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Surgical Skills > Wilson > Flashcards

Wilson Flashcards

1
Q

Why might we use a bandage?

A

Support suture lines! But also:

owner convenience and early wound management

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2
Q

Why would we use a pressure bandage?

A
  • reduce limb edema
  • reduce dead space
  • control hemorrhage
  • control granulation tissue
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3
Q

What ideal properties should a bandage have? 7

A

cheap, conformable to the wound, capable of desired function, free or particulate matter, inert, gas permeable, easily cleaned, looks nice

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4
Q

What are the three layers of a bandage?

A

Primary: dressing
Secondary - padding and absorption
Tertiary - resistant to environmental contamination

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5
Q

Which bandage layer is most important? What properties must this layer have?

A

the primary layer. Must be sterile and maintain wound contact. Can be adherent or not

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6
Q

Which type of primary bandage is aggressively adherent? Non aggressive?

A

Most aggressive is Dry - Dry, least aggressive is wet - wet.

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7
Q

Which primary bandage would you use to debride a wound for a graft?

A

dry -dry

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8
Q

Which primary bandage would you use to moderately debride with topical antibacterials and enhanced capillary action?

A

wet -dry

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9
Q

Which primary bandage would you use to minimally debride for a very high fluid producing wound?

A

wet - wet

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10
Q

Which primary bandage would you use for very sensitive tissue? What is a type of this?

A

a non-adherent dressing such as tefl a or petrolatum impregnanted or polyethylene glycol

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11
Q

Which primary bandage would you use for very sensitive tissue? What is a type of this?

A

a non-adherent dressing such as tefl a or petrolatum impregnanted or polyethylene glycol

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12
Q

What are the primary functions of a secondary bandage?

A

absorption (+ capillary), pressure distribution, and support `

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13
Q

How much pressure can you get without elastics. With a 50% stretch?

A

less than 30 minutes without elastics, but can get 6-8 hrs with a 50% stretch.

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14
Q

When is it good to use a vacuum bandage?

A

helping a skin graft to take

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15
Q

Someone phones you with a wounded animal. What do you recommend in general?

A
  • restrict movement of patient and provide support (Splint)
  • flush the wound
  • control bleeding with pressure bandage
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16
Q

within what time frame can you close a wound? what other factors influence this?

A

can usually do it if less than 8 hrs. The closer the wounds are to the head the more time you have, and the less contamination the more likely you can close it

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17
Q

What should you keep in mind while examining a new wound?

A

Use sterile gloves and possible anesthesia. Can use sterile lube and clip and prep area as well.

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18
Q

Why do we debride?

A

remove contaminated tissue and devitalized tissue. Elimates infection

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19
Q

What technology do you use to debride a wound?

A

pulsavac

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20
Q

What is an ideal solution to lavage a wound with?

A

something non-irritating and bactericidal (lactated ringers > saline, can also use povidone iodine which is not useful and chlorohexidine which is effective.)

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21
Q

Why does povidone iodine suck?

A

need to half the effective dose for it not to be irritating, and it also inhibits neutrophil migration

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22
Q

When should you use antibiotics in lavage solution?

A

at the end of treatment so it doesn’t wash out.

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23
Q

When is it important to use antimicrobila in lavage solution?

A
  • open synovial structures
  • severe muscle injury
  • cellulitis
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24
Q

When is it important to use antimicrobila in lavage solution?

A
  • open synovial structures
  • severe muscle injury
  • cellulitis
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25
Q

What are the systemic responses to major trauma? 4

A

increased metabolic rate
increased CO
increased RR
Fever

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26
Q

What are major factors in the increased metabolic rate during major trauma?

A

pain! use analgesia!

Nutritional intake - can limit catabolism

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27
Q

How does your body change in major trauma?

A

loses fat and muscle

ECF expands

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28
Q

How does your body change in major trauma?

A

loses fat and muscle

ECF expands

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29
Q

How does the body respond to losing blood?

A

increases ADH and aldosterone

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30
Q

How does the body respond to losing perfusion?

A

organ failure from schema and reperfusion injury

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31
Q

How does the body respond to starvation?

A

makes keytones

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32
Q

What does pain stimulate in the nervous system?

A

cortisol, catecholamines - increases blood glucose via insulin, mobilizing fat, gluco and glycogenesis. Increasing metabolic rate while decreasing nutritional status makes for a skinny animal.

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33
Q

How can we minimize the effects of major trauma on increased metabolism?

A

analgesia

don’t fast horses

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34
Q

How can we minimize the effects of major trauma on increased metabolism?

A

analgesia

don’t fast horses

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35
Q

What are the three types of wound closure?

