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1. Basic Surgical Techniques Flashcards

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1
Q

What is the definition of sterilisation

A

Elimination of all pathogens, including spores

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2
Q

What is the definition of disinfection

A

Removal of microorganisms, sometimes doesn’t include the spores

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3
Q

What is the definition of disinfectant

A

Agent that will destroy microorganisms

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4
Q

What is the theatre cleaning routine

A

Morning damp dusting - first thing
Between cases - disinfect
At the end of the day - damp dust everything and disinfect
Once a week - Deep clean, swabs taken, hard to reach places

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5
Q

Pre-op prep of the patient

A

Some form of starvation - can have water
Owner should bathe them before bringing it
Clipping - prior to induction/once induced
Specific surgical prep - e.g. enema if doing lower GIT surgery

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6
Q

What are the 3 theatre styles

A

First opinion
Referral
Charity

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7
Q

What are the 3 surgical scrub solution options for the patient?

A

Chlorhexidine
Povidone iodine
Isopropyl alcohol

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8
Q

What concentration and contact time is requires for Chlorhexidine and Povidone iodine

A

Chlorhexidine - 2% solution for 5 mins
Povidone iodine - 7.5% for 3 mins - good for patients with chlorhexidine sensitivity

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9
Q

Different strengths of scrubbing solutions for oral and ocular cleaning

A

Oral - 0.1% chlorhexidine
Ocular - 0.2% povodine iodine

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10
Q

What are the 4 types of draping a patient?

A
  1. Plain 4 corner drape
  2. Draping a limb
  3. Fenestrated drape
  4. Adhesive barrier drape
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11
Q

Definition of a bacterial infection

A

Bacterial infection is defined as having more than 10^5 bacteria per gram of tissue

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12
Q

What is a surgical site infection (SSI), and what are the subtypes?

A

Infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure
Incisional infection - superficial or deep
Organ/space infection

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13
Q

What are the 4 classifications of surgical wounds

A
  1. clean
  2. clean-contaminated
  3. contaminated
  4. dirty
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14
Q

Describe a ‘clean’ surgical wound and provide 3 examples

A

Non-traumatic, non-inflamed operative wound
Respiratory, GI, genitourinary and oro-pharyngeal tracts are NOT entered
Examples - ex lap, elective neuter, total hip replacement

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15
Q

Describe a ‘clean-contaminated’ surgical wound and provide 3 examples

A

Operative wound
Respiratory, GI, genitourinary tracts ARE entered but under controlled conditions
OR an otherwise clean wound with a drain placed
Examples - bronchoscopy, cholecystectomy, enterotomy

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16
Q

Describe a ‘contaminated’ surgical wound and provide 2 examples

A

Open, fresh or accidental wounds
Procedures where GI contents or infected urine is spilled
A major break in aseptic technique
Examples - cystotomy with spillage of infected urine, open cardiac massage for CPR

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17
Q

Describe a ‘dirty’ surgical wound and provide 3 examples

A

Old, traumatic wounds with purulent discharge, devitalised tissue or foreign bodies
Procedure where a viscus (viscera) is perforated or faecal contamination occurs
Examples - excision or draining of an abscess, bullae osteotomy for otitis media, perforated intestinal tract

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18
Q

6 host factors that can impact infections

A
  1. Age
  2. physical condition
  3. nutritional status
  4. diagnostic procedures - e.g. catheter
  5. concurrent metabolic disorders e.g. HAC
  6. Current medications e.g. corticosteroids, chemotherapy
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19
Q

what 3 things impact successful outcomes with no infections

A

Patient prep
Surgeon prep
Theatre behaviour

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20
Q

In what 5 surgical situations would you use antibiotics

A

Surgery >90 mins
Contaminated or dirty wound classification
Prosthesis implantation
Patients with pre-existing prosthesis undergoing certain procedures
Severly infected or traumatised wounds

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21
Q

Name 3 antibiotics that could be used during small animal surgery, and name which type of bacteria they are good against

A

Cefuroxime - 2nd gen. ceflosporin, broad-spectrum, good for gram +ve
Amoxicillin/clavulanate - broad spectrum, good for gram +ve, okay for anaerobic
Metronidazole - good for anaerobic e.g. large intestine surgery

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22
Q

Name 3 antibiotics which could be used in equine surgery

A

Procaine penicillin - IV
Gentamicin - IV
Oxytetracycline - NOT IV

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23
Q

Characteristics of an ideal suture

A

Easy to tie a secure knot
High tensile strength
Inhibit tissue actions
Non-toxic
Easily sterilised
Inexpensive

