Week 1-2 Flashcards
A surgical suture, also known as a stitch or stitches, is a _______ used to __________ and ____________ after an injury or surgery.
medical device
hold body tissues together
approximate wound edges
There are numerous types of suture which differ by _______ and _______ as well as __________ and characteristics
needle shape and size
thread material
_________ , or _______, needles with sutures consist of a pre-packed eyeless needle attached to a specific length of suture thread.
Swaged
atraumatic
The _____ and ______ needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.
ski and canoe
Monofilament versus polyfilament threads
Monofilament fibers have less _________ but create less _________ and are more appropriate with ______ tissues where ___________ can be more significant such as _________________.
tensile strength ; tissue trauma
delicate tissues ; tissue trauma
small blood vessels.
Monofilament versus polyfilament threads
Polyfilament (_________) sutures are composed of multiple fibers and are generally greater in _______ with greater ___________, however, they tend to have greater ____________ and theoretically have more propensity to harbor _________
braided; diameter
tensile strength; tissue reaction
bacteria
Other properties to consider between a mono or poly filamentous thread
Tensile strength: the ability of the suture to _____________________.
Elasticity: the ability of the suture material to ______________ such as in cases of ________.
Tissue reactivity: ______________ of the surrounding tissue that can cause materials to break down quicker and lose tensile strength.
Knot security: the ability of the suture to __________________
hold tissues in place without breaking
adapt to changing tissues ; edema
inflammatory response
maintain a knot that holds the thread in place
(Absorbable or Non absorbable?) (natural or synthetic?) suture have the (Absorbable or Non absorbable?) (natural or synthetic?) fibers have the highest rates of tissue reactivity.
Non absorbable synthetic
absorbable natural
Absorbable sutures are either degraded via ___________ or ___________ and should not be utilized on body tissue that would require greater than ___________ of tensile strength.
proteolysis : hydrolysis
two months
Absorbable sutures are generally used (internally or externally?) during surgery or to avoid further procedures for individuals with (low or high?) likelihood of returning for suture removal.
Internally ;low
Natural absorbable
Natural absorbable material includes ___________ , ___________ and ___________ which are all produced from the _____ extracted from ____________.
They are all (mono or poly?) filaments which have different degradations times ranging from ___-____days.
plain catgut, chromic catgut and fast catgut
collagen; bovine intestines
poly; 3–28
Synthetic absorbable
Synthetic absorbable material includes ________ acid, ________ acid, _________, Polydioxanone and Polytrimethylene carbonate.
Among these are monofilaments, polyfilaments and braided sutures. In general synthetic materials will keep tensile strength for longer due to less local tissue inflammation
Polyglactic
Polyglycolic
Poliglecaprone
Best used on:
Plain catgut-
Chromic catgut
Fast catgut-
Mucosal tissues
Mucosal, skin, genitalia
Mainly skin, also mucosal
Non-absorbable
They are appropriate for tissues with a (low or high?) degree of mechanical or shear force (________, certain skin location).
