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Surgical technique Flashcards

1
Q

Scenarios that result in secondary intention wound healing

A

Extensive loss of epithelium
Extensive contamination
Extensive tissue damage
Extensive oedema
Wound reopening

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2
Q

Third intention wound healing

A

Wound is closed several days after formation
Might be after infection is under control or oedema is reduced

Delayed primary closure

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3
Q

Stages in wound healing and cell types involved

A

Inflammatory
Plts- immediate
Neuts- 0-1
Macro 1-2s

Proliferative - epithelial- proluferate- closure in 48hrs
Fibroblasts- 2-4 synthesise ECM
Endothelial- 3-5d

Maturation
Modify collagen cross linking

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4
Q

When do abdominal incisions regain their strength

A

3-4m

Hence why slowly absorbable PDS is used

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5
Q

Ideal theatre designs

A

Close to surgical wards
ICU
Sterile supplies
A+E
CT

20 degree
Clean filtered air

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6
Q

Suture used in bowel, vascular anastomosis and ligation and abdominal, subcutaneous and closure

A

Bowel- vicryl as heals quickly

Vascular anastomosis- prolene- monofilament good for running stitches
Ligation- PDS

Abdo- PDS

Subcut- absorbable

Closure- non absorbable

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7
Q

Principals of vascular anastomosis

A

Prolene - non absorb mono
Evert edges

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8
Q

Principals of duct anastomosis

A

Invert edges
Mono absorbable - PDS
Performed over a stent- removed later e.g T tube CBD

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9
Q

What size of wound will you require grafting or local flap

A

1cm^3

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10
Q

Split vs full thickness

A

Full- better cosmesis
Face
Primary contracture- elastin in dermis

Split- larger
No primary contracture

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11
Q

When is delayed primary closure used

A

If the wound is dirty

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12
Q

Closure of scalp wound

A

Staples

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13
Q

What is used for third degree burn on abdo

A

Split thickness graft

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14
Q

If patient has nose bitten off by dog what reconstruction

A

Debridement, antibiotics, tetanus and rabies

For upper two-thirds defects, thin skin from the preauricular region or neck works well. For lower third defects, the thick skin of the forehead provides the best match.

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15
Q

What can you do to a split thickenss to make it spread more

A

Make it mesh

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16
Q

Blue line around mesh, how quickly does it spread

A

Re- epitheliarization
1mm/day

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17
Q

What is required for a great to stick

A

If there is granulation tissue forming

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18
Q

Closure after drained of foul/painful smelling sebaceous cyst

A

Delayed primary closure

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19
Q

Best Ix fro osteomyelitis

A

MRI

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20
Q

Closure of diabetic foot ulcer

A

VAC assisted closure- encourage granulation tissue

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21
Q

When is VAC assisted closure CI

A

Malignancy
Osteomyeltiis
Necrotic tissue with eschar

Risk of fistulation

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22
Q

Closure of wound dehiscence on abdo

A

Healthy- suture
Wound manager- some granulation tissue where there is a high
output bowel fistula present in the dehisced wound.

Bogota bag- Temporary measure to be adopted when the wound cannot be closed

VAC- ONLY if the correct layer is interposed between the suction device and the bowel.
* Failure to adhere to this absolute rule will almost invariably result in the development of multiple bowel fistulae and create an extremely difficult management problem.