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24
Q

What are the 3 potential origins of suture material

A

Natural
Synthetic
Metal

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25
2 behaviours of suture material
Absorbable Non-absorbable
26
Advantages and disadvantages of absorbable suture material
Adv - They disappear, low risk of long term foreign body reactions Dis - Lose strength over time, limited period of wound support
27
Advantages and disadvantages of non-absorbable suture material
Adv - Permanent, provide indefinable wound support Dis - don't disappear, possibility of delayed reactions
28
Advantages and disadvantages of braided suture material
Adv - easy to handle, very secure knots Dis - Greater friction and tissue drag, more tissue trauma
29
Advantages and disadvantages of monofilament suture material
Adv - minimal tissue trauma, no capillary action Dis - Harder to handle and knot, require different knots for security
30
Advantages and disadvantages of natural suture material
Adv - easy to handle and knot, high histocompatibility Dis - moderate/high tissue reaction, low tensile strength
31
Advantages and disadvantages of synthetic suture material
Adv - high tensile strength, predictable biological behaviour Dis - poorer knotting than natural materials
32
2 types of needle fixation, give an advantage and disadvantage of both
Eyed needle - multiple uses, increased tissue trauma Swaged needle - minimal trauma, single-use
33
3 parts of the needle
Point Body Eye/swage
34
3 materials surgical instruments can be made from
1. Stainless steel 2. Chromium-plated carbon steel 3. Titanium
35
What are scalpels used for and what handles and blades are used
Cutting skin Number 3 handle most common Number 4 handle - large animal 10 blade - commonly used for cutting 11 blade - stab incisions 15 blade - more delicate cutting edge
36
what are the 4 types of surgical scissors and what they are used for
1. mayo scissors - cutting tough tissue 2. metzenbaum scissors - delicate subcutaneous tissue and viscera 3. suture scissors - cutting sutures 4. iris scissors - 2 sharp tips - fine cuts
37
What are the 3 types of needle holders, and what is the difference
1. Olsen Hager - have scissor blade built in 2. Mayo Hager - no scissor blade 3. Gillies - have scissor blade but no ratchet
38
What are the 4 types of tissue handling or thumb forceps and what is the difference (not ringed forceps)
1. Treves rat toothed forceps - single tooth, larger 2. Dressing forceps - no rat teeth 3. Adson rat tooth forceps - small rat tooth 4. Debakey forceps - longitudinal and transerve serrations - least traumatic
39
Name 3 types of haemostat forceps
1. Halsted mosquito 2. Spencer Wells 3. Carmalt
40
Name 3 types of tissue/holding forceps and the differences (ringed instruments)
1. Allis - quite traumatic, not applied to the skin 2. Babcock - triangular shape, less traumatic 3. Doyen - atraumatic, designed fr bowel
41
Name 4 types of self retaining retractors and the differences
1. Balfour retractor - abdominal, 3 point 2. Finchietto retractor - abdominal, 2 point 3. Gelpi retractor - most commonly used, placed in pairs 4. Travers retractor - less prone to twisting, can't be used in small areas
42
Name 4 types of handheld retractors
1. Senn 2. Lagenbeck 3. Hohman 4. Malleable
43
Name 2 types of towel clamps
1. Backhaus towel clamp 2. Cross over towel clamp
44
What are the 4 stages of wound healing
1. Haemostasis and inflammation 2. Proliferation 3. Maturation 4. Wound contraction
45
What are they key features of the haemostasis stage of wound healing
Tissue damage => blood leaking from vessels Activation of closing cascade Platelet aggregation and release of cytokines Cytokines trigger clotting cascade further and inflammatory phase Stabilisation of platelet plug by fibrin formation
46
What are they key features of the inflammatory stage of wound healing
Vasodilation following transient vasoconstriction cytokines in the fibrin clot attract WBCs (neutrophils and macrophages) Destruction of cells by phagocytosis removes bacteria and devitalised tissue
47
What are they key features of the proliferation stage of wound healing
Formation of granulation tissue (macrophages, fibroblasts, new blood vessels) Fibroblasts proliferate => extracellular matrix, elastin and collagen Formation of new epithelial tissue Wound deficit reduced Contact inhibition - smooth layer of epithelium
48
What are they key features of the maturation stage of wound healing
Type III collagen => type I collagen Cross-linking of collagen Takes weeks to months
49
What 3 'patient factors' affect wound healing
Age Comorbidities Nutrition status
50
What 2 'wound factors' affect wound healing
Infection Location
51
What concurrent treatments can affect wound healing
Corticosteroids Radiation therapy
52
Name the 5 classifications of wound types
