Surgery Spring 2012

Front 1

2 Principles of instrument selection

Back 1

1. Closely match the size and weight of the instrument selected with those of the tissue or object being used.

2. Select instruments with the goal of minimizing tissue trauma

Front 2

4 things to keep in mind when selecting instruments with the goal of minimizing tissue trauma

Back 2

1. Select instruments and use them in such a manner that the potential for instrument damage is minimized.

2. Use only sharp instruments for cutting.

3. Use only noncrushing clamps on tissue which is to remain with the patient.

4. Forceps with fine teeth, in general, are less traumatic than forceps with coarse teeth or serrations.

Front 3

two basic types of needle holders

Back 3

Mayo-Hegar and Olsen-Hegar (combination needle holder and scissors)

Front 4

Needle selection is based primarily on what 2 things?

Back 4

1. The characteristics of the tissue being sutured
2. The relative proximity to the surgeon.

Front 5

Two basic types of surgical tissue scissors?

Back 5

1. Mayo scissors - used for cutting or dissecting dense tissue

2. Metzenbaum scissors - used for cutting or dissecting delicate tissue.

Front 6

Blunt dissection separates tissue layers- but why should blunt dissection be performed minimally?

Back 6

It results in the production of dead space. Dead space can lead to postoperative complications and possibly delayed wound healing.

Front 7

A #3 scalpel handle will accept what number blades?

Back 7

number 10, 11, 12, and 15 blades

Front 8

A #4 scalpel handle will accept what number blades?

Back 8

number 20-25 blades

Front 9

The scalpel handle can be held in what three ways?

Back 9

1. The finger-tip position: offers the most accuracy and stability in making long incisions.

2. The pencil position: most accurate for short, delicate maneuvers.

3. The palmed grip: offers power for use with special cutting instruments, such as the periosteal elevator.

Front 10

four motions of the scalpel's cutting edge used in surgery

Back 10

pressing, sliding, sawing, and scraping.

Front 11

Which motion of the scalpel's cutting edge allows for the most accurate method of separating tissue planes?

Back 11

Scraping

Front 12

Which motion of the scalpel's cutting edge allows for continuation of a cut without removing and reinserting the blade?

Back 12

Sawing

Front 13

Which motion of the scalpel's cutting edge is the most common use during surgery?

Back 13

Sliding: give precise depth and direction control.

This is the most common use of the scalpel during surgery (eg, making skin incisions).

Front 14

Which motion of the scalpel's cutting edge is useful in opening fluid-filled chambers?

Back 14

Press cuts (stab incisions) are useful in opening fluid-filled chambers; however, they are poorly controlled in depth.

Front 15

Brown-Adson vs. Dressing forceps

Back 15

Brown-Adson: multiple intermeshing fine teeth that provide a broad tip for secure, yet relatively atraumatic, grasping of tissue.

Dressing forceps: have relatively fine serrations and are designed to grasp surgical sponges.

Front 16

surgical suffix: -ectomy

Back 16

excision or surgical removal of tissue

(eg, ovariohysterectomy).

Front 17

surgical suffix: -orrhaphy

Back 17

surgical repair of by use of suture

(eg, herniorrhaphy)

Front 18

surgical suffix: -oscopy

Back 18

direct visual examination of a structure

(eg, gastroscopy)

Front 19

surgical suffix: -ostomy

Back 19

creation of a new (permanent) opening in a tissue (eg, urethrostomy). Requires that the tissue has an epithelial lining, and the cut edge of the epithelium of the tissue is sutured to the skin.

Front 20

surgical suffix: -otomy

Back 20

cutting or dissection, as in surgically incising tissue and closing the incision

(eg, gastrotomy).

Front 21

surgical suffix: -pexy

Back 21

surgical fixation of a structure by use of suture

(eg, gastropexy).

Front 22

surgical suffix: -plasty

Back 22

plastic repair of

(eg, pyoroplasty).

Front 23

Ablation

Back 23

removal, especially by cutting; separation or detachment; extirpation; eradication

(eg, total ear canal ablation [TECA]).

Front 24

Brachycephalic (obstructive) syndrome

Back 24

any of several upper airway disorders which are prevalent in brachycephalic dogs and lead to increased respiratory effort, noise, and distress. Among the conditions are elongated soft palate, stenotic nares, everted laryngeal saccules, and (possibly) laryngeal collapse.

