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Perioperative Care > Surgical Technology > Flashcards

Surgical Technology Flashcards

1
Q

Outline the layers of the skin

A
  1. Epidermis
  2. Dermis
  3. Hypodermis/Subcutaneous
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2
Q

Epithelium of the epidermis

A

Keratinised squamous epithelium

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3
Q

Where do the skin’s natural tension lines lie

A

Right angles to the angle of contraction of the underlying muscle

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4
Q

What constitutes a superficial wound

A

Involve only epidermis and dermis

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5
Q

What constitutes a deep wound

A

Involve layers deep to the dermis

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6
Q

Describe primary intention wound healing

A
  • Occurs in uncontaminated wounds with minimal tissue loss
  • Wound edges easily approximated
  • Wound heals by rapid epithelialisation and formation of minimal granulation tissue
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7
Q

Describe secondary intention wound healing

A
  • Occurs in wounds with substantial tissue loss

- Wound is left open and allowed to heal from deep aspects by granulation, epithelialisation and contraction

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8
Q

Describe tertiary intention wound healing

A
  • Wound is closed several days after its formation

- e.g. Delayed primary closure

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9
Q

List the 3 phases of wound healing

A
  1. Acute inflammatory phase
  2. Proliferative phase
  3. Maturation phase
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10
Q

Outline the inflammatory phase of wound healing

A
  • Initial trauma
  • Vasodilatation and increased vascular permeability
  • Influx of inflammatory cells (neutrophils) and fibroblasts
  • Platelet activation and initiation of the coagulation and complement cascades
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11
Q

When do neutrophils arrive at the wound

A

0-1 days

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12
Q

When do macrophages arrive at the wound

A

1-2 days

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13
Q

When do fibroblasts arrive at the wound

A

2-4 days

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14
Q

When do myofibroblasts arrive at the wound

A

2-4 days

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15
Q

When do endothelial cells arrive at the wound

A

3-5 days

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16
Q

Outline the proliferative phase of wound healing

A

Characterised by migration and proliferation of:

  • Epithelial cells
  • Fibroblasts
  • Endothelial cells
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17
Q

When is epithelial closure usually achieved

A

48 hours

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18
Q

What is the role of fibroblasts in the proliferative phase of wound healing

A

Synthesise extracellular matrix components including collagen and ground substance

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19
Q

What is granulation tissue

A

Temporary structure that forms during the proliferative stage. Contain capillaries, fibroblasts, macrophages and endothelial cells. Has a characteristic pink, granular appearance.

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20
Q

How long does skin take to regain full strength

A

6 months

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21
Q

How long does bowel and muscle take to regain full strength

A

1 month

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22
Q

How long does full maturation of the scar take

A

12-18 months

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23
Q

What vitamin aids the cross-linking of the fibrils in matrix remodelling

A

Vitamin C

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24
Q

Describe Neuropraxia

A
  • Temporary and reversible loss of function lasting 6-8 weeks (motor function first to be lost)
  • No axonal disruption
  • Crush, stretch, or contusion of the nerve
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25
Q

Describe Axontmesis

A
  • Axonal disruption
  • Supportive tissue framework is preserved
  • Wallerian degeneration occurs
  • Regeneration takes weeks to months
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26
Q

What is Wallerian degeneration

A
  • Occurs when a nerve is cut or crushed
  • Part of the axon that is separated from the neuron’s cell nucleus degenerates
  • Begins 24 hours following injury during which time the distal axon remains excitable
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27
Q

What supportive tissues are preserved in Axontmesis

A
  • Epineurium

- Perineurium

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28
Q

Describe Neurotmesis

A
  • Both the supportive tissue and the axon are disrupted

- Neuroma forms at the proximal stump

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29
Q

How long does mucosal integrity take to return after uncomplicated GI tract surgery

A

24 hours

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30
Q

How is liver regeneration achieved

A
  • Stimulated by reduction in liver mass:body ratio and release of TNF and IL-6
  • Achieved by proliferation of all cell types (hepatocytes, biliary epithelial cells, Kupffer cells)
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31
Q