1. abrasion 2. avulsion 3. incision 4. laceration 5. puncture
53
Key features of an abrasion wound
Loss of epidermis and some dermis "Graze wound"
54
Key features of an avulsion wound
Tearing of tissues from their attachments If on the distal limb - called degloving No loss of skin - just torn away
55
Key features of an incision wound
Created by a sharp object - classical surgical wound Minimal trauma
56
Key features of a laceration wound
Tearing causing an irregular defect
57
Key features of a puncture wound
Penetrating Deep damage may be substantial
58
5 things to consider when assessing a wound
1. type of wound 2. wound age 3. level of contamination 4. lavage and debridement 5. management
59
5 factors that influence bacterial contamination of a wound
1. Vascular supply 2. Devitalised tissue 3. Foreign body 4. Type of contamination e.g. bite wound vs cut by glass 5. Type of bacteria present
60
3 main goals of wound management
1. Promote healing 2. convert contaminated => clean 3. control infection
61
5 ways to debride a wound
1. Surgical 2. mechanical 3. autolytic 4. biological - rare 5. enzymatic - rare
62
Describe 3 methods of mechanical debridement
1. Lavage debridement - high volumes of lactated ringers solution or saline 2. wet to dry dressings 3. topical negative pressure wound therapy
63
describe key principals of autolytic debridement
Honey - osmotic effect - draws up fluid and also antimicrobial properties
64
2 things bandages provide
1. stabilisation of wound surface 2. protection from trauma and contamination
65
What 3 layers should all bandages have
1. primary layer = in contact layer 2. secondary layer = supportive or padded and applied light pressure 3. tertiary layer = holds others in place, should stick to itself NOT the patient
66
Name 7 categories of primary layers for bandages
1. Dry 2. impregnated 3. semi-occlusive 4. absorbent 5. alginates 6. others e.g. honey, silver, iodine 7. topical wound gels
67
Name 3 types of immobilising bandages/splints
1. Robert Jones's bandage 2. Gutter splints 3. Fibreglass impregnated with resin/ plaster of Paris cast
68
Name 4 common complications associated with incorrectly applied bandages/poorly cared for bandages
1. Swelling 2. tissue necrosis 3. decubitus ulcers (pressure ulcers) 4. patient interference
69
What 3 types of bandage are common in equine practice
1. Simple bandage 2. Figure of 8 bandage 3. Robert Jones
70
What 2 situations do you splint in equine practice
1. unstable fractures 2. unstable tendon injuries
71
What are the main elements of Halstead's principals of good surgical practice (x7)
Gentle tissue handling Strict asepsis Haemostasis Preservation of blood supply No tension on tissues Good approximation of tissues Obliteration of dead space
72
What 5 regions is the abdominal cavity divided into for a exploratory laparotomy
1. Cranial abdomen 2. GIT 3. Right paravertebral region 4. Left paravertebral region 5. Caudal abdomen
73
What are the 3 main stages of bone healing
Inflammatory Restorative Remodelling
74
Describe key features of inflammatory phase of bone healing
Lysis of osteocytes => attract inflammatory cells and macrophages Blood clot forms at the fracture site
75
Describe key features of restorative phase of bone healing
Soft callus formation External and internal calluses are formed New blood vessels Newly formed cartilages are substituted by bone tissue (endochondral ossification) Produces a hard callus
76
Describe key features of remodelling phase of bone healing
Hard callus replaced by regular bone Ends of bone are enveloped by a fusiform mass Remodelling occurs - osteoclasts
77
What 2 types of healing can occur in the restorative phase of bone healing
First intention healing - minimal callus formation Second intention healing - natural healing
78
Describe process of healing by first intention (bone)
Direct formation of bone tissue without creation of bone callus
79
What 6 conditions must occur to allow healing by first intention (bone)
Immediate stabilisation Good blood supply Perfect reduction of fracture edges Absence of micro-movements at the level of the fracture line Interfragmentary compression Absence of infection
80
Describe second intention healing (bone)
Where a bony callus forms Produced due to late treatment, poor blood supply, infection, no compression forces
81
What is an articular fracture
Where a bone breaks to the joint (articular surface of the bone)
82
What is a closed vs open fracture
Open fracture = when skin is broken with the fracture Closed = bone is broken but skin is intact
83
What is an avulsion fracture
When a small chunk of bone is torn away by a tendon or ligament
84
What 'patient factors' affect fracture scores
Weight Age Ability to manage cage rest Concurrent illness
85
What about the fracture itself can affect the fracture score
