Chapter 15: Haemostasis Flashcards
(87 cards)
1
Q
Regarding Haemostasis: Clots left in the wound delay healing
A
True
Clots can promote bacterial growth and must be broken down and absorbed, which delays healing.
2
Q
Hemostasis refers to the formation of a hematoma within a wound.
A
False
3
Q
The ‘terrible tetrad’ includes hematoma, dehiscence, necrosis, and infection.
A
True
4
Q
Dermatologic surgery typically has a high risk of bleeding due to deep visceral involvement.
A
False
5
Q
Coagulating small arterial bleeds during surgery is a key principle of hemostasis.
A
True
6
Q
Clots in wounds can promote bacterial growth and delay healing.
A
True
7
Q
Hemostasis must be addressed only during surgery.
A
False
8
Q
Initiation of coagulation involves activation of Factor VII and thrombin formation.
A
True
9
Q
Platelets are involved in aggregation and serve as a platform for coagulation.
A
True
10
Q
Fibrin mesh is stabilized by Factor V and VIII.
A
False
11
Q
Calcium is not required for fibrin polymerization.
A
False
12
Q
Patients with von Willebrand disease usually bleed from mucocutaneous surfaces.
A
True
13
Q
Thrombocytopenia is always a contraindication for cutaneous surgery.
A
False
14
Q
An INR greater than 3.0 is generally acceptable for surgery under warfarin.
A
False
15
Q
Clonidine can be used to control anxiety-related hypertension before surgery.
A
True
16
Q
Anticoagulants should always be discontinued before dermatologic surgery.
A
False
17
Q
Fasting is recommended before minor dermatologic surgery under local anesthesia.
A
False
18
Q
Topical agents such as silver nitrate help control superficial bleeding by coagulating proteins.
A
True
19
Q
Electrosurgery is contraindicated for small vessels <2 mm in diameter.
A
False
20
Q
Monopolar electrosurgery uses a single electrode for tissue coagulation.
A
True
21
Q
Bipolar electrosurgery is safer and causes less tissue necrosis than monopolar.
A
True
22
Q
Tumescent anesthesia contains diluted epinephrine that prolongs vasoconstriction.
A
True
23
Q
It is safe to use epinephrine in digits under specific precautions.
A
True
24
Q
Digital ring blocks with epinephrine are standard practice in all patients.
A
False
25
Manual compression of a bleeding site is rarely effective in controlling hemorrhage.
False
26
Tourniquets can be safely used for up to 2 hours on the lower limb under sedation.
True
27
Electrosurgery requires a moist field for optimal performance.
False
28
Undermining below the galea of the scalp reduces bleeding.
True
29
Intraoperative quadrant approach helps manage diffuse bleeding.
True
30
Chalazion clamps provide hemostasis for lip mucosal surgery.
True
31
Bipolar electrosurgery can be used in patients with defibrillators.
True
32
Suture ligation is commonly used for vessels under 2 mm diameter.
False
33
Figure-of-eight sutures are useful when bleeding vessels retract.
True
34
Metal clips may be used for quick ligation in lymph node dissections.
True
35
Plane-by-plane closure helps reduce dead space and bleeding risk.
True
36
Dead space encourages fluid and blood accumulation.
True
37
Avoiding subcutaneous detachment can reduce postoperative hematoma.
True
38
Leaving a small wound corner open after undermining may prevent hematoma.
True
39
Electrocoagulation should be avoided in dermatologic surgery.
False
40
Absorbable sutures are preferred for buried ligatures.
True
41
Hemostasis is only necessary in deep tissue surgeries.
False
42
Risk of rebound vasodilatation is highest several days after surgery.
False
43
Cold packs are useful for reducing postoperative swelling and bleeding.
True
44
Observation for 1–2 hours is useful after large undermining procedures.
True
45
Early hematoma can cause compression injury and requires surgical intervention.
True
46
Organized hematomas after 7–10 days should always be surgically removed.
False
47
Fibrin sealants can be used for diffuse oozing not controlled by standard methods.
True
48
Compression dressings reduce the risk of seroma and hematoma formation.
