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227 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Name some characteristics of an ideal suture material.
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Easy to handle
Inexpensive Easy to sterilize Good knot security Non allergenic Inhibits bacterial growth Etc |
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What does it mean for a suture material to be absorbable?
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Rapid loss of tensile strength (< 60 days)
Phagocytosis by macs and enzymatic hydrolysis May remain for > 60 days but it has no tensile strength |
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If a suture material has rapid loss of tensile strength (< 60 days), it is said to be:
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Absorbable
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Absorbable sutures are degraded by what two processes?
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Phagocytosis by macs
Enzymatic hydrolysis |
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What does it mean for a suture to be non-absorbable?
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Retains almost all tensile strength for > 60 days
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Which has the most unpredictable tensile strength loss, natural or synthetic suture material?
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Natural
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Why was synthetic suture material made?
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Introduced to increase predictability of tensile strength loss
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Which has memory - natural or synthetic suture material?
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Synthetic
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What are the disadvantages of multifilament suture materials?
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Can be a nidus for bacterial growth
Fluids wicking into suture can transport bacteria |
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Which is non-capillary, monofilament or multifilament suture materials?
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Monofilament
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Why are multifilament suture materials coated?
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Improve handling characteristics
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Is surgical gut (cat gut) natural or synthetic?
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Natural - Made from submucosa of sheep or serosa of bovine intestine
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Is cat gut absorbable or not?
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YES
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Is cat gut multifilament or monofilament?
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Multifilament
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What are the four types of suture materials that are non-absorbable?
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Silk
Nylon (Dermalon) Polypropylene (Prolene, Surgilene) Braunamid |
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What are the only two natural suture materials?
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Cat gut
Silk |
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What are the only two suture materials degraded by phagocytosis?
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Cat gut
Silk The two that are natural!!!! |
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Which can cause a severe foreign body reaction, cat gut or vicryl?
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Cat gut
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Why are some types of cat gut (chromic gut) coated with chromium salts?
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Decrease tissue reaction
Increase tensile strength Increase resistance to degredation |
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True/false: cat gut has good knot security when wet.
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False - only when dry
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True/false: cat gut has minimal capillary action, eventhough it is a multifilament suture material.
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True
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Name some disadvantages of cat gut.
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Reactive
Poor knot security when wet Irritation from packaging liquids Infected wounds increases loss of tensile strength |
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Vicryl is AKA:
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Polyglactin 910
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Polyglactin 910 is AKA:
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Vicryl
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Is Vicryl multifilament or monofilament?
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Multifilament
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Is Vicryl absorbable?
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Yes
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How is Vicryl degraded?
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Hydrolysis
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What would cause the tensile strength of vicryl to decrease?
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Alkaline environments
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What is Vicryl coated with?
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Calcium stearate
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Which is more reactive, Vicryl or cat gut?
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Cat gut
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Which is stable in contaminated wounds - Vicryl or cat gut?
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Vicryl
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What are some disadvantages of Vicryl?
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Tissue drag
Can serve as a nidus for urinary calculi Rapidly degraded in infected urine Rapidly hydrolyzed in alkaline environments |
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Dexon is similar to what other suture material? In what ways?
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Vicryl
Similar tensile strength Rapidly degraded in infected urine and alkaline environments |
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What is so cool about Vicryl rapide?
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50% loss of tensile strength in 5 days
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Polyglycolic acid is AKA:
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Dexon
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Dexon is AKA:
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Polyglycolic acid
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Is Dexon multi or mono filament suture? Absorbable? Natural or synthetic?
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Synthetic
Absorbable Multifilament |
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By which process is Dexon degraded?
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Hydrolysis
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Poliglecaprone is AKA:
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Monocryl
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Monocryl is AKA:
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Poliglecaprone
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True/false: Monocryl is monofilament.
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True
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What is the most pliable suture material?
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Monocryl
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True/false: monocryl has little memory.
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True
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I have an infected wound. Should I use monocryl or cat gut?
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Monocryl; tensile strength for the other is lost more rapidly in infected wounds
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The only disadvantage to using monocryl:
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Its EXPENSIVE
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Polydiaxanone is AKA:
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PDS
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PDS is AKA:
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Polydiaxanone
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True/false: Monocryl and PDS are both monofilament suture materials.