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23
Q

Zadik procedure anaesthesia

A

1% lignocaine in ring block

For toenail removal

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24
Q

What is used in Piere block and antidote

A

Pierre block- Prilocaine

Less cardiotoxic

Methylene Blue

25
What drugs increase lidocaine toxicity
BB Cipro
26
Local doses
Agent Dose plain Dose with adrenaline Lignocaine 3mg/Kg 7mg/Kg Bupivicane 2mg/Kg 2mg/Kg Prilocaine 6mg/Kg 9mg/Kg
27
What is CI with diathermy
Alcohol based skin prep Use cholrhexidine or iodine
28
When to give Abx in surgery
If giving prosthetic or implant/valve Tourniquet - give early Dirty or clean contaminated
29
Which electrical device should you use in ERCP sphincterotomy
Monopolar
30
Modes of electrocautery
Cutting - uses a continuous waveform with a low voltage- giving high power * Precise cutting without thermal damage Causes vaporisation Coagulation - pulsed waveform with a high voltage. Causes thermal damage Causes evaporation Blending- alternating of both Desiccation - Active electrode in direct contact with tissue * Low current and high voltage system * Results in loss of cellular water but no protein damage (unlike coagulation) used for treating nodules under the skin where minimal damage to the skin surface is desired. Fulguration- Electrode probe is held away from tissue * Produces spray effect with local, superficial tissue destruction * Low amplitude and high voltage system - superficial skin charring - over a wider area than when operating in contact with the probe, and this technique is therefore used for very superficial or protrusive lesions such as skin tags
31
What devices are used in brain tumours
Ultrasound based devices * These include CUSA and Harmonic scalpel. * They generate high frequency oscillations that seal and coagulate tissues.
32
Disinfection vs sterilisation
Disinfection- eliminating or reducing harmful microorganisms Sterilization -killing all microorganisms
33
Methods of sterilisation
Autoclave- reusable surgical equipment- like metal - air removed pressurised steam at a temperature of 134 degrees for 3 mins For TB Endoscopy/laparoscope- 2% glutaraldehyde solution Ethylene oxide- used in industry - Cannula/sutures Gamma rays- thermal stable Plastic syringes, transfusion, needles
34
Flap vs graft
Graft takes fast Covers larger area Requires granulation tissue to take Flap- used for bone, tendon, or joint Non graftable
35
Reconstruction of skin from where tumour of face removed
Unsure on boundaries <2cm can leave >2cm- graft Certain of boundaries- local flap
36
Level of evidence
1- systemic review, meta analysis 2- randomised controlled trial 3- pseudo randomised or historical controls 4- case reports 5- panel opinion
37
Chemo has extravasated mx?
When an extravasation reaction is suspected, the infusion should be stopped and the infusing device aspirated. The extremity should be elevated. As a general rule cold compresses have been shown to reduce the incidence of subsequent ulceration with doxorubicin. Warm compresses have been found to be beneficial in extravasation of vinca alkaloids. - vincristine
38
TPN/contrast extravasated mx
Withdraw infusion Hyaluronidase into infusion site
39
Suture to close abdo
Polydiocanaone Mono
40
Suture for skin closure
Poliglecaprone mono (monocryl)
41
Pre tibial 3-7cm flavour, necrotic and haematoma, bone fine
Debride and split thickness
42
Simple finger laceration closure
Interrupted 5/0 Ethilon Removal after 14d
43
Forehead laceration closure
Interrupted Prolene 5/0 Removal after 4-5d Sterries in children
44
Excision of sebaceous cyst or lipoma closure
Interrupted 2/0 Vicryl to fat 3/0 monocryl to skin
45
Inguinal hernia closure
Prolene 3/0 mesh vicryl 2/0 fasciae, fat Monocryl 3/0 skin
46
Laparoscopic appendectomy/chole closure
PDS all ports >5mm Mono 3/0 or glue to skin Silk to drains
47
Midline lap closure
1 PDS to midline fasciae 2/0 vicryl to fat 3/0 mono to skin 3/0 Vicryl Rapide for new stomas
48
Pfannestiel closure
1 PDS to rectus 2/0 vicryl to fat 3/0 monocryl to skin
49
Femoral embolectomy closure
5/0 prolene ot arterotomy 2/0 vricyl to fascia and fat 3/0 monocryl to skin
50
Use of prolene
Vascular anastomosis Cardiac surgery
51
Ethilon use
Skin incision or traumatic wounds Removed after 4-14d
52
Steel wire use
Close sternum after median stenotomy
53
Ethibond use
Prostehtic heart valves Tendon repair Ribs
54
PDS sue
Closing linea alba Hernia defects Intestinal or ureteric anastomosis
55
Monocryl use
Skin closure
56
Vicryl use
Skin and soft tissue closure Ligation of vessels
57
Cutting vs reverse cutting vs round bodied needle
Cutting- sharp on concave edge For tough tissue such as skin and fascia Can weaken tissue Reverse- sharp on convex edge Used when risk in cutting suture out and causing damage- thin skin, tendon, ligaments, eye Round taper point- needle point round Blunt- liver or spleen Taperpoint- leaky tissue- bowel, vessel, myocardium
58
What anticoagulant does blood bank store donated blood in
Citrate - binds to Ca preventing coag
59
Tourniquet types
Single cuff pneumatic- knee arthroscopy Different pressure Double cuff- regional block Non pneumatic- venopuncture

eMRCS questions (45 decks)

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