Front 25

Celiotomy

Back 25

incision into the abdominal cavity

Front 26

Cesarean section (cesarotomy)

Back 26

from the Latin word to cut; delivery of a fetus by incision through the abdominal wall and uterus

Front 27

Débridement

Back 27

the removal of all foreign material and all contaminated and devitalized tissues from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed

Front 28

Dehiscence

Back 28

a splitting open, as in a surgical wound. This term is most commonly used to apply to the abdominal wall layer.

Front 29

Intussusception

Back 29

prolapse of one part of the intestine (intussusceptum) into the lumen of an immediately adjacent part (intussuscipiens), causing partial or complete intestinal obstruction

(eg, ileocecal intussusception)

Front 30

Laparotomy

Back 30

incision through the flank or, more generally, through any part of the abdominal wall.

Front 31

Marsupialization

Back 31

conversion of a closed cavity, such as an abscess or cyst, into an open pouch, by incision it and suturing the edges of its wall to the edges of the wound (eg marsupialization of a prostatic cyst). Such a connection is rarely permanent, because epithelial surfaces do not come in contact.

Front 32

Mucocele

Back 32

dilatation of a space or cavity with accumulated mucous secretion

(eg, cervical salivary mucocele)

Front 33

Onychectomy

Back 33

excision of a claw or nail at the nail bed; declawing procedure

Front 34

Resection

Back 34

excision of a portion of an organ or other structure

(eg, lateral ear resection)

Front 35

En bloc resection

Back 35

refers to a radical resection or amputation.

Front 36

Torsion

Back 36

the state of being twisted

(eg, splenic torsion)

Front 37

Typhlectomy

Back 37

surgical removal (ablation) of the cecum

Front 38

Volvulus

Back 38

rotation (twisting) of a portion of the gastrointestinal tract on its mesenteric axis so as to occlude the lumen

(eg, gastric dilatation/volvulus [GDV])

Front 39

Absorbable vs. Nonabsorbable suture

Back 39

Nonabsorbable: Maintain tensile strength for longer than 60 days after implantation.

Absorbable: Lose tensile strength within 60 days after implantation.

Front 40

Suture: Surgical gut "catgut": Natural Origin?

Back 40

Submucosa of sheep small intestine

Front 41

Suture: Surgical gut "catgut": filaments?

Back 41

Multifilament

Front 42

Suture: Surgical gut "catgut": types available?

Back 42

Two types: Plain (nontreated) and chromic (treated with chromic acid).

Front 43

Suture: Surgical gut "catgut": Tensile strength loss?

Back 43

Variable; more rapid in an infected wound, highly vascularized environment, and when exposed to gastric pepsin.

**Plain surgical gut: essentially 100% loss by 10 days.

** Chromic surgical gut: 60% loss by 28 days and 80% loss by 60 days.

Front 44

Suture: Surgical gut "catgut": Knot security?

Back 44

** Use at least 3 throws.

* Good when dry, fair when wet

* Relative knot security (dry): 63%.

Front 45

Suture: Surgical gut "catgut": Absorption mechanism?

Back 45

* Foreign body reaction

* Inflammatory cells produce acid proteases.

* Phagocytosis

Front 46

Suture: Surgical gut "catgut": Tissue reaction?

Back 46

* Intense inflammatory reaction (most reactive of all suture materials).

* Plain gut is more reactive than chromic gut.

* Tissue reaction is especially intense in cats.

Front 47

Suture: Surgical gut "catgut": Handling characteristics?

Back 47

Good

Front 48

Suture: Polyglactin 910 (Coated Vicryl): Synthetic origin?

Back 48

Glycolic acid to lactic acid ratio of 9:1.

Front 49

Suture: Polyglactin 910 (Coated Vicryl): filaments?

Back 49

Braided, multifilament, noncoated and coated (with calcium stearate) forms are available.

Front 50

Suture: Polyglactin 910 (Coated Vicryl):Tensile strength loss?

Back 50

50% loss by 21 days.
80% loss by 28 days.

* Polyglactin 910 is more quickly absorbed (63 days) from the tissues than PGA suture

Front 51

Suture: Polyglactin 910 (Coated Vicryl):Knot security?