High
tendons
Sutures
Natural non-absorbable : ______
Synthetic non-absorbable: ______,______,_________
Silk
nylon, polypropylene and surgical steel
Sutures
Natural non-absorbable : Silk - ____filament
Synthetic: includes nylon, polypropylene and surgical steel all of which are _____filaments
poly
mono
A Marjolin ulcer is a ___________ that arises in the setting of ____________ skin, _______ scars, and _______ wounds
cutaneous malignancy
previously injured
longstanding
chronic
_____________________ (ERAS) is a modern approach to help people _______ following surgery
Enhanced Recovery After Surgery
recover quicker
ERAS PROTOCOL
Pre-Operative
•Ensuring the patient is as healthy as possible prior to surgery, through ______ and ________
•Optimising medical management, including _________ and ________
•__________ prior to surgery to enhance bowel recovery and avoid bowel prep if appropriate
•Solids allowed until _______ pre-operatively (unless contra-indicated)
•Intake of clear fluids until ______ prior to surgery, with some centres moving towards being able to drink clear fluids up to the time of leaving the ward
•Loading with 12.5% _________ within 2 hours of surgery
exercise and weight loss
smoking and alcohol cessation
Altered diet; 6 hours
2 hours
carbohydrate beverage
ERAS PROTOCOL
Intra-Operative
•Use of multimodal and _______ analgesia, including regional anaesthesia*
•Includes avoidance of ____-acting benzodiazepines in the elderly
•Use of multimodal postoperative __________________ prophylaxis
•Use of _______________ surgery
•Targeting a goal-directed fluid therapy regime, including goal-directed _______ management
opioid-sparing
short; nausea and vomiting
minimally invasive
haemostasis
Regional anaesthesia includes _______ and ________ anaesthesia, __________ catheters, and _____________ regional blocks
spinal and epidural anaesthesia
rectus sheath catheters
local anaesthetic regional blocks
ERAS PROTOCOL
Post-Operative
Ensure adequate _________ is achieved to allow for early mobilisation
Early ________ and optimising nutrition
Multi-disciplinary post-operative patient follow-up, including in the post-acute care phase
pain control
oral intake
There are several parts to the operating theatre:
List them
Scrubbing area
Operating room
Anaesthetic room
Storage area
There are several parts to the operating theatre:
_____________ – contains sinks and sterile gowns, gloves, and masks/visors etc
___________ – contains the scrub nurse table
Scrubbing area
Operating room
Storage area also are often sterile
T/F
T
The time it takes for a tissue to no longer require support from sutures will vary depending on tissue type:
Days: ____,_______, or ______
Weeks to Months: ________ or ______
Months to Never: ______________
Muscle, subcutaneous tissue or skin
Fascia or tendon
Vascular prosthesis
The ideal suture is the (smallest or largest ?) possible to produce uniform tensile strength, securely hold the wound for the required time for healing, then _________. It should be predictable, easy to handle, produce minimal reaction, and knot securely.
Smallest
be absorbed
_________ sutures are commonly used for deep tissues and tissues that heal rapidly
Absorbable
For the more commonly used absorbable sutures, complete absorption times will vary:
Vicryl rapide =___ days
Vicryl = ___ days
Monocryl = ~____ days
PDS = ~_____ days
42
60
100
200
Non-Absorbable Sutures
Non-absorbable sutures are used to provide _____-term tissue support, remaining ______ by the body’s ________ (until removed manually if required).
long
walled-off
inflammatory processes
Non-absorbable sutures
Uses include for tissues that heal (rapidly or slowly?) , such as ______ or ______ , closure of __________, or _______ anastomoses.
slowly
fascia or tendons
abdominal wall
vascular
Monofilament vs Multifilament
Suture materials can also be sub-classified by their structure:
Monofilament suture – a single stranded filament suture (e.g _____,——- *, or prolene).
Multifilament suture – made of several filaments that are twisted together (e.g _______ or _______ ).
nylon; PDS
braided silk or vicryl
Monofilament vs Multifilament sutures
Monofilament suture
-(Lower or Higher?) infection risk
-(good or poor?) knot security and ease of handling.
Multifilament suture
-(good or poor?) knot security and ease of handling
-(Lower or Higher?) infection risk
Lower; poor
Good; Higher
The larger the size ascribed to the suture, the _______ the diameter is, for example a 7-0 suture is ______ than a 4-0 suture.
smaller
smaller
When choosing suture size, the _______ size possible should be chosen, taking into account the _______ of the tissue.
smallest
natural strength
Commonly, surgical needles are made from _____________ .
stainless steel
Surgical needles are composed of:
The _______ end connects the needle to the suture
The _________ or ____________ is the region grasped by the needle holder.
