Cathcart

Question 1

How does tension slow healing? 4 reasons

Answer 1

• pulls the small vessels closed and reduces blood supply
• skin can even make a tourniquet
• can pull apart wound
• can limit mobility of nearby joints

Question 2

What affects tension?

Answer 2

• breed/species
• body position
• wound shape
• wound tension

Question 3

How can you remove dead space after undermining?

Answer 3

walking sutures

Question 4

How can you remove dead space after undermining?

Answer 4

walking sutures

Question 5

What is a releasing incision?

Answer 5

nearby small incisions that open after you close your wound

Question 6

What is the difference between vascularized and nonvascularized grafting

Answer 6

vascularized requires micro surgery to reconnect vessels.

Question 7

What is the difference between vascularized and nonvascularized grafting

Answer 7

vascularized requires micro surgery to reconnect vessels.

Question 8

What should the general shape of a sub dermal flap be?

Answer 8

twice as long as it is wide to continue proper blood supply to the flap.

Question 9

name two kinds of flaps

Answer 9

rotation flaps

transposition flaps

Question 10

What is an axial pattern flap?

Answer 10

carries artery or vein so can be larger than a sub dermal flap

Question 11

What is an axial pattern flap?

Answer 11

carries artery or vein so can be larger than a sub dermal flap

Question 12

“region that an artery supplies”

Answer 12

angiosome

Question 13

What do you need to consider when making a axial pattern flap?

Answer 13

can’t rotate more than 180 degrees or you may kink the artery. Also don’t trim dog ears.

Question 14

What are the important characteristics of a good graft?

Answer 14

healthy donor site on to healthy vascular wound
defatting tissue with minimal handling
good graft adherence with good apposition
needs to be immobilized
graft needs to touch all surfaces

Question 15

How does a graft stay alive initially?

Answer 15

vessels in skin still draw out nutrient from the wound bed via osmosis.

Question 16

Three I’s of graft survival

Answer 16

• plasmatic imbition (graft takin gup oxygen and nutrients from wound bed)
• Inosculation (open blood vessels on graft meet with those in tissue)
• Direct vessel ingrowth from wound to the graft

Question 17

Three I’s of graft survival

Answer 17

• plasmatic imbition (graft takin gup oxygen and nutrients from wound bed)
• Inosculation (open blood vessels on graft meet with those in tissue)
• Direct vessel ingrowth from wound to the graft

Question 18

What is a full thickness graft?

Answer 18

epidermis still attached to dermis. - require microvascular anatomosis

Question 19

What is a split thickness graft?

Answer 19

epidermis and part of the dermis. Skin will grow back in donor site so you don’t need to completely close it. Less cosmetic since hair comes from dermis.

Question 20

How do you implant punch/pinch grafts?

Answer 20

cut holes in granulation tissue and implant them

Question 21

if an animal bleeds during surgery what does it do to the tissues? 5

Answer 21

irritates them and prevents copatation of wound edges. delays healing, encourages infection. promotes adhesions.

Question 22

What is primary vs secondary and intermediate hemorrhage? what causes each?

Answer 22

primary is immediate bleeding during surgery.
immediate is within 24 hrs after surgery.
secondary is after that. often caused by ineffective treatment of primary bleeding OR restoration of normal blood pressure after surgery is over.

Question 23

What is primary vs secondary and intermediate hemorrhage? what causes each?

Answer 23

primary is immediate bleeding during surgery.
immediate is within 24 hrs after surgery.
secondary is after that. often caused by ineffective treatment of primary bleeding OR restoration of normal blood pressure after surgery is over.

Question 24

How do you deal with a primary hemorrhage in surgery?

Answer 24

gentle digital pressure while you enlarge incision to improve visibility. then you can also lavage or have an assistant aid to make visibility even better

Question 25

How can you stop superficial bleeds?

Answer 25

put pressure with a gauze for several minutes. compress, don't wipe.

Question 26

How can you stop superficial bleeds?

Answer 26

put pressure with a gauze for several minutes. compress, don't wipe.

Question 27

When is it appropriate to use hemostats to stop bleeding?

Answer 27

when you do not need to save the vessel. The crushing will activate clotting. Larger vessels require a proper ligation.

Question 28

which way do you point hemostats for small bleeds? large bleeds?

Answer 28

small point towards (use tip), large away (use jaw).

Question 29

When selecting a vascular clip, how do you decide a size?

Answer 29

diameter of vessel should be 1-2/3 the length of the clip.

Question 30

What are the advantages and disadvantages of using ligatures instead of clips?

Answer 30

ligatures are more secure but take longer to place - usually preferred for large vessels.

Question 31

What are the advantages and disadvantages of using ligatures instead of clips?

Answer 31

ligatures are more secure but take longer to place - usually preferred for large vessels.

Question 32

For what sized vessels can you use cautery??

Answer 32

arteries up to 1mm, veins up to 2mm

Question 33

What is the risk of using mono polar cautery?

Answer 33

risk of distant burns due to current taking alternate pathway to ground plate

Question 34

What must you keep in mind using bipolar cautery?

Answer 34

don't let tips touch or it will short circuit.

Question 35

Why is bipolar cautery advantageous?

Answer 35

less current needed and less risk of injury to surrounding tissue as there are no pathway burns. Also works in a wet field and very precise.

Question 36

Is cautery as secure as ligation?

Answer 36

no, can cause secondary hemorrhage and its associated problems (increased infection, delayed healing)

Question 37

What is ligasure? what is the max vessel size?

Answer 37

a biolar vessal sealing device that measures vessel and adjusts current accordingly. can be used up to 7mm diameter vessels

Question 38

When would you use gel foam?

Answer 38

diffuse low level bleeds like liver biopsy - can potentiate infection so use sparingly.

Question 39

When would you use gel foam?

Answer 39

diffuse low level bleeds like liver biopsy - can potentiate infection so use sparingly.

Question 40

How do you use bone wax?

Answer 40

to stop bleeding from cancellous bone but only for surgery since it traps in bacteria

Question 41

Why do we want to avoid dead space?

Answer 41

``` slows healing (impedes fibrin bridge and compromised blood supply) increased risk of infection - seroma has nutrients that attract them ```

Question 42

How can we minimize dead space?

Answer 42

mayo dissection careful technique don't remove fat

Question 43

How can we manage dead space?

Answer 43

layered wound closure tacking suture compression bandages drainage

Question 44

How can we manage dead space?

Answer 44

layered wound closure tacking suture compression bandages drainage

Question 45

How do passive drains remove fluid?

Answer 45

capillary action + gravity and or pressure gradients.

Question 46

How do active drains work?

Answer 46

use suction to remove fluid

Question 47

What is omentalization?

Answer 47

using the omentum as a natural drain

Question 48

What are the advantages to a vacuum assisted closure?

Answer 48

pressure stimulates angiogenesis and granulation tissue. Also greatly deduces microorganisms. Also controls dead space.