True
49
Late-stage liquefied hematomas may be aspirated without reopening the wound.
True
50
Postoperative assessment should occur 2–4 hours after ambulatory surgery.
True
51
Surgical hemostasis should be planned across all perioperative phases.
True
52
Regarding haemostasis, Thrombocytopenia is important to identify
True - While moderate thrombocytopenia often does not affect minor cutaneous surgery, it is still important to assess platelet count and clinical signs of bleeding to determine surgical risk.
53
Von Willebrand factor is primarily an abnormality in factor VIII
False
vWF is a platelet-type bleeding disorder involving defective platelet adhesion and may be associated with abnormalities in Factor VIII, but it is not primarily a Factor VIII disorder.
54
The risk of thrombotic events is elevated in patients who discontinue their anticoagulation briefly
Discontinuation of anticoagulants increases the risk of serious thrombotic events such as stroke, MI, or PE, even if stopped for a short time.
55
Hypertension above 160 mmHg systolic should be stabilised prior to surgery
False
Robinsons specify systolic BP >180 mmHg should be stabilized preoperatively. Hypertension at 160 mmHg was not stated as a clear cutoff.
56
Regarding cessation of antiaggregants and anticoagulants for dermatological surgery
Cease warfarin 2 - 3 days prior
Cease aspirin the day prior
Cease warfarin 2–3 days prior
✅ True (in selected high-risk cases)
Warfarin is generally continued for most dermatologic surgeries, but in anatomically high-risk areas or when substituting with LMWH, it is ceased 2–3 days prior, depending on INR.
Cease aspirin the day prior
❌ False
Aspirin must be discontinued 5–7 days prior if being stopped, due to irreversible inhibition of cyclooxygenase. Stopping it the day before is inadequate.
57
Regarding cessation of antiaggregants and anticoagulants for dermatological surgery
Cease heparin 12hrs prior
Cease LMWH 2 hrs before surgery
Cease heparin 12 hrs prior
❌ False
Standard (unfractionated) heparin should be stopped 2–3 hours before surgery, not 12 hours.
Cease LMWH 2 hrs before surgery
❌ False
Low Molecular Weight Heparin (LMWH) should be stopped 12–15 hours before surgery, not just 2 hours.
58
Regarding Anaesthesia, Dilute concentrations of adrenaline 1: 1 000 000 will provide pronounced and prolonged vasoconstriction
✅ True
This is the typical dilution used in** tumescent anesthesia,** providing prolonged and effective vasoconstriction.
59
Regarding Anaesthesia, At least 15 minutes should pass following injection before incision for the full vasoconstrictive effects
True
60
Regarding Anaesthesia, For acral sites, adrenaline 1:100,000 can be used
❌ False
For fingers/toes, **1:200,000 is the recommended dilution.** 1:100,000 is too concentrated and may increase ischemic risk.
61
Regarding Anaesthesia, Adrenaline can be used in circumferential ring blocks
❌ False
Circumferential ring blocks should be avoided due to the risk of ischemia, even when using safe dilutions.
62
Adrenaline should not be used in people with peripheral vascular disease, DM, or vasospastic conditions
False
**This statement applies to acral sites only**
63
Regarding haemostasis enhancers, Aluminium chloride is less likely than other stypics to leave pigment
✅ True
Aluminium chloride (and trichloroacetic acid) is less likely to stain the skin compared to silver nitrate or ferric sulfate.
64
Regarding haemostasis enhancers, Continuous wave Nd:YAG laser can be used for hemostasis
❌ False
Robinsons mention carbon dioxide (CO₂) laser, not Nd:YAG, as being useful for incisional hemostasis in dermatologic procedures.
65
Regarding haemostasis enhancers, Monoterminal electrocoagulation provides the least tissue destruction to achieve haemostasis for bleeding vessels with electrosurgery
❌ False
Bipolar electrocoagulation causes three times less tissue necrosis than monopolar (monoterminal) electrosurgery. Therefore, bipolar is the least destructive.