A

primary (surgical or laceration)
delayed primary (resolved inection + debridement but before granulation tissue)
secondary (after granulation)

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36
Q

What is the number one reason not to close a wound?

A

tension on suture lines (caused by motion)

also tissue considerations (if it is lost etc)

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37
Q

Should you use braided suture for non surgical wounds?

A

no! infection!

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38
Q

Why does a primary wound fail to close?

A

tension! also devitalized tissue and infection

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39
Q

List 5 ways to reduce tension

A

Undermining tissue
tension relieving sutures (near far far near/mattresses)
tension reliving incisions
plasty
pre-suturing (stretching skin over a mass)

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40
Q

When a wound closure fails what is the cost?

A

lose tissue
costs money
infection

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41
Q

When a wound closure fails what is the cost?

A

lose tissue
costs money
infection

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42
Q

What must you do to perform a delayed primary closure?

A

resolve any infection and debride wound. Must be before granulation tissue occurs.

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43
Q

What are the advantages and disadvantage of closing a wound secondary?

A

allows infection to resolve and the host self debrides. The tissues are harder to manipulate though.

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44
Q

What are the three components of second intention healing?

A

granulation, contraction and epithelialization

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45
Q

What may harm secondary healing via stopping contraction?

A

contact inhibition and tension, also lost of miofibroblasts

46
Q

Why don’t limb wounds contract as well as body wounds?

A

less vasculariation, less skin elasticity

fewer myofibrils and cytokines

47
Q

Why don’t limb wounds contract as well as body wounds?

A

less vasculariation, less skin elasticity

fewer myofibrils and cytokines

48
Q

Why do limb wounds epithelialize slower than body wounds?

A

we don’t know

49
Q

What meds can inhibit granulation tissue?

A

corticosteroids, white wound lotion (lead/zinc), copper sulcate, amnion, skin grafts,

50
Q

How do corticosteroids change wound healing?

A

inhibit granulation tissue and slows epithelialization

51
Q

How do lead acetate/zinc sulfate change wound healing?

A

inhibits granulation tissue by slows epithelialization by killing fibroblasts

52
Q

How does copper sulfate change wound healing?

A

inhibits gran. tissue by killing fibroblasts

53
Q

How does furacin change wound healing?

A

stimulates granulation tissue and inhibits epithelialization

54
Q

How does prep H change wound healing?

A

stimulates granulation tissue production while slowing contraction and epithelialization

55
Q

How does amnion change wound healing?

A

inhibits granulation tissue and promotes epithelaization - actually speeds healing!

56
Q

How des split thickness skin grafting change wound healing?

A

inhibits gran tissue and promotes contraction

57
Q

How des split thickness skin grafting change wound healing?

A

inhibits gran tissue and promotes contraction

58
Q

Ideal properties of suture? 12

A

maintain strength, non electrolytic, noncapillary, non allergenic, non cacinogenic, good handling, secure knots, no reactivity, absorb dependably or inert, cheap, available, easily cleaned, doesn’t fair bacteria

59
Q

What are the two ways to classify suture?

A

absorbable/not

synthetic/natural

60
Q

Ideal properties of suture? 12 (7 important)

A

maintain strength, noncapillary, good handling, secure knots, no reactivity, absorb dependably or inert, doesn’t fair bacteria

non electrolytic, non allergenic, non carcinogenic, cheap, available, easily cleaned,

61
Q

What are the two ways to classify suture?

A

absorbable/not

synthetic/natural

62
Q

Which sutures are absorbable?

A
  • collagen
  • surgical gut
  • anything poly/glycomer
63
Q

Which sutras are not absorbable?

A

silk, cotton, nylon, polyproplyene polymerized caprolactam, polyester, steel

64
Q

Why is surgical gut a bad suture choice?

A

poor strength (down to 50% in 14 days), non capillary, knots don’t tie well, phagocytosis causes unpredictable absorption, favours bacteria

65
Q

Why is Dexon (polyglycolic acid) a poor suture choice

A

it is capillary and doesn’t have much strength. It is braided and favours bacteria.
Breaks down reliably in 100 days - good point.

66
Q

Why is coated vicryl a good/poor suture choice?

A

non capillary and graded but otherwise good. smiler strength to dexon and surgical gut.

67
Q

why is PDS II a good/poor suture choice?

A

generally good on all fields! a bit hard to handle. breaks down in 180 days. it is non capillary and doesn’t attract bacteria! yay!

68
Q

why is PDS II a good/poor suture choice?

A

generally good on all fields! a bit hard to handle. breaks down in 180 days. it is non capillary and doesn’t attract bacteria! yay!

69
Q

why is maxon a good/poor suture choice?

A

good in all ways, good to use when there may be bacteria present.

