Surgical Technology Flashcards
Give some absorbable suture materials?
Catgut
Chromic catgut
Vicryl
Dexon
PDS
Give some permanent (non absorbable) suture?
Silk (although not well preserved)
Prolene
Ethibond
Biological sutures?
Silk
Catgut
Chromic catgut
(all braided)
Synthetic sutures?
PDS
Vicryl
Dexon
Prolene
Ethibond
Synthetic monofilament sutures?
PDS
Prolene
Synthetic braided sutures?
Vicryl
Dexon
Ethibond
How are suture size numbers determined?
The higher the index number the smaller the suture i.e. : 6/0 prolene is finer than 1/0 prolene.
When the /0 is removed they become thicker with ascending numerical value
which sutures should be used in vascular surgery?
always monofilament
braided potentially thrombogenic
Features of a redivac drain?
Suction type of drain
Closed drainage system
High pressure vacuum system
Features of low pressure drainage systems?
-Consist of small systems such as the lantern style drain that may be used for short term drainage of small wounds and cavities
-Larger systems are sometimes used following abdominal surgery, they have a lower pressure than the redivac system, which decreases the risks of fistulation
-May be emptied and re-pressurised
Features of latex tube drains?
-May be shaped (e.g. T Tube) or straight
-Usually used in non pressurised systems and act as sump drains
-Most often used when it is desirable to generate fibrosis along the drain track (e.g. following exploration of the CBD)
Features of corrugated drain?
Thin, wide sheet of plastic, usually soft
Contains corrugations, along which fluids can track
Features of chest drains?
May be large or small diameter (depending on the indication)
Connected to underwater seal system to ensure one way flow of air
what is level V evidence?
Panel or expert opinion
What is level IV evidence?
Evidence derived from case series or case reports
What is level III evidence?
Evidence derived from well designed pseudo-randomised controlled trials (e.g. alternate allocation) or historical controls
What is level II evidence?
Evidence derived from at least one properly designed randomised controlled trial
What is level I evidence?
Evidence obtained from systematic review of all relevant randomised controlled trials
what are stapled anastomoses associated with?
staple line bleeding
For an anastomosis to heal which criteria must be fulfilled?
Adequate blood supply
Mucosal apposition
Minimal tension
Key technique for vascular anastomosis?
1.Always use non absorbable monofilament suture (e.g. Polypropylene).
2.Round bodied needle.
3.Correct size for anastamosis ( i.e. 6/0 prolene for bottom end of a femoro-distal bypass).
4.Suture should be continuous and from inside to outside of artery to avoid raising an intimal flap.
when are laparoscopic hernia repairs indicated?
where there are bilateral hernias or recurrence of a previous open repair.
What is annual probability of hernia strangulation?
3%
What are the types of grafting technique?
Split thickness
Full thickness
Skin Substitute
Composite
Types of local flap?
Transposition
Pivot
Alphabetplasty (e.g. Z-Y)
Types of regional flap?
Myocutaneous
Fasciocutaneous
Neurocutaneous
Types of distant flap?
Free tissue transfer
what are prelamination techniques?
Allows creation of specialised flaps e.g. buccal mucosa
When are full thickness grafts used?
Most commonly used for facial reconstruction
Include dermal appendages
Provide superior cosmetic result
Intraoperative strategies for infection mitigation?
-Prepare the skin with alcoholic chlorhexidine (Lowest incidence of SSI)
-Cover surgical site with dressing
what may increase surgical site infection?
having the wound using a razor (disposable clipper preferred)
Using a non iodine impregnated incise drape if one is deemed to be necessary
Tissue hypoxia
Delayed administration of prophylactic antibiotics in tourniquet surgery
When to give preoperative antibiotic prophylaxis?
Antibiotic prophylaxis if:
- placement of prosthesis or valve
- clean-contaminated surgery
- contaminated surgery
Use local formulary
Aim to give single dose IV antibiotic on anaesthesia
If a tourniquet is to be used, give prophylactic antibiotics earlier
What is the difference between cleaning, disinfection and sterilisation?
Cleaning refers to removal of physical debris.
Disinfection refers to reduction in numbers of viable organisms.
Sterilisation is removal of all organisms and spores.
Method of sterilisation?
1.autoclaving
2. glutaraldehyde solution (2%)
3. ethylene oxide
4. gamma irradiation
What is the action of topical silver nitrate?
cauterise the exuberant granulation tissue and promote healing.
Management of sudden full dehiscence?
- Analgesia
- Intravenous fluids
- Intravenous broad spectrum antibiotics
- Coverage of the wound with saline impregnated gauze (on the ward)
- Arrangements made for a return to theatre
what is a mucous fistula?
conduit between the skin and a redundant segment of bowel
by definition they are usually seen in patients who have an end stoma
When are mucous fistulas commonly seen?
following a sub total colectomy where the distal sigmoid colon is deemed too friable to close
Common site of gastrostomy?
epigastrium
Use of loop jejunostomy?
Seldom used as very high output
May be used following emergency laparotomy with planned early closure
Use of percutaneous jejunostomy?
Usually performed for feeding purposes and site in the proximal bowel
Common site of percutaneous jejunostomy?
Usually left upper quadrant
Use of loop ileostomy?
Defunctioning of colon e.g. following rectal cancer surgery
Does not decompress colon (if ileocaecal valve competent)
Common site of loop ileostomy?
Usually right iliac fossa
Use of end ileostomy?
Usually following complete excision of colon or where ileo-colic anastomosis is not planned
May be used to defunction colon, but reversal is more difficult
Common site of end ileostomy?
Usually right iliac fossa
Use of end colostomy?
Where a colon is diverted or resected and anastomosis is not primarily achievable or desirable
Common site of end colostomy?
Either left or right iliac fossa
Use of loop colostomy?
To defunction a distal segment of colon
Since both lumens are present the distal lumen acts as a vent
Common site of loop colostomy?
May be located in any region of the abdomen, depending upon colonic segment used
Use of caecostomy?
Stoma of last resort where loop colostomy is not possible
Common site of caecostomy?
Right iliac fossa
Use of mucous fistula?
To decompress a distal segment of bowel following colonic division or resection
Where closure of a distal resection margin is not safe or achievable
any region of abdomen for clinical need
In which electrosurgical modality does a sinusoidal, non modulated waveform result in vaporization of the tissues?
cutting current
Features of coagulation current?
-Modulated current with intermittent dampened sine waves of high peak voltage
-Evaporation, rather than vaporisation of intracellular fluid occurs
-Results in formation of coagulum
What is desiccation current?
-Active electrode in direct contact with tissue
-Low current and high voltage system
-Results in loss of cellular water but no protein damage
What is fulguration current?
-Electrode probe is held away from tissue
-Produces spray effect with local, superficial tissue destruction
-Low amplitude and high voltage system
What is blend current?
Alternating cutting and coagulation modes
Total average power is less than with cutting
Most common gas for pneumoperitoneum in laparoscopic surgery?
CO2
gas delivered is adjusted to maintain a constant intra-abdominal pressure of between 12 and 15 mmHg
(more than this may lead to reduced venous return and hypotension)
Which drain is standard following breast surgery?
Redivac type system that is made of polypropylene.
What is an early sign of abdominal wound dehiscence?
seepage of pink serosanguineous fluid through a closed abdominal wound is an early sign of abdominal wound dehiscence
