Surgical Instruments and Suture Review Flashcards
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Jacob’s Chuck
- Used to drive IM pins and K-wires during orthopedic surgery
- Key used to tighten or release pin grip
- May have attachment for protecting surgeon’s hands from pin penetration near top of handle
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Straight Mayo Dissecting Scissors
- Plain edge (vs. serrated edge)
- Thick blades (~1/3 of instrument length)
- Used to incise dense tissue (fascia, linea alba, trimming skin)
- Blades can be straight or curved
- Straight blade: greater mechanical advantage
- Curved blade: improved visualization of tissue, more versatile
Is polypropylene an absorbable or non-absorbable suture material?
non-absorbable
These suture properties are ideal for use in infected tissues:
absorbable and monofilament
These are small, specialized tissue forceps used for ophthalmic surgery:
Bishop-Harmon Tissue Forceps
This antibiotic can be added to a suture coating to help prevent bacterial growth in a surgical wound:
Triclosan
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Babcock Tissue Forceps
- Smooth flat tips are used to grasp tissue
- Grasps tissue at right angles of tension application
- Tips can crush but are less traumatic than Allis tissue forceps
- Used for helping to grasp and retract robust soft tissues (stomach, bladder)
When is silk suture used?
Cardiovascular surgery
Is chromic gut an absorbable or non-absorbable suture material?
Absorbable
This refers to a suture’s ability to resist deformation or breakage:
tensile strength
Self-inflicted injuries can occur when using this instrument to drive Steinman pins:
Jacob’s chuck
T/F: Nylon suture is very resistant to degradation due to its lack of hydrolyzable bonds
False
Nylon is susceptible to degradation. Hydration may lead to disruption of hydrogen bonds leading to loss of tensile strength.
This hemostat has multiple uses including occlusion of small vessels and securing stay sutures:
Mosquito hemostats
This suture is rarely used due to the severe inflammatory reaction it can cause:
catgut
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Backhaus Towel Clamp
- Penetrating clamp
- Used to hold quarter drapes or Huck towels securely to patient skin
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Straight Metzenbaum Scissors
- Plain edge (vs. serrated edge)
- Thin, delicate blades (~1/4 of length of instrument)
- Used to incise soft tissues (subcutaneous tissues, intestine, bladder, etc)
- Blades can be straight or curved
- Straight blade: greater mechanical advantage
- Curved blade: improved visualization of tissue, more versatile
This type of monofilament suture has many uses including closure of enterotomies, cystotomies, and many other –otomies:
polydioxanone
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Extraction Forceps
- Strong, heavy instrument used to grasp loose/luxated teeth for extraction
- Various sizes and tips to accommodate different shaped teeth
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Dental Explorer
- Increases tactile sensation for detecting areas of enamel decay
When is polymerized caprolactam suture used?
Skin sutures ONLY
Not recommended for implantation in tissues due to sinus formation
Because of rapid loss in tensile strength, this suture type should not be used for slower healing tissues:
polyglycolic acid or polyglactin 910
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Straight Kelly Hemostatic Forceps
- Transversely oriented serrations
- Serrations do not extend the entire length of the jaw (unlike with Mosquito or Crile hemostatis forceps)
- Designed for tip clamping of small to medium vessels
- Smaller than Rochester-Carmalt, bigger than Halstead-Mosquito
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Periodontal Probe
- Long, thin, blunt tipped instrument
- Used to measure pocket depths around a tooth
- Establishes the state of health of the periodontium.
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Lempert Rongeur
- Forceps with cupped jaws and blunted or tapered tips
- Used to remove small fragments of bone, to recontour bone, or to prepare bone for grafting
- Jaws mat be straight, curved or angled
- Lempert has finer tipped jaws and are used in more restricted areas (bulla osteotomy)
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Malleable Retractor
- Double ended blunt retractor
- Various sizes
- Can be bent at various angles
- Used for retracting viscera in abdominal and thoracic surgery
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Scaler
- Removes dental deposits from above gumline
- Variety of tips and shank angles to allow access between teeth
When is caprolactone suture used?
Closure of cystotomies (non-infected bladders), subcutaneous tissues
In what application is Polyglactin 910 suture most commonly used?
