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surgery > Intraoperative Procedures > Flashcards

Intraoperative Procedures Flashcards

1
Q

Goals of suturing

A

Stop bleeding
Close any dead space
Approximate the wound edges
Minimize scar formation

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2
Q

What determines selection of suture material?

A

Type of wound and incision that needs to be closed

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3
Q

What is used for peritoneum? Fascia

A

3-0 monocryl
Fascia: large absorbable suture like 0-vicryl

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4
Q

What is used for deep space/deep dermal sutures? Skin?

A

smaller absorbable such as 3-0 vicryl
Skin: subcutaneous suture, staples, or glue

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5
Q

What is used for superficial wounds and delicate tissues?

A

absorbable sutures such as polyglactin (ex vicryl) or polyglycolic acid ( ex dexon)

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6
Q

What type of suture is used for deeper tissues and those requiring prolonged support?

A

Non-absorbable sutures like nylon (ethilon) or propylene (prolene) are often used

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7
Q

If the wound is expected to heal rapidly and not require long-term support, what sort of sutures are preferred?

A

Absorbable

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8
Q

When are non-absorbable sutures used?

A

Prolonged support necessary, such as in cardiovascular or orthopedic surgeries

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9
Q

How does location of the wound require impact suture choice?

A

Some areas are more likely to harbor bacteria than others, so would prefer monofilament sutures such as nylon or polyprolene
Multifilament may be used in areas where more flexible suture required such as scalp

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10
Q

How does expected tension impact selection of suture?

A

High-tension areas may require stronger and more durable sutures, such as braided polyester (ethibond)
Low tension areas may be sutured with finer materials like polyglactin like vicryl

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11
Q

How is number associated with size of suture?

A

Small numbers - large diameter sutures
Size of suture needs to be appropriate for thickness of tissue being sutured

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12
Q

What should be done if patients have an allergy?

A

Adjust sutures accordingly such as not using silk

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13
Q

What are the 7 factors that influence suture selection?

A

Type of tissue
Healing characteristics
Location of wound
Expected tension
Size of suture
Biocompatibility and allergy
Cost and availability

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14
Q

What suture material may have allergies to it and what is the general reaction?

A

Silk, catgut, chromic gut, nickel, titanium/alloys, adhesives
Redness, itching, inflammation, swelling

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15
Q

What should be used to close the abdominal fascia in an open bowel resection? 4-0, 2-0, 0, or 5-0

A

0

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16
Q

What should be used when closing the skin of an incision following carpal tunnel repair? 0-vicryl, 2-0 monocryl, 6-0 catgut, 4-0 nylon

A

4-0 nylon (generally removed after a few days)

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17
Q

What should be used to close an incision on the scalp? 0-vicryl 2-0 silk 4-0 monocryl 4-0 prolene

A

4-0 prolene (purple and easy to see)

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18
Q

What should be used for a 12 year old male presenting to the ED with a 2 cm laceration just above his right eyebrow? 6-0 nylon, 2-0 nylon, 0 vicryl, 2-0 vicryl

A

6-0 nylon (vicryl is absorbable and we want non-absorbable and will be taken out)

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19
Q

What is the style of closure based on?

A

Wound size
Location
Amount of stress/tension the wound will undergo while healing

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20
Q

When are simple interrupted sutures placed?

A

Low tension lacerations and wounds

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21
Q

When placing simple interrupted sutures, what must you do?

A

Take care to ensure each stitch is of equal distance, depth, and tension to optimize wound healing and minimize scar formation

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22
Q

What is the most commonly used material for simple interrupted sutures?

A

Nonabsorbable - nylon or prolene

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23
Q

What is the benefit of the rule of halves?

A

Ensure tension evenly distributed along wound edges
Promotes better wound healing
Reduces risk of tissue of tissue ischemia or necrosis caused by excessive tension on the wound edges
Helps maintain and aesthetically pleasing outcome, particularly in cosmetically sensitive areas

24
Q

When is a simple running/continuous stitch acceptable?