The _________
swaged
needle body or shaft
Needle point
Needle bodies can be ______,_______, or _________
round, cutting, or reverse cutting:
Needle bodies can be round, cutting, or reverse cutting:
Round bodied needles are used in _____ tissue such as ______ and _____
Cutting needles are ______ in shape, and have _____ cutting edges to penetrate _____ tissue such as the ______ and _______, and have a cutting surface on the con______ edge
Reverse cutting needles have a cutting surface on the con_____ edge, and are ideal for ______ tissue such as _______ or ______ sutures, and have reduced risk of cutting through tissue
friable; liver and kidney
triangular; 3; tough; skin and sternum;cave
Vex; tough; tendon or subcuticular
The needle point acts to pierce the tissue, beginning at the maximal point of the body and running to the end of the needle, and can be either _____ or _______
sharp or blunt
Needle points
Blunt needles are used for ________, and in _____ tissue, and can potentially reduce the risk of blood borne virus infection from needlestick injuries.
Sharp needles pierce and spread tissues with minimal cutting, and are used in areas where ______ must be prevented.
abdominal wall closure; friable
leakage
Allis forceps are _______ surgical instruments, used to grasp ____ tissues (such as _____)
Babcock forceps are ______ instruments with a (rough or smooth?) end, allowing for more delicate structures (such as ______) to be held in an _______ manner
Dunhill forceps are (small or large?) forceps with _____________ ends, often used to grasp ———- prior to ligation
Lane tissue forceps have ______ teeth, allowing the grasping of _____ tissues, such as ______
toothed ; firm tissues ;fascia
jawed ; smooth ; bowel; atraumatic manner
small ;curved serrated ;vessels
interlocking teeth; tough ; fascia
Littlewood forceps have ____ ended teeth, used to grasp ______ tissues, such as ______. They are often used to gain entry via the _________ for _______ surgery.
Sawtell forceps are _______ forceps with a ——— end, often used to grasp ———— prior to ligation
Available as curved or straight, Spencer Wells forceps can be used to ______ medium to large sized vessels prior to ligation
blunt ;tough ;fascia. ; umbilicus ; laparoscopic
curved ; serrated ; vessels
clamp
Debakey forceps are _______ forceps used in a wide variety of procedures, importantly can be used to grasp tissues (such as ______ ) without damaging them
Lanes forceps are ______ instruments, useful for grasping tissues and are widely used within all surgical specialities (however not to be used to grasp _____)
Gillies forceps are (narrow or wide?) ________ forceps, often used to grasp ______ (not to be used to grasp _______)
non-toothed ; bowel
toothed ; bowel
narrow ; toothed ; skin ; bowel
Mayo scissors are ______ scissors, with _______ ends, often used to cut _______ or ________, either straight or curved
McIndoe scissors are used often for cutting or dissecting ______, characteristically have a ______ blade
heavy; semi-blunt; thick tissues or sutures
tissues; curved
Rampleys can be used for handle ______ or _______
guaze or sponges
Diathermy is the use of ________ frequency alternate polarity radio-wave ________ to _______ or _____ tissue during surgery.
high frequency
electrical current
cut or coagulate
Diathermy
It allows for ______ to be made with limited ________ and is now used in nearly all surgical disciplines.
precise incisions
blood loss
Diathermy uses _______ frequencies
very high
Diathermy
Depending on the temperature reached, different results occur: at 60oc, ________ occurs (______), between 60-99oc, _____ occurs and the tissues ______, and at around 100 oc, the tissues ______ (_______).
cell death ; fulgurate
dehydration; coagulate
vaporise; cutting
Diathermy
Cutting uses a __________ waveform with a __________ voltage.
Coagulation alternatively uses a __________ waveform with a __________ voltage.
continuous ; low
pulsed ; high
abscess is a localised collection of ____ surrounded by __________.
pus
granulation tissue
Pus contains ______ tissue with suspended _____________ and ________. It forms when the primary insult is a _______ bacterium and extensive tissue necrosis occurs.
necrotic
dead and viable neutrophils
dead pathogens
pyogenic bacterium
Over time, the acute inflammation will cease and, if not ___________, the abscess will be replaced by ______.
surgically drained
scar tissue
An abscess can be a source for _________________ of a pathogen, with the abscess acting as a _______ for the infection.