Dental surgery
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Spencer Stitch Scissors
- Hooked tip used to entrap suture for cutting
- Used for post-op suture removal
- Not generally used in OR
This concentration of chlorhexidine solution is appropriate for preputial flushes and cleaning open wounds:
0.05%
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Hohmann Retractor
- Various sizes with variety of tip lengths and styles (blunt vs. sharp)
- Used to lever muscle and soft tissues away from surgical field and bone during orthopedic surgeries
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Freer Periosteal Elevator
- Small periosteal elevator
- Double ended
- Standard in every orthopedic surgery pack
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Olsen-Hegar Needle Holders
- Combined needle driver/scissor
- Must have experience with instrument to avoid accidentally cutting suture prematurely
- Various sizes available
- Size of driver jaws should match needle size
- Textured tungsten-carbide jaw inserts provide intermediate needle holding security over smooth jaws or jaws with teeth
- Limits twisting and rotation of needle
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Stevens Tenotomy Scissors
- Narrow, delicate tipped precision scissors – Pointed or blunted tips
- Used for precision cutting, such as in ophthalmic and urologic surgery
- Straight or curved blade
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Bishop-Harmon Forceps
- Tips consist of fine teeth (2 x1) at a right angle
- Smaller than other thumb forceps
- Used to grasp tissue in ophthalmologic surgery
This self-retaining retractor is used to keep the abdominal wall open during a laparotomy:
Balfour Retractor
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Castroviejo Needle Holders
- Microsurgery needle driver
- Used for ophthalmic and vascular surgery
- Spring loaded handle
- Releases and grabs needle with minimal motion of hands
- Locking and non-locking styles
T/F: Polypropylene suture is very resistant to degradation due to its lack of hydrolyzable bonds
True
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Balfour Retractor
- Blunt blades of used to retract abdominal wall laterally
- Various sizes (pediatric- large)
- Central “bladder blade” can be used to retract rib cage cranially (access to liver and diaphragm
- Must be used with caution to protect underlying tissues
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Mallet
- Metal or nylon capped
- Used in orthopedic surgery to advance an osteotome for making precise osteotomies
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Finochietto Retractor
- Adjustable rib retractor
- Various sizes (pediatric – large)
- Used for retraction of chest wall during intercostal thoracotomy and median sternotomy
- Flat retractor blades are perpendicular to instrument
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Wing Tipped Dental Elevator
- Wing tipped elevators are used to sever the periodontal ligament by rotating the instrument around the tooth
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Vernon Cartilage and Wire Scissor
- Smooth or serrated blades
- Used to incise thick, tough tissue and orthopedic wire
- Can be used to cut suture intra-operatively
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Chisel (A) and Osteotome (B)
- Osteotome is bevelled on both sides and a chisel is bevelled on one side
- Osteotomes are used more commonly
- Various tip widths
- Used to create osteotomy in numerous orthopedic procedures
This “Jekyll and Hyde” retractor has a blunt and a forked end for increasing its utility:
Senn Retractor
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Kern Bone Holding Forceps
- Used to grip and manipulate bone during fracture reduction and repair
- Pediatric and adult sized instruments
- Jaws are serrated with grasping points at tips to promote strong grip on bone
- Ratcheted handle with quick release lever
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Barraquer Eyelid Speculum
- Wire self retaining instrument used hold eyelids open during enucleations, and surgery of the cornea and third eyelid
This type of needle driver can also cut suture:
Olsen Hagar
This surgical prep has residual activity lasting hours beyond the actual contact time:
Chlorhexidine
What is the most commonly utilized scalpel handle?
Bard-Parker Number 3 Scalpel Handle
- Accepts disposable blades
- # 10, 11, 12, and 15
- Ribbed grip area
- May have measurement scale on handle
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Adson Tissue Forceps
- Tips consist of fine teeth (2x1)
- Results in less crush injury than with Brown-Adson tissue forceps
- Poor grip of fat or other friable tissues
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Snook Hook/Spay Hook
- Flat, thin handle allows for better visualization of tissue
- Used to blindly hook the uterine horn/mesometrium during OHE
- Can be used to retract thinner layers of superficial tissue
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Mayo-Hegar Needle Holders
- Various sizes available
- Size of driver jaws should match needle size
- Textured tungsten-carbide jaw inserts provide intermediate needle holding security over smooth jaws or jaws with teeth
- Limits twisting and rotation of needle
Is Glycomer 631 an absorbable or non-absorbable suture material?
absorbable
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Poole Suction Tip
- Attaches to suction hose
- Used to suction large amounts of fluid from body cavity
- Blunt tip prevents trauma to organs
- Inner cannula unscrews and can be used as a modified Frazier suction tip
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Derf Needle Holders
- Ophthalmic needle drivers
- Small size useful for suturing smaller structures (eyelids, conjunctiva)
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Weitlaner Retractor
- Ringed retractor with self-retaining ratchet
- Various sizes
- Multiple pointed prongs on each arm
- Useful for retraction of soft tissue in a small, superficial incision
- Must take care with tips to avoid injury to underlying soft tissues
What is the most commonly used needle shape?