Back 51

** Fair; use multiple throws (4).

Front 52

Suture: Polyglactin 910 (Coated Vicryl):Tissue reaction?

Back 52

Minimal

Front 53

Suture: Polyglactin 910 (Coated Vicryl):Handling characteristics?

Back 53

* Noncoated: Fair.

* Coated: Good.

Front 54

Suture: Polyglactin 910 (Vicryl Rapide): compared to (Coated Vicryl)?

Back 54

* Both are braided and synthetic

* Vicryl Rapide has similar handling, knot security, etc. as Coated Vicryl

* Vicryl Rapide has shorter tensile strength loss: Loses most of tensile strength by 10-14 days.Completely absorbed in 42 days.

Front 55

The first antibacterial suture to protect against bacterial colonization at the suture line?

Back 55

Polyglactin 910 (Coated Vicryl Plus)

Front 56

antibacterial agent found in Polyglactin 910 (Coated Vicryl Plus)?

Back 56

Triclosan is the antibacterial agent and is a broad spectrum agent.

Front 57

Suture: Polydioxanone (PDS): Synthetic origin?

Back 57

Polymer of paradioxanone

Front 58

Suture: Polydioxanone (PDS): filaments?

Back 58

Monofilament

Front 59

Suture: Polydioxanone (PDS):Tensile strength loss?

Back 59

* Slower than for PGA or polyglactin 910 (coated).

* Absorption approaches that of a nonabsorbable.
- 26% loss by 14 days.
- 42% loss by 28 days.
- 86% loss by 56 days.

* Absorption is essentially complete by 6 months.

Front 60

Suture: Polydioxanone (PDS): Knot security?

Back 60

* Similar to PGA and polyglactin 910

* Relative knot security: No figure available.

Front 61

Suture: Polydioxanone (PDS): Tissue reaction?

Back 61

* Minimal

* Similar to PGA and polyglactin 910.

Front 62

Suture: Polydioxanone (PDS): Handling characteristics?

Back 62

* Exhibits greater flexibility than PGA or polyglactin 910.

* Less tissue drag than either PGA or polyglactin 910.

Front 63

Suture: Poliglecaprone 25 (Monocryl): origin?

Back 63

Synthetic origin.

Front 64

Suture: Poliglecaprone 25 (Monocryl):filaments?

Back 64

Monofilament.

Front 65

Suture: Poliglecaprone 25 (Monocryl): Absorption mechanism?

Back 65

Absorption by hydrolysis

Front 66

Suture: Poliglecaprone 25 (Monocryl): tensile strength

Back 66

Strong intitial tensile strength (strongest of all absorbable monofilaments)

* Absorbed faster than polyglactin 910 opolydioxanone.

* 70% loss by day 14; complete by d100

Front 67

Suture: Poliglecaprone 25 (Monocryl): handeling and knot security

Back 67

* More pliable than PDS or Maxon; not good for linea alba (absorbed too fast)

* Good for subQ tissues

* Good knot security

Front 68

4 absorbable suture types commonly used at Small Animal Clinic of the TAMU Veterinary Teaching Hospital

Back 68

* Surgical gut
* Polyglactin 910
* Polydioxanone
* Poliglecaprone 25

Front 69

What type of suture tends to be more reactive?

Back 69

Sutures of natural origin tend to be more reactive

ex: surgical gut, collagen, silk, cotton

Front 70

5 nonabsorbable suture types commonly used at Small Animal Clinic of the TAMU Veterinary Teaching Hospital

Back 70

1. Silk
2. Nylon
3. Polymerized caprolactam
4. Polypropylene
5. Stainless steel

Front 71

Suture: Silk: Natural origin?

Back 71

Obtained from the cocoon of the silkworm

Front 72

Suture: Silk: filaments?

Back 72

Multifilament: May be coated with teflon, oil, wax, or silicone

Front 73

Suture: Silk: Tensile strength?

Back 73

Gradual loss occurs.
- 30% loss after 14 days.
- 80% loss after 3 months.
- By 1 year minimal strength remains.

Front 74

Suture: Silk: Knot security?

Back 74

Knot security: Fair.

* Relative knot security: 57%.

Front 75

Suture: Silk: Tissue reaction?