Type of fracture Open or closed Associated soft tissue injuries Single or multiple fractures
86
Non patient factors affecting fracture score
Owner finances Owner commitment Surgical expertise of vet surgeon Surgical equipment available
87
What 4 forces can be applied to a fracture
Bending Torsion Tension Axial compression
88
On the following long jones, which aspect is the tension aspect? (femur, tibia, radius, humerus, mandible)
Femur - lateral aspect Tibia - medial aspect Radius - cranio-medial aspect Humerus - latero-cranial aspect Mandible - dorsal aspect
89
Why is it important to know which is the tension aspect of the bone when applying a plate
Plate is always applied to the tension side of the bone Will not be broken by tensile force but will be broken by successive compressions
90
What is the formula for strain in terms of fractures
Strain = change in length/original length
91
Name 5 main options for fixing a fracture
Intramedullary pin and cerclage wire Plating +/- compression Intramedullary nail External fixator Pin and tension band
92
Which forces are intramedullary pins good and bad at counteracting
Good - bending forces Bad - Axial compression, rotation
93
What are the 2 placement options for an IM pin
Normograde placement (from the proximal end) Retrograde placement (enters proximal fragment distally)
94
Why are external fixators really useful in fracture repair
Counteract all forces applied to a fracture Good for open fractures where wound management may be required
95
Name some complications associated with external fixators
Pins are prone to infection Require frequent examinations May require staging down Several follow up radiographs often required
96
What are the benefits of plate fixation of fractures
Allow reconstruction of comminuted fractures Protect against axial rotations
97
What force do plate fixators NOT protect against in fractures
Bending
98
Name 3 types of plates for fixing fractures
1. Buttress plate 2. Neutralisation plate 3. Compression plate
99
Explain how lag screws work and why it is used
Allow compression to be applied to a fracture Glide hole and thread hole pulls far fragment of bone against the near fragment
100
Things to consider with avian fractures
Pneumatised bone Periosteal blood supply of pneumatised bone must be preserved Avian bone heals mostly from the endosteum
101
In what 4 fracture situations do you immediately euthanise a horse
1. Comminuted fractures of proximal and middle phalanx 2. Compound/open fracture of long bone 3. Complete fracture of long bones 4. Pelvic fracture
102
What suture material, size, pattern and other techniques do you use to close a gastrotomy
Material - absorbable monofilament Size - 3/0 in cats, 3/0 or 2/0 in dogs Pattern - 1 layer closure of 2 layer closure (more common) Omentalise
103
Why do we "omentalise" when performing intestinal surgery
Draping omentum over site of incision Improves vascular supply Lymphatic drainage Rich source of inflammatory and immunogenic cells
104
Name 4 reasons for performing a urinary bladder cystotomy
1. Calculi need removing 2. Biopsy 3. Tumour 4. Ureteral ectopia
105
During which period are the intestine/bladder most likely to breakdown after surgery
72-96 hours (lag phase) This is when all support ad strength is provided by the sutures
106
Name 3 complications which could occur after abdominal surgery
Wound infection Peritonitis Uroabdomen
107
Clinical signs of postoperative complications abdominal surgery/bladder surgery
Dull, lethargy, anorexic Bladder breakdown => vomiting, diarrhoea Abdominal guarding Pyrexia, increased HR and RR
108
Which layer of the lines alba is most important when it comes to closure
External rectus sheath
109
Gives examples of prophylactic surgery for tumours
Ovariectomy/ovariohysterectomy for mammary neoplasia
110
Give an example of an oncological emergency requiring surgery
Bleeding splenic hemangiosarcoma
111
What is 'staging' of a tumour and what imaging modality is best
looking for metastatic spread - CT scan best
112
Name the 4 types of tumour removal surgeries (margins)
1. debulking/cytoreduction - leaving some behind 2. marginal resection 3. wide resection 4. radical resection
113
Name 2 types of clinical reasoning
1. pattern recognition 2. problem based clinical reasoning
114
what are the 4 questions/stages to work through during problem based clinical reasoning (type 2)
1. what is the problem 2. which body system is involved and how 3. where in the body system ins the problem located 4. what is the lesion
115
What are the benefits of shared decision making
Tailors decisions to individual client informed consent Better adherence to treatment plan Strengthens the relationship between vet and client Less likely to get complaints
116
What are the disadvantages of shared decision making
More time consuming?

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