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SAM 2 > Surgery Lecture 2. September 15 > Flashcards

Surgery Lecture 2. September 15 Flashcards

1
Q

Surgical wound. Healing

A
  • primary apposition
  • primary wound healing
  • defining factors (see later)
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2
Q

Defining factors of surgical wound healing

A

Local:
- tissue perfusion
- dead space
- technical errors
- infection

General:
- kachexia
- hypoalbuminaemia
- inflammation
- immunosupression
- chemo-/radiotherapy

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3
Q

Complication of the surgical wound

A
  1. Aseptic (NO BACTERIA, e.g. suture insufficiency, haematoma, seroma)
  2. Septic
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4
Q

Types of the septic surgical wounds

A
  1. Incisional superficial
  2. Incisional deep
  3. Organ/cavity
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5
Q

Incisional superficial septic surgical wound

A

Time of onset after surgery: within 30 days
Localisation: only skin or subcutis
Clinical signs:
- superficially purulent
- positive bacteriology
- at least one of the followings: pain, swelling, erythema, warmth

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6
Q

Incisional deep surgical septic wound

A

Time of onset after the surgery: without implants: within 30 days; with implant: within 1 year
Localisation: deeper layers (e.g. fascia, muscle)
Clinical signs:
- deeply purulent
- wound insufficiency of opened abscess
- fever and local pain (except for negative bacteriology)
- deep abscees

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7
Q

Organ/cavity septic surgical wound

A

Time of onset after surgery: without implants: within 30 days, with implant: within 1 year
Localisation: any tissue affected by surgery except for skin, subcutis and muscle
Clinical signs:
- pus accumulation in organ or cavity
- positive bacteriology

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8
Q

Clean <-> clean/contaminated <-> contaminated <-> septic

A
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9
Q

“Clean” surgery category of the wound

A
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10
Q

“Clean/contaminated” surgery category of the wound

A
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11
Q

“Contaminated” surgery category of the wound

A
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12
Q

“Septic” surgery category of the wound

A
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13
Q

Perioperative bleeding. Causes

A

Surgical technical anomaly
- direct iatrogenic trauma,
- invasive tissue dissection
- incomplete ligature

Coagulopathy
- congenital (von Willebrandt, haemophilia A,B)
- acquired (trauma-shock, immuno-mediated thrombocytopenia, DIC, SIRS, splenic torsion, hepatopathy, uremia, etc)

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14
Q

Coagulation tests used for prevention of perioperative bleeding

A

Primary haemostasis: platelet count, bleeding time
Secondary haemostasis: APTT (intrinsic), PTT (extrinsic)

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15
Q

Intraoperative surgical haemostasis

A

Physical compression: swab/gauze, vessel forceps, ligature

Coagulation:
- electrocautery
- gelatine-sponge: Spongostan
- oxidated cellulose mesh: Surgicel
- electronic tissue sealing device
- argon spray
- laser
Etc

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16
Q

Basic instrument set

A
  • drape
  • towel clamps
  • sharp instruments (scalpel, scissors)
  • needle holders
  • tissue forceps, vessel forceps
  • sponges, laparotomy pads
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17
Q
A

Scissors

18
Q
A

Needle holders

19
Q
A

Tissue forceps

20
Q
A

Vessel forceps

21
Q
A

Towel clamps

22
Q
A

Towel clamps

23
Q
A

Towel clamps

24
Q
A

Retractor

25
Q
A

Curette spoon

26
Q
A

Suction device

27
Q

Gastrointestinal set

A

Retractors + bowel clamps + “staplers”

28
Q

Thoracic set

A

Finochietto retractor + a traumatic instruments + “staplers”

29
Q

Microsurgery set (e.g. vascular, ophthalmologic)

A

A traumatic “de Bakey” instruments + operating microscope

30
Q

Suture materials. Size

A

Metric scale: diameter (mm) x 10
USP (US Pharmacopoeia) 14/0 -> 7

31
Q

Suture materials. Structure

A
  • monofilament
  • multifilament
32
Q

Suture materials. Crucial properties

A
  • material (absorbable <-> nonabsorbable)
  • structure (monofilament <-> polyfilament)
  • tensile strength
  • time of losing the majority of tensile strength
  • type of absorption
  • time of complete absorption
  • knot security
  • tissue reactivity
  • drainage property
  • tolerance against contamination
33
Q

Types of absorbable suture materials

A

Natural:
- catgut (plain, chromic)
- collagen

Synthetic:
- polyglycolic acud (Dexon, Maxon)
- polyglactin (Vycryl, Monacryl)
- polydioxanone (PDS)

34
Q

Types of nonabsorbable suture materials

A

Natural:
- silk (Mersilk)
- cotton

Synthetic:
- polyamide (Nylon, Supramid, Suturamid, Ethilon)
- polyester (Dagrofil, Ethibond, Ti-Cron, Mersilene
- polyolefins (polipropilen, polietilen)

Stainless steel

35
Q

Types of surgical needles

A
36
Q

Classification of suture patterns

A

According to:

  1. Knot
    - interrupted
    - continuous
  2. Tissue layer
    - skin, intracutaneous, subcutaneous, fascial, abdominal, intestinal, etc
    - appositional/ inverting/ tension sutures
    - penetrating (Albert)/ seromucular (Lembert)
  3. Other categories:]
    - tension sutures
    - plastic sutures (intracutaneous)
    - “crushing”/ “non-crushing”
37
Q

Simple interrupted suture

A
  • skin
  • fascia
  • GI tract
38
Q

Cruciate (X-) suture

A

Skin

39
Q

Interlocking continuous suture

A
  • skin
  • diaphragm
40
Q

Lembert suture (seromuscular)

A
41
Q

What are appositional sutures

A

SAM 2 (11 decks)

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