66
Regarding haemostasis enhancers, Undermining can greatly reduce surgical bleeding
✅ True
When done correctly in the proper anatomical plane (e.g., below the galea), undermining can be nearly bloodless.
67
Regarding haemostasis enhancers, Vessels greater than 1 mm require ligation
❌ False
Vessels greater than 2 mm generally require ligation for secure hemostasis.
68
Regarding haemostasis enhancers, Ligations are performed for blood vessels only
❌ False
Ligations are also used for lymphatic vessels, which may leak lymph ("dribble") and need to be controlled during surgery.
69
The following should be performed to avoid accumulation of blood, Pressing on a closed wound to aspirate blood
❌ False
Blood or fluid should be pressed or aspirated before final sutures are placed. Pressing a closed wound is not the correct technique for evacuation.
| Robinsons - page 233
70
The following should be performed to avoid accumulation of blood; Leaving a corner of the wound open
✅ True
Leaving a small part of the wound open (e.g., at flap junctions) facilitates early passive drainage and may help prevent hematoma formation
| Robinsons - page 233
71
The following should be performed to avoid accumulation of blood; Performing a imbrication suture
✅ True
A double imbricating suture (modified purse-string) can be used to compress tissues and control bleeding, especially in vascular lesions.
| Robinsons - page 233
72
The following should be performed to avoid accumulation of blood; Fixomul and unfolded gauze
❌ False
Folded, voluminous gauze is recommended for better compression. Unfolded gauze lacks sufficient pressure for effective hemostasis.
| Robinsons - page 236
73
The following should be performed to avoid accumulation of blood; Leaving a Jackson -Pratt drain in place for 3d
❌ False
Drains should be removed within 24 hours (ideally) to minimize infection risk. 3 days is too long.
| Robinsons - page 234
74
Regarding haemostasis
Post op bleeding risk is greatest in the first 12hrs
Robinsons states first 24 hours
75
There are three stages of haematoma formation
??? True - LJF says 4
76
Haematomas begin to liquefy after 7 days
✅ True
After 7–10 days, fibrinolysis begins and hematomas may liquefy, becoming fluctuant.
77
Bromelain can accelearate haematoma resolution
True
Bromelain, a proteolytic enzyme derived from pineapple stems, exhibits anti-inflammatory and fibrinolytic properties that contribute to its effectiveness in reducing hematomas.
78
Evacuation of a haematoma is always necessary to ensure a healthy wound
❌ False
Only expanding hematomas or those causing complications require evacuation. Organized/liquefied hematomas can often resolve without surgical evacuation (e.g., aspirated later if fluctuant).
79
Topical hemostatic agents such as silver nitrate work by causing vasoconstriction of small arterioles.
False – They cause protein coagulation leading to eschar formation, not vasoconstriction.
80
A dry surgical field is essential for optimal electrosurgical coagulation.
✅ True – Moisture disperses current, leading to charring and ineffective coagulation.
81
Monopolar electrosurgery causes less collateral tissue damage than bipolar electrosurgery.
❌ False – Bipolar electrosurgery causes significantly less tissue necrosis.
82
Plane-by-plane closure helps minimize hematoma formation by reducing dead space.
✅ True – It promotes hemostasis and prevents fluid accumulation.
83
Postoperative cold compresses are especially useful after surgeries in the temple and periorbital areas.
✅ True – These regions are prone to hematoma, and cold compresses reduce swelling and bleeding.
84
Fibrin sealants are useful for managing diffuse intraoperative bleeding that is not responsive to electrosurgery or ligation.
✅ True – They are recommended in such situations.
85
Leaving a Jackson–Pratt drain in for more than 48 hours is recommended
❌ False – Drains should be removed within 24 hours to minimize infection risk.
86
A hematoma that is organized and firm always requires surgical evacuation.
❌ False – Organized hematomas may resorb and can often be managed conservatively or aspirated if fluctuant
87
7. Bipolar electrosurgery is contraindicated in patients with cardiac defibrillators.
❌ False
Explanation: Bipolar electrosurgery is preferred in these patients as the current does not disperse beyond the forceps tips.