Back 75

* Moderate cellular reaction (produces the greatest cellular reaction of the nonabsorbable suture materials).


* This reaction is clinically important in areas near the surface of the body, in contaminated areas, in the lumen of the gastrointestinal tract, and in the lumen of the urinary bladder. Can serve as a nidus for calculus formation in the lumen of the urinary bladder or gallbladder.

Front 76

Suture: Silk: Handling characteristics?

Back 76

ideal

Front 77

Suture: Nylon: Synthetic origin?

Back 77

1, 6 hexanediamine + adipic acid =polyhexamethylene adipamide

Front 78

Suture: Nylon: filaments?

Back 78

Monofilament and multifilament types are available

Front 79

Suture: Nylon: Tensile strength loss?

Back 79

* Monofilament: Minimal loss by 2 years.

* Multifilament: Essentially complete loss by 6 months.

Front 80

Suture: Nylon:Knot security?

Back 80

Poor - use 4-5 throws; possesses "memory".

* Knots are bulky and time consuming.


Relative knot security: 66%.

Front 81

Suture: Nylon: Tissue reaction?

Back 81

Minimal

Front 82

Suture: Nylon:Handling characteristics?

Back 82

Monofilament - fair


Multifilament - moderate.

Front 83

Suture: Polymerized Caprolactum (Vetafil, supramid): Origin?

Back 83

Synthetic origin: A polyamide suture of the nylon family.

Front 84

Suture: Polymerized Caprolactum (Vetafil, supramid): filaments?

Back 84

multifilament

Front 85

Suture: Polymerized Caprolactum (Vetafil, supramid): tensile strength?

Back 85

extremely strong tensile strength

Front 86

Suture: Polymerized Caprolactum (Vetafil, supramid): Knot security

Back 86

Moderate - use 3-4 throws.

Front 87

Suture: Polymerized Caprolactum (Vetafil, supramid):Tissue reaction?

Back 87

Very reactive

NOT for use below the surface of the skin

Front 88

Suture: Polymerized Caprolactum (Vetafil, supramid):Handling characteristics?

Back 88

Good

Front 89

Suture: Polypropylene (Prolene, Surgilene): Origin?

Back 89

Synthetic origin: Polymer of prolene (a derivative of propane gas).

Front 90

Suture: Polypropylene (Prolene, Surgilene): filaments?

Back 90

Monofilament.

Front 91

Suture: Polypropylene (Prolene, Surgilene): Tensile strength loss?

Back 91

None (prolonged retention of strength).

Front 92

Suture: Polypropylene (Prolene, Surgilene): Knot security?

Back 92

Excellent if tied correctly; has a "locking action" if knots are set firmly.

Relative knot security: 89%.

Front 93

Suture: Polypropylene (Prolene, Surgilene): Tissue reaction?

Back 93

* Least reactive.

* Least potentiating effect in converting a contaminated wound into an infected wound.

Front 94

Suture: Polypropylene (Prolene, Surgilene): Handling characteristics?

Back 94

Moderate; somewhat slippery in handling and tying.

Front 95

Suture: Stainless steel: origin?

Back 95

Metallic origin.

Front 96

Suture: Stainless steel: filaments?

Back 96

Monofilament and multifilament forms are available

Front 97

Suture: Stainless steel: tensile strength?

Back 97

Has the highest tensile strength of all suture materials.

Front 98

Suture: Stainless steel: Knot security?

Back 98

Absolute

Relative knot security: 92%.

Front 99

Suture: Stainless steel: Tissue reaction?

Back 99

* Least reactive. Causes virtually no inflammatory reaction on implantation, except for that caused by irritation from the inflexible ends.

* Its physical characteristics favor some cutting of the tissue.

Front 100

Suture: Stainless steel: Handling characteristics?

Back 100

Multifilament - fair.
Monofilament - poor

* Handling difficulties are overcome with experience.