70
Q

why is monocryl a good/poor suture choice?

A

good in all ways, breaks down in 90 days though so good for SQ layer and good when bacteria may be present

71
Q

why is Biosyn a good/poor suture choice?

A

best absorbable for strength. lasts 110 days. good in all other ways.

72
Q

why is Biosyn a good/poor suture choice?

A

best absorbable for strength. lasts 110 days. good in all other ways.

73
Q

why is silk a good/poor suture choice?

A

multifiliment - favors bacteria and is capillary, but is very strong.

74
Q

why is cotton a good/poor suture choice?

A

really favours bacteria. capillary. reactive.

75
Q

why is nylon a good/poor suture choice?

A

its good!

76
Q

why is prolene a good/poor suture choice?

A

great for closing skin, bad for tendons because they have a bit of stretch to them

77
Q

why is vetafil a good/poor suture choice?

A

multifilament! capillary, reactive, favors bacteria. comes in a cassette so no waste.
DO NOT BURY or it gets infected!

78
Q

why is polyester a good/poor suture choice?

A

capillary, bacteria, and reactive. poor choice but strong.

79
Q

why is stainless steel a good/poor suture choice?

A

hard to handle.

80
Q

why is stainless steel a good/poor suture choice?

A

hard to handle.

81
Q

how do you choose a suture material?

A

mainly based on strength and how long it takes to decay

82
Q

What do you use to close skin?

A

monofilament that isn’t absorbable

83
Q

what do you use for subcutaneous tissue

A

snythetic absorbable

84
Q

what do you use to close fascia?

A

monofilament - either absorbable or not

85
Q

what do you use to suture tendon?

A

monofilament absorbable or nylon

86
Q

how do you choose a type of needle circle?

A

wound depth

87
Q

needle head for skin?

A

cutting

88
Q

needle head for bowel, fascia, tendon or subQ?

A

taper

89
Q

needle head for bowel, fascia, tendon or subQ?

A

taper

90
Q

When you see a wound, what do you consider before attempting to deal with it?

A

location, how it was injured, how long it was injured, if it is contaminated

91
Q

When you see a puncture wound, what do you need to do?

A

imaging before you take out the puncture object so you can see how deep it is

92
Q

what are picture wounds predisposed to?

A

innoculation and foreign body.

93
Q

what secondary problems do burns cause?

A

smoke inhalation, protein loss, sepsis

94
Q

what kind of injury are serum scald and chronic diarrhea?

A

chemical burns

95
Q

what two kinds of gun injurys

A

low velocity - tumbling phenomenon - different tissue density changes projection
high velocity -destroys everything in path

96
Q

What’s a major problem with all gun wounds?

A

high contamination

97
Q

What causes a vascular injury?

A

a poorly applied cast

98
Q

What is a clean wound?

A

surgery, elective. no drains

99
Q

how often are clean wounds infected?

A

2.5%

100
Q

what is a clean-contaminated wound?

A

a hallow viscous surgery (Bladder or sinus), or a clean surgery with a drain

101
Q

how often are clean-contaminated wounds infected?

A

4.5% - more able to justify prophylactic antibiotics

102
Q

What is a contaminated surgery?

A

gastro, a contaminated wound, or an open fresh wound less than 4 hours old.

103
Q

Infection rate of contaminated surgery?

A

5.8%

104
Q

What is a dirty surgery?

A

old wounds over 4 hrs old, GI rupture

105
Q

dirty surgery infection rate?

A

18.1% - use antibiotics!

106
Q

What are the 5 events of wound healing?

A 
wounding
acute vascular phase
inflammatory phase
cellular phase
maturation phase
107
Q

What are the 5 events of wound healing?

A 
wounding
acute vascular phase (bleeding, vasoconstriction, clot)
inflammatory phase (serum and granulation)
cellular phase (fiberous tissue + capillary growth)
maturation phase (crosslinking, collagen remodelling, gains strength)
108
Q

what is involved in the inflammatory stage of wound healing?

A

vasodilation, inflammatory cells, cellular adhesion. also many vasoactive factors such as histamine, serotonin, cytokines, kinins, prostoglanins

109
Q

what occurs when a wound epithelialises?

A

fibrin seal, epithelials migrate to area and proliferate under direction of macrophages

110
Q

what occurs when a wound epithelialises?

A

fibrin seal, epithelials migrate to area and proliferate under direction of macrophages

111
Q

What three major factors influence wound healing?

A

surgeon (our skill, suture choice, etc), the wound environment (infection, contamination degree) and the patients systemic condition (age, nutrition, immune)

112
Q

when there is low oxygen how does this effect granulation?

A

increases granulation

Surgical Skills (4 decks)

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