencil grip, a fingertip grip (or a palmed grip).

Tissues stabilized with the nondominant hand when incising.

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8
Q

Four scalpel motions can be used:

A
  • 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)
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9
Q

Describe image depiction.

A

Image depicts press cut incision technique.

  • A – reverse press cut incision into the peritoneal cavity
  • B – press cut incision into a fluid-filled structure
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10
Q

Describe image depiction. (3)

A

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
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11
Q

Describe image depiction. (3)

A

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
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12
Q

Describe image depiction. (3)

A

Palmed grip
* Strongest hold on the scalpel

  • Allows exertion of great pressure on the tissue
  • Usually unnecessary in surgical situations
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13
Q

If you have a choice, which should you favor: scalpel or scissors?

A

scalpel

less tissue damage and more precision

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14
Q

Curved vs straight scissors.

A
  • Curved scissors – greater maneuverability and visibility
  • Straight scissors – mechanical advantage for cutting dense tissue
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15
Q

Describe image depiction.

A

Tripod (thumb–ring finger) grip is recommended for maximal control.

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16
Q

Identify instrument and describe its use.

A

Mayo scissors

  • For dissecting soft tissue
  • Thick blades approximately one-third of the length.
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17
Q

Identify instrument and describe its use.

A

Metzenbaum scissors

  • Dissecting delicate soft tissue
  • Thin delicate blades approximately
    one-fourth of the overall length.
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18
Q

Identify instrument and describe its use.

A

Blunt/sharp operating (utility) scissors

  • Often reserved for use on inanimate objects (e.g., suture material).
    “suture scissors”, lankasakset
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19
Q

Identify instrument and describe its use.

A

Suture scissors for suture removal.

tikkisakset

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20
Q

Identify instrument and describe its use.

A

Bandage scissors for cutting bandages and tape.

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21
Q

Identify instrument and describe its use.

A

Tenotomy scissors for cutting through tendons.

Frequently limited to ophthalmology and neurosurgery.

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22
Q

Grasping instruments can be either: (2)

A
  • Needle holders or
  • Tissue forceps
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23
Q

Types of Tissue forceps (6)

A
  • Crushing tissue forceps
  • Non-crushing tissue forceps
  • Hemostatic forceps
  • Thumb forceps
  • Towel clamps
  • Bone-holding forceps
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24
Q

Guidelines etc. for needle holders: (5)

A
  • 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.
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25
Q

Identify instrument

A

Mayo-Hegar needle holders

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26
Q

Identify instrument

A

Olsen-Hegar needle holders

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27
Q

Identify instrument

A

Mathieu needle holders

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28
Q

Identify instrument

A

Castroviejo needle holders

used in a pencil grip, ophthalmology

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29
Q

Needle holders - grips

A

Thenar grip

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30
Q

Needle holders - grips

A

The thumb-ring finger grip

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31
Q

Needle holders - grips

A

Palmed grip

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32
Q

Needle holders - grips

A

Pencil grip

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33
Q

Tissue forceps are Used for

A

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

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34
Q

Purpose of tissue forceps with:
* Cross-serrations
* Longitudinal serrations

A
  • Cross-serrations – tip-clamping
  • Longitudinal serrations – jaw-clamping
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35
Q

Crushing tissue forceps Should be used to

A

grasp only tissue slated for excision.

(cause you don’t want to crush tissue that will remain in the body cavity)

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36
Q

Identify instrument

A

Allis tissue forceps

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37
Q

Identify instrument

A

Babcock tissue forceps

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38
Q

Identify instrument

A

Ochsner-Kocher forceps

Note they have a tooth at the tip.

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39
Q

Non-crushing tissue forceps include: (3)

A
  • Various peripheral vascular clamps
  • Partial occlusion forceps
  • Doyen forceps are considered non-crushing, but actually induce tissue trauma (dependent on use duration).
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40
Q

Identify

A

Doyen intestinal forceps

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41
Q

Crushing instruments used to clamp blood vessels are called

A

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.
42
Q

What instrument would you use to hold bowel that requires resecting?

A

Doyen intestinal forceps

You do not want to crush the tissue that you must reconnect thus use doyen’s which are less traumatic.

43
Q

Identify

A

Halsted-mosquito hemostats,
Hemostatic forceps

Used on more delicate tissues (cause they is smol).