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True
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How is PDS degraded by the body?
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Hydrolysis
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For PDS, absorption is complete by ____ days.
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182
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I want to suture a contaminated/infected wound. Which do I want to use, Monocryl or PDS?
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Either is fine!!
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The disadvantages of PDS:
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Tendancy to kink
EXPENSIVE Clear product - difficult to see |
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Which five of the suture materials listed are multifilament?
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Cat gut
Vicryl Dexon Silk Braunamid |
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Maxon has similar characteristics to what other suture material?
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PDS
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Is silk absorbable?
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NO
Neither are Dermalon, Polypropylene or Braunamid |
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True/false: Silk has good initial tensile strength.
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True
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How long does it take sillk to have 100% tensile strength loss?
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2 years
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How is silk degraded?
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Phagocytosis
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Which two types of suture material are not the best to use in wet environments?
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Cat gut
Silk |
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What are the disadvantages of using silk as a suture material?
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Moderate tissue reaction and capillarity
Potentiate infection Poor to fair knot security Loses tensile strength when wet |
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Nylon is AKA:
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Dermalon
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Dermalon is AKA:
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Nylon
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Does Nylon (Dermalon) have memory?
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YES
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Why does Nylon have poor knot security?
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Because it has a low coefficient of friction
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True/false: PDS is minimally reactive and biologically inert.
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False, this is describing Nylon
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What are the disadvantages of Nylon?
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Poor knot security
Poor handling Memory Suture ends can cause irritation |
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Is polypropylene absorbable?
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No
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What is the least thrombogenic suture material?
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Polypropylene (Prolene/Surgilene)
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Does polypropylene have memory?
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YES
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Dermalon and Polypropylene are both inert. What does this mean for us?
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Very minimal tissue reaction
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Which has better knot security, Polypropylene or Nylon?
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Polypropylene
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Name four suture materials taht are good in contaminated wounds:
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Vicryl
Monocryl PDS Polypropylene |
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Name two suture materials that are difficult to handle due to their slippery nature.
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Nylon
Polypropylene |
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Which suture material should you never bury?
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Braunamid
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Which suture material is not sterile?
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Braunamid
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True/false: Braunamid has very little tissue reaction.
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False - it is extremely reactive
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Put in order of smallest to largest: 0, 5/0, 2, 10/0, 5, 1/0
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10/0, 5/0, 1/0, 0, 2, 5
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What is the most common method to size suture material?
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USP
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What are the three methods to size suture?
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USP
Metric Gauge |
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Cyanoacrylic adhesives are only applied to:
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Skin
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Name some advantages of cyanoacrylate adhesives.
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Easy to use
Rapid polymerization Strong bond Non toxic Good tissue apposition |
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Name some disadvantages of cyanoacrylate adhesives.
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Slow biodegredation
Potential foreign body reaction Poor adhesive action in wet tissue Contaminated or infected wounds |
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A swaged needle is AKA:
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Eyeless
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Which is less traumatic, a swaged needle or eyed needle?
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Swaged
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When suture is directly attached to the needle, this is AKA:
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Swaged
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The most useful type of needle:
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1/2 circle needle
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What are the two disadvantages of an eyed needle?
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Dull
Tissue trauma |
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What types of tissues would I want to use a tapered needle point on?
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Viscera
Muscle Subcutis |
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I would want to use a cutting needle point on what type of tissue?
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Skin
Intradermal Subcuticular |
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What are the two basic suture patterns?
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Continuous
Interrupted |
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How close to the wound edge do you want to take your bite?
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4 mm
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What does it mean to be a continuous suture?
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Knots at the beginning and end of a running line of continuous identical sutures
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When each stitch is cut and tied, this is a ________ suture pattern.
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Interrupted
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Why should knots be offset from the wound?
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Knots cause irritation because that is the greatest mass of suture material
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What are the advantages of simple interrupted
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More knots along the suture line means that if a knot fails you won't get dehiscence
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Which suture pattern uses more throws for each knot - a simple interrupted or a continuous pattern?
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Continuous - b/c you only have two knots. Use 6-7 throws as opposed to 4
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What are the disadvantages of a simple interrupted suture pattern?