Front 101

3 sutures with the strongest tensile strength

Back 101

stainless steel, polyester, polymerized caprolactum

Front 102

3 sutures with the weakest tensile strength

Back 102

(natural origin): silk, cotton, surgical gut

Front 103

4 sutures with the strongest knot security

Back 103

Stainless steel > polypropylene, polybutester, polymerized caprolactum

Front 104

4 sutures with the weakest knot security

Back 104

surgical gut, noncoated polyester, silk, coated polyester

Front 105

7 monofilament suture types

Back 105

1. polydioxanone
2. polyglyconate
3. poliglecaprone 25
4. Ethilon (Nylon)
5. polypropylene
6. stainless steel
7. polybutester

• Monofilament strands are better for contaminated environment

Front 106

9 multifilament suture types

Back 106

1. Surgical gut
2. Polyglycolic acid
3. Polyglactin 910
4. Collagen
5. Silk
6. Cotton
7. Surgilon (Nylon)
8. Polymerized caprolactum
9. Polyester

Front 107

6 principles of suture material selection

Back 107

1. Sutures should be at least as strong as normal tissue through which they are placed.

2. A suture is not needed after a wound has healed

3. The relative rates that a suture loses strength and the wound gains strength are important.

4. If the suture biologically alters the healing process, these changes must be understood.

5. A proper assessment of the local wound conditions must be made.

6. The mechanical properties of the suture should closely match those of the tissue to be closed.

Front 108

3 things to remember when picking suture for a contaminated or infected wound

Back 108

1. Want to minimize the number of sutures placed

2. Want to use as small of suture as possible

3. Monofilament sutures are better for withstanding contamination

Front 109

When do wounds gain strength postoperatively?

Back 109

Wounds do not gain strength until 4-6 days postoperatively

Front 110

How do visceral wounds heal?
When is their maximal strength gained?

Back 110

* Visceral wounds heal rapidly.

* Maximal strength is gained within 14-21 days.

Front 111

Suture type for visceral wounds

Back 111

Absorbable suture materials are generally used

Front 112

How do fascia wounds heal?
What type of suture material should be used?

Back 112

* Fascia wounds heal very slowly.

* Absorbable suture materials are commonly used in veterinary surgery

Front 113

How does skin heal? What type of suture is indicated?

Back 113

* Skin wounds heal slowly.

* A nonabsorbable suture is indicated.
* A noncapillary suture is indicated.

Front 114

The size of most suture materials is reported in what two measurements?

Back 114

United States Pharmacopeia (U.S.P.) size and metric measures

Front 115

Monofilament stainless steel has what additional measuring system?

Back 115

Brown and Sharpe (B&S) gauge.

Front 116

suture material with highest tensile strength

Back 116

stainless steel

Front 117

suture material with lowest tensile strength

Back 117

Surgical gut

Front 118

The weakest point of a suture line is where?

Back 118

usually the knot

Front 119

suture material with highest relative knot security

Back 119

stainless steel

Front 120

suture material with lowest relative knot security

Back 120

Polyester-coated

Front 121

5 characteristics which differentiate surgical needles

Back 121

1. Type of point
2. How suture is attached
3. Curvature
4. Length
5. Diameter

Front 122

2 type of points of surgical needles

Back 122

1. Taper point (non-cutting)
2. Cutting Edge

Front 123

What is a Taper point (non-cutting) needle used for?

Back 123

Used for internal closure (used for most tissues except skin).

** makes a circular defect when passed through the tissues.

Front 124

What is a Cutting edge needle used for?

Back 124

Used for dense structures (eg: skin, fascia).

Front 125

3 types of Cutting edge needles

Back 125

1. Regular cutting edge.
2. Reverse cutting edge
3. Tapered cutting edge

Front 126

Regular cutting edge needle

Back 126

* Cutting edge is on the inside of the needle.

* Not routinely recommended, as the suture will tend to cut out of the tissue.

Front 127

Reverse cutting edge needle

Back 127

* Cutting edge is on the outside of the needle.

* Suture is less likely to cut out of the tissue when this needle type is used.

Front 128

Tapered cutting edge needle

Back 128

AKA: "K" needle - Deknatel, Inc.

* Has advantages of both taper point needle (makes a circular defect) and cutting edge needle (easily passed through dense tissues


* Somewhat more expensive than the needle types listed above.

Front 129

2 ways Suture is Attached to needles

Back 129

1. Swaged-on needle
2. Nonswaged-on needle

Front 130

Advanatages of a Swaged-on needle

Back 130

* Used for delicate suture work.

* Less traumatic to use than nonswaged-on needles, since the needle size and suture size are closely matched.

Front 131

disadvanatage of a Swaged-on needle

Back 131

More expensive to use than suture without a needle.