1/2 circle
This monofilament, non-absorbable suture is commonly used to place skin sutures:
Nylon
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Curved Halsted Mosquito Hemostatic Forceps
- Transversely oriented serrations
- Serrations extend along the entire length of the jaw
- Designed for tip clamping of small vessels
- Smaller than Rochester-Carmalt and Kelly hemostatic forceps
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Speed Lock Bone Holding Forceps
- Used to grip and manipulate bone during fracture reduction and repair
- Pediatric and adult sized instruments
- Tips can be serrated or pointed
- Locking mechanism easily manipulated with fingers
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Allis Tissue Forceps
- Intermeshing teeth at tip are used to grasp tissue
- Grasps tissue at right angles of tension application
- Should only be used on tissues to be discarded due to crushing effect of tips
- Will create severe crush artifact therefore should not be used on tissues submitted for histopathology
- Frequently used for positioning of suction tubing and electrocautery wire on patient drape
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Curette
- Used for subgingival cleansing, root planing and curettage
- Double ended instrument
- Each end has one blade with one cutting edge
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Senn Retractor
- Double ended retractor
- Blunt or sharp fork on one end and right angle blade on other end
- Used in soft tissue and orthopedic surgery for retraction of tissues in small working spaces
- Hand held retractor typically used by assistant
- Used for both soft tissue and orthopedic surgery
This group of surgical scrubs has a broad spectrum of activity but is deactivated in the presence of organic material:
iodophors
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Periosteal Elevator
- Used to reflect muscle and soft tissue from bone
- Various sizes with round or straight edges
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Calculus removal forceps
- Uneven tipped instrument useful in removing large pieces of calculi prior to scaling
When is nylon suture used?
Skin closure, orthopedic repair (lateral tibiofabellar suture)
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Straight Kelly Hemostatic Forceps
- Transversely oriented serrations
- Serrations do not extend the entire length of the jaw (unlike with Mosquito or Crile hemostatis forceps)
- Designed for tip clamping of small to medium vessels
- Smaller than Rochester-Carmalt, bigger than Halstead-Mosquito
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Army-Navy Retractor
- Double ended blunt retractor
- Blades differ in length
- Hand held retractor typically used by assistant
- Used for both soft tissue and orthopedic surgery
This retractor is great at retracting the biceps femoris and vastus lateralis but watch out to not puncture that sciatic nerve:
Gelpi Retractor
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DeBakey Tissue Forceps
- Parallel ribbed tips
- Most frequently used thumb forceps in soft tissue surgery
- Less traumatic than Brown-Adson thumb forceps
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Straight Rochester-Carmalt Hemostatic Forceps
- Designed for jaw clamping (vs. tip clamping)
- Used for clamping pedicles/tissue
- Longitudinally oriented serrations with cross-hatched tips
- Jaws can be straight or curved
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Frazier Suction Tip
- Fine tipped suction tip for removal of small amounts of fluid from surgical field
- Used mostly for orthopedic and neurologic surgery
- Covering hole on top of instrument created stronger negative pressure
- Can clog easily with blood clots/small tissue remnants
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Gelpi Retractor
- Ring retractor with self-retaining ratchet
- Various sizes
- Used for retraction of soft tissues (especially useful for retraction of muscle bellies during orthopedic or spinal surgery)
- Sharp tips must be placed with caution
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Straight Doyen Intestinal Tissue Forceps
- Thin, slightly bowed jaws
- Fine, longitudinally oriented grooves
- Straight or curved configuration
- Used for intestinal lumen occlusion (enterotomies, resection and anastomosis)
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Brown Adson Tissue Forceps
- Tips consist of fine teeth in two parallel rows
- Used frequently for general tissue handling but serrated teeth can crush tissue
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Jaeger Eyelid Plate
- Used to protect globe when making incisions into the eyelid
- Placed between the eyelid and globe
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Wedge Tipped Dental Elevator
- Wedge tipped elevators (luxators) are used to weaken the periodontal ligament and luxate the tooth for extraction.
- Note the flat vs. concave tip
This instrument comes in various shapes and sizes and is used to remove small bits of bone from the surgical field:
Rongeur
This frequently used antiseptic skin prep has broad spectrum activity but should never be applied to open skin or mucosa:
isopropyl alcohol