A

If wound very clean and easy to bring edges together, quicker and adequate
Technique of choice to help stop bleeding from skin edge

25
Q

Indications for mattress suture

A

Good choice when skin edges difficult to evert
Provide relief of wound tension while still allowing skin edge approximation

26
Q

2 types of mattress suture

A

Vertical mattress
Horizontal mattress

27
Q

Indications for vertical mattress

A

Lacerations around joints or areas with significant tension
Wounds that occur on a surface that is concave or posterior neck surfaces

28
Q

Contraindications to vertical mattress stitch

A

Face
Palms
Soles
Areas where blind, deep suture should not be performed

29
Q

Indications for horizontal mattress

A

Wounds under tension and very fragile wounds
Spreads out tension over wound edge

30
Q

What is the problem with the subcuticular (buried) suture?

A

Requires more skill
Need to enter skin on opposite side at a depth similar to where you exited

31
Q

Indications for subcuticular suture

A

wounds under little tension
Patients who are prone to keloid formation

32
Q

What is used commonly to close small laparoscopic incisions

A

Interrupted subcuticular

33
Q

What type of suture is commonly used with interrupted subcuticular?

A

Vicryl or monocryl

34
Q

What are benefits of the interrupted subcuticular?

A

No suture removal required and better cosmetic result

35
Q

This is most commonly used in plastic surgery for a better cosmetic result and no suture removal is required

A

Running subcuticular

36
Q

What is the most commonly used method of securing sutures in cutaneous surgery?

A

Instrument tie
Square knot or surgeon’s know preferred

37
Q

How much should a instrument tie be tightened?

A

Enough to approximate without constricting tissue and impeding blood flow “approximate not strangulate”

38
Q

How many throws will hold almost all sutures securely? What is the minimum number of throws?

A

5
Minimum: 3

39
Q

What tie is helpful when tying a knot deep in the abdomen and most often performed with the non-dominant hand?

A

Free hand tie

40
Q

Indications for staples

A

Placed quickly = main advantage ie when need to close bleeding wound
Used often to close laparotomy incisions

41
Q

Cons of staples

A

More scarring

42
Q

How far apart should each staple be placed?

A

About 1 cm

43
Q

How are staples removed?

A

Staple remover device
If do not have, clamp

44
Q

When can skin glue be used?

A

Primary closure or in conjunction with buried suture
Closure of low tension, easily approximated wounds

45
Q

When is skin glue contraindicated?

A

Wound with active infection or on mucosal surfaces and areas of high moisture

46
Q

When is adhesive tape aka steri strips used?

A

After sutures removed to keep skin closure from separating
As means of closure for relatively small wounds whose edges easily come together

47
Q

How is bleeding from skin edges managed?

A

Apply pressure (most stops after pressure for a few minutes with a gauze pad)
Use electrocautery (Bovie)

48
Q

How to use a bovie?

A

Ensure pt is grounded
Gloves are intact
Coag and cut buttons to cut or stop bleeding
Surgeon can ask for blend setting to enhance cutting currents to coagulate small bleeders during dissection and coagulation currents to dissect tissue during hemostasis

49
Q

When should bovie not be used?

A

Can remove lesions but vaporizes tissue so not for suspicious lesions that could be cancerous or pre-cancerous

50
Q

How is bleeding from a vessel managed?

A

Apply pressure for at least 5-7 minutes
Electrocautery unit if vessel is small
Tie off vessel if large or do not have access to electrocautery unit

51
Q

Options for tying off vessel

A

Regular and stick tie

52
Q

What is a regular tie

A

adequate for most veins and small arteries
3-0 or 4-0 silk or vicryl suture around vessel and under the clamp and tied with at least 3 or 4 knots

53
Q

What is a stick tie?

A

more secure for bleeding from vessel, especially for arteries

54
Q

Tips for assisting during bleeding

A

If you can’t see, it is likely the surgeon can’t see
Help retract
Suction blood
Use tapes/sponges to blot blood away from surgical site
Suction surgical smoke/plume away from surgical site
Use care not to wipe or remove eschar from site that has been cauterized

55
Q
A

surgery (7 decks)

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