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More suture material is used - this means more suture material is present for irritation
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Which has slightly better tissue apposition, simple interrupted or simple continuous?
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Continuous
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Which are you able to place more quickly, a simple interrupted or a simple continuous pattern?
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Continuous
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When you turn tissue edges outward, this is an _________ pattern.
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Everting
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When you turn tissue edges inward, this is an _______ pattern.
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Inverting
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What is an apposing tissue pattern?
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Tissue edges are in direct apposition
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Most common pattern used for skin closure:
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Simple interrupted
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Which is more tedious - a simple interrupted or a simple continuous?
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Simple interrupted
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Which tends to evert more, a horizontal mattress or a vertical mattress pattern?
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Horizontal mattress
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Which tends to evert more, a horizontal mattress or a vertical mattress pattern?
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Horizontal mattress
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True/false: both horizontal mattress and vertical mattress patterns relieve tension.
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True
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True/false: both horizontal mattress and vertical mattress patterns relieve tension.
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True
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Why do you have to be careful to not tie horizontal mattress knots too tight?
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B/c this pattern reduces blood supply to the superficial capillaries - the area may heal but the skin will all slough off.
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Why do you have to be careful to not tie horizontal mattress knots too tight?
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B/c this pattern reduces blood supply to the superficial capillaries - the area may heal but the skin will all slough off.
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Which takes more time - simple interrupted or cruciate?
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Simple interrupted
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Which takes more time - simple interrupted or cruciate?
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Simple interrupted
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Which uses more suture material - cruciate or simple interrupted?
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Simple interrupted
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Which uses more suture material - cruciate or simple interrupted?
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Simple interrupted
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True/false: Cruciate pattern is NOT good for tissue under tension.
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False - it is good for that
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Ford interlocking is mainly used in large or small animals?
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Large
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Ford interlocking and the mattress patterns are mainly used in large or small animals?
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Large
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True/false: ford interlocking is difficult to remove.
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True
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Do skin staples invert or evert skin?
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Evert it
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Why are skin staples difficult to use in cats?
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B/c their skin is so thin
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Where are bites taken for intradermal suture pattern?
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Lower portion of dermis
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Name some suture patterns used for intradermal closure:
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Continuous vertical mattress
Continuous horizontal mattress Simple interrupted |
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Describe how you would bury a knot.
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Bite deep to superficial on the near side
Bite superficial to deep on the far side Both strands should be on the same side Tie knot parallel to wound |
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Which provides less tension when suturing muscle, a simple continuous or a simple interrupted?
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Simple continuous
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When suturing muscle, what do you suture?
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The fascia
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What suture pattern would you use to close the linea alba (external rectus sheath)?
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Simple interrupted
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What suture pattern would I use to close a wound in the stomach or bladder?
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Cushing pattern (inverting continuous horizontal mattress)
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Does a cushing pattern penetrate the lumen of an organ being repaired?
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No, extends only to the submucosa
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Describe the difference between a Cushing and a Lembert pattern.
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Cushing - bites taken parallel
Lembert - bites perpendicular |
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When would you use a simple interrupted appositional pattern?
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Intestinal surgery
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Why shouldn't you use an inverting pattern on the intestines?
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Because it compromises the lumen - thats why you use the simple interrupted appositional pattern instead
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Why is hemostasis so important in surgery?
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Blood obscures the surgical field
Ideal bacterial growth medium Decreases antimicrobial activity Prevents coaptation of wound edges Hypovolemia |
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When does primary hemorrhage occur?
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Immediately following traumatic vessel injury
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Describe delayed hemorrhage.
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Occurs 24 hrs following surgery
Incorrect vessel ligation Necrosis of vessel following ligation Intraoperative hypotension |
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You have a small bleeder. How should you stop the hemorrhage?
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Gentle compression
Use gauze sponges and blot - don't wipe |
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Most commonly used hemostatic forceps:
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Halstead mosquito
Rochester-Carmalts |
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You have a small bleeder and you want to use the mosquito forceps to stop the hemorrhage. Describe how you would do this.