What clinical sign precludes wound dehiscence

A

Pink serosanguinous fluid from the wound

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32
Q

At what rate does nerve regrowth occur when it happens

A

1mm/day

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33
Q

List the drugs that impair wound healing

A
  • NSAIDs
  • Steroids
  • Immunosuppressive agents
  • Anti-neoplastic drugs
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34
Q

Outline the two types of abdominal wound dehiscence

A
  1. Superficial = skin alone fails

2. Complete = all layers fail

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35
Q

List the common factors that increase the risk of wound dehiscence

A
  • Malnutrition
  • Vitamin deficiencies
  • Jaundice
  • Steroid use
  • Major wound contamination
  • Poor surgical technique that does not follow Jenkins rule
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36
Q

How should sudden dehiscence be managed

A
  1. Analgesia
  2. IV fluids
  3. IV broad-spectrum antibiotics
  4. Cover wound with saline impregnated gauze
  5. Arrange return to theatre
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37
Q

How can scar contractures be treated

A

Z-plasty

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38
Q

Define a Hypertrophic scar

A

Excessive remaining scar tissue confined to the site of the original wound due to fibroblast overactivity

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39
Q

Define a Keloid scar

A

Excessive scar tissue that extends beyond the original wound

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40
Q

List the risk factors for Keloid scar formation

A
  • Young age
  • Male sex
  • Dark pigmented skin
  • Genetic
  • Site (shoulders, sternum, head, neck)
  • Tension on wound
  • Delayed healing
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41
Q

Does hair removal prior to surgery reduce surgical site infection

A

No evidence to suggest this

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42
Q

What is the ideal theatre temperature

A

20-22 degrees

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43
Q

What are the stages of the WHO surgical checklist

A
  1. Before induction of anaesthesia
  2. Before skin incision
  3. Before patient leaves operating room
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44
Q

What suture should be used for abdominal mass closure

A

1 PDS

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45
Q

What gas is used to induce pneumoperitoneum

46
Q

Describe Jenkin’s rule

A

Each bite of abdominal wall should be a minimum of 1cm and adjacent bites must be a maximum of 1cm apart

47
Q

What layers are included in mass closure of the abdomen

A

All layers of the abdominal wall and peritoneum, except subcutaneous fat and skin

48
Q

Describe monopolar diathermy

A
  • Current flows through the diathermy unit into a handheld device
  • Electricity flows from the tip of the device into the patient
  • The earth electrode is some distance away and a large part of the patient is included in the circuit
49
Q

Describe bipolar diathermy

A
  • Electrical current flows from one electrode to another

- Both electrodes are contained within the same handheld device

50
Q

Which of monopolar and bipolar diathermy has a higher voltage

51
Q

Monopolar power output

52
Q

Bipolar power output

53
Q

Which parts of the body is bipolar diathermy useful for

A

Extremities - penis, scrotum, digits

54
Q

What purpose is bipolar diathermy limited to

A

Coagulation (some cutting devices have been developed)

55
Q

What type of current and frequency do diathermy circuits use

A

AC at 200kHz to 3.3MHz

56
Q

When is continuous current used

A
  • Monopolar cutting

- Bipolar circuits

57
Q

When is attenuated current used

A
  • Monopolar blended cutting
  • Desiccation (coagulation)
  • Fulguration
  • Spray
58
Q

What is the minimum electrode pad size

59
Q

What output is used for pure cutting

A

Continuous output - high local temperature causes tissue disruption

60
Q

When is blended cutting favoured over pure cut

A

When small vessel haemostasis is required

61
Q

What is the difference between blended and pure cutting

A

Blended cutting uses an attenuated output

62
Q

What is dessication

A

Contact coagulation used to obtain haemostasis in small blood vessels

63
Q

What is Fulguration

A

Non-contact coagulation used to dry an area of capillary bleeding using an attenuated output

64
Q

Uses of argon beam laser

A
  • Eye surgery

- Endoscopic ablation

65
Q

Use of CO2 laser

A
  • ENT ablation surgery

- Cervical ablation surgery

66
Q

Use of Nd:YAG laser

A
  • Endoscopic debulking surgery
  • GI bleeding coagulation
  • Laparoscopic surgery
67
Q

How do Harmonics work

A
  • Provide electrical energy to piezoelectric ceramic plate
  • Expands and contracts at 55500Hz
  • Creates ultrasonic waves that break down H-H bonds resulting in protein denaturation
68
Q