It can also cause continually rising pressures within the tissue, resulting in _____ and _________ of local structures.
systemic dissemination
harbour
pain; destruction
The basic principles for the management of a wound or laceration are:
List all 5
Haemostasis
Cleaning the wound
Analgesia
Skin closure
Dressing and follow-up advice
In cases of significant injury or laceration of vessels, steps may need to be taken to reduce bleeding and aid haemostasis.
These include ________,_______,________, or _________
pressure, elevation, tourniquet, or suturing.
Wound cleaning is important for reducing infection and promoting healing. There are five aspects of wound cleaning:
List all
Disinfect
Decontaminate
Debride
Irrigate
Antibiotics
five aspects of wound cleaning:
Disinfect the __________ with antiseptic and Avoid getting ________
Decontaminate the wound by _________
Debride any _______ where possible
Irrigate the wound with _____
Antibiotics for high-risk wounds or signs of infection
skin around the wound ; alcohol or detergents inside the wound
manually removing any foreign bodies
devitalised tissue
saline
Remember to not use adrenaline with local anaesthetic if administering ________________
in or near appendages (e.g. a finger)
Skin Closure
To aid wound healing, the edges of the wound can be manually opposed. There are four main methods of doing so:
List all
Skin adhesive strips
Tissue adhesive glue
Sutures
Staples
Skin Closure
Skin adhesive strips (e.g. Steri-StripsTM) are suitable if ___________ are present
Tissue adhesive glue :a popular choice in ___________
Staples can be used for some ____ wounds
no risk factors for infection
paediatrics
scalp
When applying a wound dressing to a non-infected laceration, the first layer should be __________ (such as a __________), followed by an __________ to attract any __________, and finally __________ to secure the dressing in place.
non-adherent ; saline-soaked gauze
absorbent material ; wound exudate
soft gauze tape
Any sutures or adhesive strips should be removed _______ after initial would closure (or ______ if on the head)
tissue adhesive glue will naturally slough off after ______.
10-14 days
3-5 days
1-2 weeks
Remove dressings at the same time as the sutures or adhesive strips.
T/F
T
foreign body (________ giant cell)
mycobacterium tuberculosis (_______ giant cell)
fat necrosis (________ giant cell).
foreign-body
Langhans
Touton
There are two main types of healing, ________ intention and _______ intention.
In both types, there are four stages which occur; _______,________,_______, and ________
primary; secondary
haemostasis, inflammation, proliferation, and remodelling.
Any wound made by a scalpel will heal by _________ intention. Surgeons can aid healing by ensuring adequate opposition of the wound edges, through use of surgical glue, sutures, or staples.
primary
When sutures are used to close a wound, ensuring the correct tension of the sutures is essential:
Too loose and the _________________, limiting the primary intention healing and reducing wound strength
Too tight and the ______________ and lead to tissue necrosis and wound breakdown
wound edges will not be properly opposed
blood supply to the region may become compromised
Healing by secondary intention occurs when ___________, therefore healing must occur from the (top or bottom?) of the wound (up or down?)wards.
the sides of the wound are not opposed
bottom
upwards
Local factors affecting wound healing
M
I
L
F
S
mechanical factors
Infections
Location of wound
Foreign material
Size and type of the wound
Radiation damage
Systemic factors affecting wound healing
???
Co-morbidities
Obesity
Nutrition
Increasing Age
Classification of wound contamination
?
Clean
Clean contaminated
Contaminated
Dirty
Classification of wound contamination
Clean
_____ signs of inflammation, ____ opening of any of the tracts
Clean contaminated
___________ case that is otherwise _____.
________ opening of respiratory, GI, biliary, or GU tract with _____ spillage
No; no
Urgent or emergency; clean
Elective; minimal
Classification of wound contamination
Contaminated
_____ spillage from GI tract or entry into biliary or GU tract (in the presence of __________). Or a ________ trauma <___ hours old or a ________ wound to be grafted or covered
Dirty
________ inflammation (e.g. _____)
Preoperative _______ of respiratory, gastrointestinal, biliary, or genitourinary tract, or a penetrating trauma >___ hours old
Gross; infected bile or urine
Penetrating; 4; chronic open
Purulent; abscess; perforation;4
Fibroadenoma:_______ lesions, _____-defined and ______ on palpation, (pain or painless?)