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Point tip of the hemostat towards the vessel
Instrument should be perpendicular to vessel Use the tip of the instrument Grasp smallest amount of tissue possible |
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For larger isolated vessels and vascular pedicles, which forcep would I use, mosquitos or Carmalts?
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Carmalt
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The concave portion of Carmalts should face which direction?
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Towards the transected end
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Name two topical hemostatic agents that you can use to stop hemorrhage.
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Gelfoam (gelatin that swells and forms a clot)
Surgicel (regenerated oxidized cellulose - get a pH change) |
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What is bone wax used for?
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Placed on cut bone surface as a hemostatic agent; e.g. like for a mandibulectomy
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What are some of Halstead's tissue handling principles?
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Minimal surgical trauma
Accurate hemostasis Preservation of adequate blood supply Asceptic surgical technique No tension on tissues Careful tissue approximation Obliteration of dead space |
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What is used to load the scalpel blade?
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Needle holders
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What are the three scalpel grips?
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Pencil
Fingertip Palm |
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Which scalpel grip has minimal cutting edge contact?
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Pencil grip
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How do you steady your hand when holding the scalpel in a pencil grip fashion?
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By resting it on the patient
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Which scalpel grip allows for maximum length of blade edge to be in contact with the cutting surface?
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Fingertip grip
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True/false: The fingertip scalpel grip allows for less variation in incisional depth.
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True
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Describe how you can prevent a jagged incision.
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Incise skin completely on the first pass
Apply lateral and longitudinal tension to the skin Blade should be perpendicular to the skin |
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What are the three general types of scissors in a small animal pack?
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Metzenbaums
Mayo Blunt sharps |
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Which type of scissors would I use for soft tissue dissection?
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Metzenbaum
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Which type of scissors would I use for dense CT, like linea or fascia?
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Mayo
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Which scissors do I use to cut suture?
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Blunt-sharps (operating scissors)
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When using scissors, the majority of motion for cutting comes from which finger?
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Thumb
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What is the only acceptable grip for tissue forceps?
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Pencil grip
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When you are not using the instrument, what do you do with tissue forceps?
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Palm the instrument
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What is the best position to grasp a needle with needle holders?
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At the midpoint - less risk of bending the needle
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What are the two forces used when biting with the needle?
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Driving force
Rotational force |
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When suturing, should you start with the far or near side of the incision?
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Far side
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Four throws makes what type of knot?
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Square knot
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True/false: towel clamps are non-traumatic.
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True
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How much drape and skin do you engage in a towel clamp?
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Minimal amount of drape; minimal amount of skin
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Specific name of our towel clamps:
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Backhaus
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Definition of a surgical site infection:
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Any infection that occurs at the site of surgery within 30 days of the procedure
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Absence of pathogenic microbes or infection in living tissue =
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Asepsis
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Methods and practices that prevent cross contamination in surgery =
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Aseptic techniques
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What are the three main parts to aseptic technique?
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Prevent contamination
Isolate operating site Create sterile field |
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How do we isolate the operating field?
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Via surgical draping
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What is sterilization?
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Absolute destruction of all living organisms
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What is killed by sterilization?
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All bacteria/spores
Fungi Some viruses |
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What are the two general methods of sterilization?
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Physical
Chemical |
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True/false: Sterilization is for inanimate objects; the patient cannot be sterilized.
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True
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Why must surgical instruments be cleaned thoroughly after surgery prior to autoclaving?
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Because organic material can shield organisms from the sterilization process
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What are the three general types of physical sterilization?
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Heat
Filter Radiation |
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What is filtration sterilization used for?
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Liquids or gases
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Radiation sterilization is used for what?
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Suture material
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What is the most reliable form of physical sterilization?
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Heat
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Why don't we use radiation sterilization?
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It is very expensive; only major companies use it when they produce materials
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The relative humidity during wet heat sterilization is what?
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100%
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Describe the type of sterilization done by an autoclave.
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Wet heat sterilization
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How does wet heat sterilization kill bacteria?
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Destruction of bacterial cellular protoplasm - via denaturation of proteins
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Which works better, wet heat or dry heat?
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Wet heat
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Which is a faster process, wet heat sterilization or dry heat?
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Wet heat
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How does pressure affect the temperature of steam?