44
Q

Identify

A

Crile hemostats,
Hemostatic forceps

45
Q

Identify

A

Kelly hemostats,
Hemostatic forceps

46
Q

Identify

A

Rochester-Carmalt hemostats,
Hemostatic forceps

47
Q

Tweezer-like, nonlocking instruments used to grasp tissue (and inanimate objects) are called

A

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.
48
Q
A

Brown-Adson forceps,
Thumb forceps

49
Q
A

Debakey forceps,
Thumb forceps

50
Q
A

Adson forceps,
Thumb forceps

51
Q
A

Dressing forceps,
Thumb forceps

52
Q

Grip for thumb forceps?

A

Thumb forceps - pencil and palmed grip

53
Q

Towel clamp types: (2)

A

Backhaus towel clamps
Jones towel clamps

54
Q
A

Backhaus towel clamp

55
Q
A

Jones towel clamp

56
Q
A

Lane bone holding forceps,
Bone-holding forceps

57
Q
A

Bone holding forceps with speedlock,
Bone-holding forceps

58
Q

Instruments that Help improve exposure by deflecting tissue away from the area of
interest are called?

A

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.
59
Q
A

Senn retractor,
Hand-held retractors

60
Q
A

Malleable retractor,
Hand-held retractors

61
Q
A

Hohmann retractor (ortho),
Hand-held retractors

62
Q
A

Gelpi retractor,
Self-retaining retractors

(pronounced with a hard G)

63
Q
A

Weitlaner retractor,
Self-retaining retractors

64
Q
A

Balfour retractor,
Self-retaining retractors

65
Q
A

Finochietto retractor,
Self-retaining retractors

66
Q
A

Periosteal elevator (dental)

are mainly used to lift full thickness soft tissue flaps.

67
Q
A

surgical Curette

designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure.

68
Q
A

Rongeur (ortho)

heavy-duty surgical instrument with a sharp-edged, scoop-shaped tip, used for gouging out bone.

69
Q
A

Suction tip

70
Q

Ideal suture material must not… (1.-11.)
These will be on the exam!

A
  • 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
71
Q

Suture Flexibility is determined by

A

torsional stiffness and diameter.

The more flexible the suture, the better your knot should hold.

72
Q

A suture’s surface characteristics and coating influence what?

A

movement through tissues.

73
Q

Suture Capillarity means that high capillarity increases

A

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.

74
Q

Image depicts what?

A

Monofilament vs multifilament

Monofilament is a bit more beneficial so it tends to be more common in practical use.

75
Q

Suture Knot tensile strength refers to?

A

the ability of the suture knot to withstand forces

76
Q

Explain this table.
(most important is USP)

A

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.

77
Q

Name 8 Suture characteristics:

A
  • 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
78
Q

Pros and cons between mono- and multifilament suture materials.

A

Monofilament
* Low capillarity
* Less tissue damage

Multifilament
* Knot security
* Handling
* Flexibility
* Strength

However, monofilament should be preferred unless indicated otherwise.

79
Q

Review this table.

A
80
Q

Absorbable suture material can be either

A

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.

81
Q

Mechanism behind how absorbable suture material is absorbed in the body.

A

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.

82
Q

Describe Non-absorbable suture material.

A
  • 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.
83
Q

Describe Tissue adhesives

A

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).

84
Q

Relevant information generally on the suture package

A
  1. size (gauge of suture and length)
  2. product name
  3. needle name and point type (conventional cutting)
  4. needle code: shape and size
  5. production information, batch number
  6. description of suture (undyed braided)
85
Q

Needles are chosen for

A

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.)
86
Q

Name the 6 main types of suture material needle.

A

taper point
taper cut

regular cutting
reverse cutting

spatula point
blunt point

87
Q
  1. 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?

A

taperpoint

88
Q
  1. Reverse cutting edge tip and taper point body
    * For dense, tough fibrous tissue (fascia, ligaments)
    * Cardiovascular procedures

What type of needle is described?

A

tapercut

89
Q
  1. 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?

A

regular cutting

90
Q
  1. Three cutting edges, one on the outside
    * Stronger than regular cutting needle
    * Reduced amount of tissue cut out

What type of needle is described?

A

reverse cutting

91
Q
  1. Flat on the top and bottom, cutting sides
    * Ophthalmologic procedures

What type of needle is described?

A

spatula point

92
Q
  1. Blunt point
    * Spreads, does not cut
    * Soft, parenchymal tissue (liver, kidneys, spleen etc.)

What type of needle is described?

A

bunt point

93
Q
A
94
Q

Needle holders - 4 grips

A
95
Q
A
96
Q
A
  • 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.

97
Q
A
98
Q
A
99
Q
A
100
Q
A
101
Q
A
102
Q
A

Surgery I (9 decks)

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