Lipoma:________ and _______ benign adipose tumour
Cysts: (rubbery or hard?), (smooth or irregular?) , and (well-defined or indistinct?), (pain or painless?)
Nodullarity: (rubbery or hard?) , (smooth or irregular?) , and (well-defined or indistinct?) , (pain or painless?)
Carcinoma: (rubbery or hard?) , (smooth or irregular?) , and (well-defined or indistinct?) (painful or painless?)
highly mobile; well; rubbery, painless
soft; mobile
hard, smooth, and well-defined, either
rubbery, irregular, and indistinct, pain
hard , irregular, and indistinct, often painless, rarely painful
Adenoma
A _______ adenoma is a benign _______ tumour, typically occurring in the _______ female population.
Papilloma
_________ papillomas are a benign breast lesion that usually occur in females in their ________yrs, most typically occurring in the _________ region
Phyllodes tumours* are _________ tumours. They are commonly (smaller or larger?), occur in an ______ age group, and are comprised of both epithelial and stromal tissue.
ductal; glandular; older
Intraductal; 40-50; subareolar
rare fibroepithelial; larger; older
benign breast lesions can present in a variety of ways. However in general, benign breast lumps tend to be more (mobile or fixed?) and have (smoother or rougher?) borders than their malignant counterparts, which often have ______ surfaces, a _____ consistency, and can be ______ to different layers of tissue.
Mobile; smoother
craggy; firm; fixed
Malignant lesions tend to present as a single mass, whilst it is possible to get multiple benign breast lumps.
T/F
T
Differential Diagnosis of Benign breast lump
The main differentials to consider include _______,_______, and _______
cysts, abscesses, and malignant lesions.
The mainstay of distinguishing between breast lumps is __________________[.
the Triple Assessment
All suspicious breast lesions should undergo the triple assessment, warranting _________,________,_________
examination, imaging, and histology.
Common benign tumour subtypes include ________,________,________,________ and ___________
Fibroadenoma, Adenoma, Papilloma, Lipoma, and Phyllodes Tumours
Plain catgut is a natural suture material derived from the _________ of _________ or the _________ of _________.
submucosa ; sheep intestine
serosa ; cattle intestine.
Chromic catgut is a modification of __________ that is tanned with _________ to improve ________ and delay ________.
plain catgut
chromic salts
strength; dissolution
Current methods for fighting SSIs involve the use of sutures coated with common antibiotics (________). Unfortunately, these antibiotics have been rendered ineffective due to the _____________________________
triclosan
increasing rate of antibiotic resistance.
The cruciate anastomosis is an arterial network located on the ______ surface of the ______________.
Some authors refer to it as the ____________________.
The cruciate anastomosis is formed by the: _____________________ artery. And ____________ artery
posterior; proximal femur
collateral circulation at the hip joint
First perforating branch of deep femoral
Inferior gluteal
An arthrotomy is a _________ of a ________ , which should include inspection of the _______, ___________ structures, _________, and __________.
surgical exploration of a joint
cartilage; intra-articular
joint capsule; ligaments
Traumatic brain injury is classified as ______,_________, or ________, based on the __________________.
mild, moderate, or severe
Glasgow Coma Scale (GCS) score
Wagner’s classification of Foot ulcers
Ulcer grading Description
Grade O
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
No ulcer but high-risk foot
Superficial ulcer
Deep ulcer, no bony involvement or Abscess with bony involvement (as shown by X-ray) abscess
Localized gangrene e.g. toe, heel etc
Extensive gangrene involving the whole foot