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Increases it
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What are the two components to steam (wet heat) sterilization?
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Heated steam
Pressure |
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Flash autoclaving is done at what temperature?
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270 degrees F
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Describe a situation when you would use flash autoclaving:
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If you drop a scalpel handle on the floor during surgery and it is the only one you have - flash autoclave is used for such emergencies
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What can be flash autoclaved?
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Metal objects; not packs
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When you flash autoclave something, how long is the timer set for?
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3 mins
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Why are physical sterility indicators on an autoclave misleading?
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It doesn't tell you if something is sterile, it just indicates that the machine made it to a specific temperature, pressure and time
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Autoclave tape is considered what type of sterility indicator?
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Chemical indicator
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What exactly does autoclave tape tell you when it has changed color?
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That the autoclave made it to a certain temperature
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podium/кафедра
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壇
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Слёт раввинов (ВЫСОКИЕ ШЛЯПЫ), говорят одно и то же РАЗ ЗА РАЗОМ. С самого РАССВЕТА. О чем же они говорят с этой КАФЕДРЫ? О Святой ЗЕМЛЕ естесственно.
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What are the three types of sterility indicators?
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Physical (machine)
Chemical (tape) Biological |
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What is the only type of sterility indicator to truly indicate sterility?
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Biological
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Most reliable sterility indicator:
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Biological
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Following sterilization, how long are biological indicator vials incubated?
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24-48 hrs; then checked for turbidity
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3 things used as wrapping material for autoclaves:
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Muslin fabric
Paper Plastic tubing |
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Describe how to load an autoclave.
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Put larger packs on periphery where steam enters; put packs on side rather than lying flat
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How long is a pack sterile?
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As long as it is not wet or damaged, technically forever
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Ethylene oxide is used for what type of sterilization?
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Chemical
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Why might you use chemical sterilizaiton?
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Used for objects that cannot be steam sterilized; camera equipment, plastics, etc.
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What is the MOA for ethylene oxide?
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Alkylination
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Why do you have to allow time for aeration if you have sterilized something with ethylene oxide?
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It has an unpleasant odor; it is also toxic and irritating to skin and mucus membranes
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How long would you let a non-implantable object aerate after being treated (sterilized) w/ EO?
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6 hrs
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How long would you let implantable material aerate after being sterilized w/ EO?
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48 hrs
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What can you add EO to speed up the process of sterilization?
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Heat and moisture
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Chemical agents that are used for destruction of pathogenic organisms on inanimate objects:
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Disinfectants
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True/false: Disinfectants destroy the vegetative form of bacteria but not necessarily spores.
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True
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Name a few disinfectants:
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Ethyl alcohol
Isopropyl alcohol |
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What is the MOA of disinfectants?
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Denatures proteins
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The total cidal activity for disinfectants =
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10 mins
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Are antiseptics used on inanimate or animate objects?
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Animate
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Where might you use an antiseptic?
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Skin or wound
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What is the weakest link of aseptic technique? How can you help this?
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Surgeon's hands
Antiseptics |
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Characteristics of a good antiseptic:
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Antimicrobial activity
Non-irritating Nontoxic Retains antimicrobial properties in vivo |
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What are the two populations of bacteria on our skin?
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Transient
Resident |
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Which has a rapid turnover, transient bacteria or resident?
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Transientq
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True/false: resident bacteria on your hands can be removed by washing
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True, but not completely removed
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Why is it easier to remove bacteria from mucus membranes than it is from skin?
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Because there are no hair follicles
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Are soaps weak or strong antiseptics?
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Weak
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Which has a greater residual antiseptic effect, iodine or alcohol?
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Iodine
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What are some disadvantages of iodophores (povidone iodine)?
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Decreased effectiveness in organic material
Dermal irritation Unreliable residual activity Toxicity |
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How does chlorhexidine work?
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Alters cell wall permeability
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Which has great residual activity, chlorhexidine or iodine?
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Chlorhexi
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Which does not have activity reduced by organic matter, iodine or chlorhexi?
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Chlorhexi
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You have a wound that is almost completely granulated in and you want to use chlorhexi. Should you?
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No, b/c of potential inhibition of contraction and epithelialization
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