List the types of braided non-absorbable suture

A
  • Silk
  • Linen
  • Cotton
  • Polyester
  • Nurolon
69
Q

List the types of monofilament non-absorbable suture

A
  • Polypropylene (Prolene)
  • PVDF (Novafil)
  • Steel
70
Q

List the types of braided absorbable suture

A
  • Polyglycolic acid (Dexon)

- Polyglactin 910 (Vicryl)

71
Q

List the types of monofilament absorbable suture

A
  • Polydiaxone (PDS)

- Polyglyconate (Maxon)

72
Q

Which needle should be used for abdominal closure

A

Round-bodied blunt needle

73
Q

Which needle should be used for skin closure

A

Cutting needle

74
Q

When should facial sutures be removed

75
Q

When should scalp sutures be removed

76
Q

When should hand/limb sutures be removed

77
Q

When should abdominal wound sutures be removed

A

10-20 days

78
Q

Most commonly used abdominal self-retainer

79
Q

Most commonly used retainer for inguinal hernia repair

80
Q

What size blade should be used for opening the abdomen

81
Q

What size blade should be used for stab incisions e.g. laparoscopic ports

82
Q

What is the difference between open and closed drains

A
  • Open = into dressings

- Closed = into container

83
Q

What is the purpose of latex tube drains e.g. T-tube

A
  • Act as sump drains

- Desired effects is to generate fibrosis along the drain tract

84
Q

List the purposes of drains

A
  • Minimise deadspace
  • Where there is risk of leakage
  • Drain fluid collections
  • Divert fluid
  • Decompression
85
Q

How do hydrocolloid dressings work

A

Form a gel that absorbs secretions

86
Q

What type of dressing is useful for desloughing wounds

87
Q

What class of laser is Nd:YAG

88
Q

What is Argon laser used for

A

Coagulation

89
Q

How is the penetrance of the laser determined

A

Determined by wavelength of the laser

90
Q

What suture is typically used for anchoring drains

91
Q

What suture is suitable for mass closure of the abdomen

92
Q

What suture is suitable for skin closure

93
Q

What suture is suitable for vascular anastomosis

A

6/0 Polypropylene (Prolene) - non-absorbable continuous suture

94
Q

What is the thinnest available suture size

95
Q

What is the thickest available suture size

96
Q

What suture is most commonly used in laparoscopic surgery

A

Polyester (Ethibond)

97
Q

How long should a patient be monitored following core biopsy

98
Q

What type of biopsy is typically taken for skin tumours

A

Excisional biopsy

99
Q

List the medical contraindications to day-case surgery

A
  • ASA >2
  • BMI >35
  • Specific problems e.g. bowel resection
  • Extensive pathology
  • Operation >1 hour
100
Q

What are the early complications of vascular anastomosis

A
  • Haemorrhage or leak

- Thrombosis

101
Q

Late complications of vascular anastomosis

A
  • Infection
  • Stenosis
  • Pseudoaneurysm at the suture line
  • Rupture
102
Q

What suture should be used for duct anastomosis

A

Monofilament absorbable sutures e.g. PDS

103
Q

List the early complications of duct anastomosis

104
Q

List the late complications of duct anastomosis

A
  • Stenosis

- Intraductal stone formation

105
Q

Which anastomoses are at biggest risk of leak

A
  • Oesophageal

- Rectal

106
Q

Pneumoperitoneum pressure

107
Q

List the physiological consequences of pneumoperitoneum

A
  • Raised or reduced CO
  • Increases SVR
  • Increases MAP
  • Increases CVP
  • Reduces venous return
  • Increases partial pressure of CO2
  • Increases peak inspiratory pressure
  • Reduces urine output
108
Q

How should 10mm laparoscopic ports be closed

109
Q

How should 5mm laparoscopic ports be closed

A

Skin only required

110
Q

When should the tourniquet be deflated to allow for reperfusion

A
  • 90 minutes in upper limb

- 120 minutes in lower limb

111
Q

How high should the tourniquet be inflated

A
  • 50mmHg over SBP in upper limb

- 100mmHg over SBP in lower limb

Perioperative Care (6 decks)

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