Surgical principles Flashcards
Halsted’s Surgical Principles
Strict asepsis during preparation and surgery.
Good haemostasis to improve visibility and limit infection and dead space- pressure, ligation, cauterisation
Minimize tissue trauma.
Good surgical judgement ensuring elimination of dead space and adequate removal of material.
Minimize surgery time through knowledge of anatomy and technique.
Correct use of instruments and materials.
Wound Healing and suture material selection
Sutures only neededto support the tissue until healed.
Skin and subcutaneous tissues heal in < 2 weeks.
Fibrous tissue heals slowly. Only approx. 20% of full tissuestrength 20 days post- surgery.
Patient factors: age, weight, health status.
Suture handling properties:
Tissue drag
Knot security
Memory
Time to loss of tensile strength
Chromic catgut
Absorbable multifilament (twisted collagen)
Rate of loss of tensile strength-Medium but variable 2-3 weeks
Tensile streangth- poor
Handling- good handling, poor knot security- can fray, swell etc
Known to cause inflammation
poliglecaprone 25)
Monocryl
Absorbable Monofilament
Loss of strength-Rapid (within 2 weeks)
Tensile strength- high
Excellent handling with some memory
Gut surgery, doesn’t wick bacteria into wound
Polyglactin 910
(Vicryl)/polyglycolic acid (PGA)
Absorbable, multifilament (braided)
Loss of strength- Medium (approx. 3-4 weeks)
Strength- moderate
Handling- Excellent handling, moderate knot security
Will wick bacteria but is interchangeable with monocryl
Vicryl is coated so handles nicely
Could be used for linear alba but there’s better
PDS (polydioxanone) Biosyn/Maxon
Good for linear alba, questionable use for skin as it lasts for a long time
Absorbable monofilament
Slow rate of loss of strength- 6 weeks
High strength
Poor handling
Polyamide- Nylon
Eg Surpamid; Ethilon
Tricky to handle
Can be used in skin but needs removal
Non absorbable mono or multifilament
High strength
No loss of strength
Poor handling
Suggested OHE technique
Dorsal recumbency
Large clip – xiphisternum to pubis
Count swabs & instruments
Skin incision approx. 4-6 cm long, start at the umbilicus (cats more caudal & smaller incision!)
Grasp the linea alba with rat toothed forceps. Elevate & make stab incision with scalpel blade. Extend with mayo scissors or forceps & blade
Locate the uterine horns then follow to the ovaries.
Palpate the suspensory ligament & break down digitally +/- transect. Vital to exteriorise the ovary as much as possible to aid ligature placement.l
Create window in the broad ligament as close as possible to the pedicle.
Modified 3 clamp technique- make sure no other mesentery/ viscera trapped in the clamps!
Double ligate the ovarian pedicles with encircling ligatures- traditional ‘text-book’ method.
RS recommends a strangulating knot such as a modified miller’s knot or constrictor knot for a bitch spay. Cat: single simple ligature with a surgeon’s knot usually sufficient.
Millers knot
Check the ovaries have been removed in their entirety- want to avoid ovarian remnant syndrome!
Break down the broad ligament.
Ligate any large vessels.
Locate the cervix- ligate the uterine body.
Transfixing ligature + miller’s knot into the crush of the haemostats.
Transect the uterine body proximal to the ligatures, then carefully release the stump.
Check for haemorrhage; swab count, then close!
Closure of the linea alba: 2-0 PDS simple continuous. 5 throws at the beginning of the suture line, 7 throws at the end.
Closure of the subcutaneous fat: Simple continuous eg Vicryl/PGA, monocryl (short acting absorbable). 3 throws at the beginning of the suture line, 4 at the end
Closure of the skin: Intradermal simple continuous pattern eg Vicryl 3/0 or 4/0 or Poliglecaprone 25 3/0 or 4/0.
Dog castration Open
Incise the spermatic fascia and the parietal vaginal tunic.
Separate the ligament of the tail of the epididymis from the tunic.
Ligate the vascular cord and the ductus deferens together.
Close the vaginal tunic and cremaster muscle with an encircling ligature.
Repeat for second testicle
Close subcut tissue and skin.
Dog castration closed
Incise the spermatic fascia
Place traction on the testicle while the fibrous attachments between the spermatic cord and scrotum are broken down (requires quite a lot of pulling!)
Ligate the entire cord with a transfixing ligature & encircling or modified miller’s knot as per bitch spay.
Repeat for 2nd testicle
Close subcut tissue and skin.