Front 132

Disadvantage of Nonswaged-on needle

Back 132

More traumatic because the size of the needle is larger than the diameter of the suture material.

Front 133

5 curvature types of surgical needle shafts

Back 133

a. Straight
b. 1/4 circle
c. 3/8 circle
d. 1/2 circle
e. 5/8 circle

Front 134

Needle length

Back 134

the length of the needle as measured along its arc, or curve.

Front 135

Needle chord length

Back 135

the straight line distance measured between the point and the end of a curved needle.

Front 136

The suture pattern most frequently used

Back 136

Simple interrupted (appositional)

Front 137

# of tissue penetration points for Simple interrupted

Back 137

2

Front 138

5 Mattress patterns

Back 138

1. Horizontal mattress (everting)
2. Vertical mattress (appositional)
3. Cruciate (cross mattress) (appositional)
4. Lembert (similar to a vertical mattress) (inverting)
5. Halstead (similar to a horizontal mattress)

Front 139

# of tissue penetration points for mattress patterns

Back 139

at least four tissue penetration points

Front 140

asepsis

Back 140

The absence of pathogenic microbes in living tissue.

Front 141

sterilization

Back 141

The process of killing all microorganisms with the use of either physical or chemical agents.

Front 142

antiseptic

Back 142

A chemical agent that either kills pathogenic microorganisms or inhibits their growth as long as there is contact between the agent and microbe. This term is reserved for agents applied to the body.

Front 143

disinfectant

Back 143

A germicidal, chemical substance that kills microorganisms on inanimate objects, such as instruments and other equipment, that cannot be exposed to heat.

Front 144

antimicrobial agents

Back 144

Drugs used to alter the activity of microbial agents in the patient.

May be bacteriostatic (inhibits microbial growth; growth may resume upon removal of the agent) or bactericidal (kills the microorganisms).

Front 145

clean operations

Back 145

Nontraumatic wounds without inflammation or breaks in surgical technique. The respiratory, alimentary, and genitourinary tracts are not entered

(e.g. ovariohysterectomy, hip prosthesis)

Front 146

clean-contaminated operations

Back 146

The gastrointestinal or respiratory tracts are entered without significant spillage or the oropharynx, genitourinary tract, or biliary tract are entered in the absence of obvious infection. There may be a minor break in aseptic technique.

(e.g. enter-otomy, gastrotomy, pulmonary resection)

Front 147

contaminated operations

Back 147

There is a major break in sterile technique, gross spillage from the intestinal tract, or the genitourinary tract or biliary tract are entered in the presence of infected urine or bile. Fresh, traumatic wounds are generally considered to be contaminated (e.g. oral or anal surgical procedures).

Front 148

dirty operations

Back 148

There is acute bacterial inflammation encountered, or clean tissues are transected for the purpose of surgical access to a collection of purulent material. A traumatic wound with retained devitalized tissue, foreign bodies, fecal contamination, and/or
44
delayed treatment, or from dirty source (e.g. external trauma or perforation of a viscus such as from a gunshot injury to the abdomen).

Front 149

The most common source of bacteria that contaminate surgical wounds?

Back 149

the animal's endogenous microbial flora

Front 150

The most common vehicle for delivering bacteria to the wound?

Back 150

Air in contact with the surgical wound is the most common vehicle for delivering bacteria to the wound

Front 151

Dietary restrictions prior to small animal surgery

Back 151

* Food intake is generally restricted 6 to 12 hours prior to anesthesia to ensure an empty stomach

* Access to water is generally not curtailed.

* Operations of the large intestine often require specialized preparations such as extended dietary restriction (48 hours) or enteric antibiotics such as oral kanamycin, neomycin, or penicillin G.

Front 152

general guidelines for clipping hair when preping for surgery

Back 152

* Clip at least 20 cm on each side of the incision

* Removal of hair the night before surgery is associated with a significantly higher superficial skin infection rate than removing the hair immediately prior to surgery.

Front 153

3 purposes of the preoperative skin preparation

Back 153

1) remove soil and transient microorganisms from skin

2) reduce the resident microbial count to sub-pathogenic levels in a short period of time and with the least amount of tissue irritation

3) to inhibit rapid rebound growth of microorganisms.