Principles of Surgery Flashcards
(279 cards)
1
Q
Define sepsis
A
Presence of pathogens and toxic products in tissues
2
Q
Define asepsis
A
Absence of pathogenic microbes in tissues
3
Q
Define antiseptic
A
Chemical agent that kils or inhibits pathogenic microorganisms; ONLY for agents applied to the body
4
Q
Define disinfectant
A
Chemical that kills microorganisms on inanimate objects
5
Q
Define disinfection
A
The removal of microorganisms but not necessarily their spores
6
Q
Define sterilisation
A
Complete elimination of microbial viability by physical/chemical means
7
Q
What can wound infection lead to?
A
Adverse effect on procedureAdverse effect on general healthIncreased morbidity and moralityFurther treatment neededIncreased costsIncreased hospital stay
8
Q
What will almost all surgical wounds become?
A
Contaminated but not all infected
9
Q
What three things are the factors involved in sugical wound infection?
A
BacteriaLocal wound environmentLocal and systemic defence
10
Q
What bacterial factors affect there ability to cause infection?
A
Presence and growthNumber of bacteriaType and virulence of bacteriaDuration of exposure to bacteriaTiming of exposure to bacteria
11
Q
When are the host defences at their lowest in relation to surgery?
A
First three hours after wounding
12
Q
What are the surgical factors affecting the risk of wound infection?
A
Duration of surgeryPatient and surgeon preparationType of surgery
13
Q
What four things in surgical wounds can increase chances of infection?
A
Dead space and seromaForeign materialBlood clotsDevitalised tissue
14
Q
What are the patient factors that can increase the risk of wound infection?
A
AgeNutritionDiseasesTherapy
15
Q
Which ages of dogs are more at yisk of wound infections?
A
Young and old (>8yrs)
16
Q
Give some examples of diseases that can increase the risk of wound infection
A
DiabetesRenal failureEnocrinopathiesCancerHypoalbuminaemiaTraumaInfectionInflammationImmunodeficiency
17
Q
What are the four NRC categories of wound classification?
A
CleanClean-contaminatedContaminatedDirty
18
Q
Describe a clean wound
A
Non-traumaticElective surgery with primary intention healingNo inflammationNo break in aseptic techniqueRespiratory, alimentary or urogenital tract not entered
19
Q
Describe a clean-contaminated wound
A
GI or respiratory tract entered without spillageUrogenital tract entered in absence of infectionBiliary tract entered in absence of infected bileMinor break in aspetic technique
20
Q
Describe a contaminated wound
A
Gross spillage from GITEntrance into urogenital or biliary tract with infectionFresh traumatic woundMajor break in aseptic technique
21
Q
Describe a dirty wound
A
Perforated viscus encounteredAcute bacterial inflammationPus encounteredTraumatic wound greater than 4 hoursTransection of clean tissue
22
Q
How does the infection rate vary with categories of wound?
A
Increases with increased contamination
23
Q
What is the decisive period?
A
First 2-3 hours after wound exposure/inoculation
24
Q
When is there intense activity between bacteria and host in wounds?
A
Decisive period
25
When is abtibiotic treatment only beneficial?
First 3 hours - decisive period
26
Why should we provide antibiotics 1 hour before surgery or wound inoculation?
To allow time for them to reach the necessary concentrations within the body to combat infection
27
What are the four key areas within aseptic technique?
Surgeon preparationSurgical instrumentsPatient preparationOperating theatre
28
What are the non-sterile barriers we use in aseptic techniques?
Scrub suitsCapShoes/shoe coversFace mask
29
What are the three areas in which the surgeon prepares aseptically?
Non-sterile barriersSkin preparation (scrubbing up)Sterile barriers
30
What are the two sterile barriers that vets use?
Gowns and gloves
31
Describe how scrub suits and shoes should be worn for aseptic techinque
Limit transmission of dirt, debris and bacteriaMade from loose weave lint-free fabricA barrier for danderWorn only in theatreTops tucked into trousersTrousers tucked into boots
32
Describe the key points to be done before scrubbing up
Remove all jewelleryNails short and cleanMask on before scrubbingAppropriate antisepticBrush and soap readyWater running at correct speed and temperature
33
What are the two recognised methods for scrubbing up?
Timed scrub - scrub for a set timeCounted brush stroke method - do each scrub a number of times
34
What are the three requirements for scrubbing up?
Nail pickBrushAntiseptic agent
35
What are the four antiseptics used in scrubbing up?
ChlorhexidineIodine (Povidone-iodine)AlcoholSterillium (alcohol again)
36
What does chlorhexidine kill?
Broad spectrum of bacteriaVariable against virusesNo action against spores
37
How does chlorhexidine kill?
Precipitation of cellular contentsAlteration in cell permeability
38
What are the benefits for chlorhexidine?
Rapid initial killPersistent residual activityNot inactivated by organic materialNot generally toxic - only when direct contact
39
What does iodine kill?
BacteriaVirusesFungiNot spores
40
How does iodine kill?
IodinationInhibition of protein synthesis
41
What decreases the action of iodine?
Organic materialHard water
42
How long a contact time does iodine need to work?
2 minutes
43
Where should iodine be used?
Mucosal surfacesNear open wounds
44
What problems are associated with using iodine?
Corrodes instrumentsAcute contact dermatitisAllergic reaction in sensitive people
45
What does alcohol kill?
Broad spectrum of bacteria
46
How does alcohol kill bacteria?
Protein denaturationInhibition of cell division
47
What does alcohol enhance the action of?
ChlorhexidineIodine
48
Where should alcohol be avoided using?
Near open wounds
49
What does sterillium kill?
BacteriaFungiVirusesTB
50
How does sterillium improve skin health?
MoisturisingMaintains skin lipidsNo reported allergiesNo scrubbing
51
What must you not mix sterillium with?
Hand creams or disinfectants
52
Where should your gown be tied?
At the back wrapped around you
53
What are the two types of gloving?
ClosedOpen
54
What is closed gloving?
Most common for surgical proceduresRequires long-sleeved gownGloves must cover cuff of gown
55
What is open gloving?
Gloving for procedures that only require sterile hands
56
What are the two main methods of sterilising instruments?
PhysicalChemical
57
Where should clipping be carried out?
In the prep room
58
Describe clipping
Clip a wide area of the patientAllow for a change in planLengthen incisionAllow for drain placement
59
Describe aseptic skin preparation on the patient
Antiseptics used of all the clipped areaScrub inside to outScrub until no further organic debrisNo less than five minutes contact time
60
What should be carried out on the patient in the theatre for aseptic preparation?
Repeat prep room preparationWipe off excess scrub with alcoholApply final solution
61
What does draping reduce the risk of?
Contamination by surrounding hair or skin
62
What are the two types of drapes?
DisposableReusable
63
What are the three uses for surgical drapes?
Cover whole patientCover whole tableCover instrument trolley
64
What is primary draping?
Single fenestrated drape4 field drapes
65
What is secondary draping?
Skin towelsAdhesive drapes
66
What are the four areas in the surgical field?
Incision siteSterile drapes on the patientInstrument trolleySurgical team
67
What parts of the surgical team are counted as the surgical field?
Front of the bodyBelow the neck and above the waistArms and hands
68
Describe an operating theatre design
End room with a single doorSeparate patient preparation areaSeparate scrubbing areaOnly necessary correctly attired personnel
69
Describe how the operating theatre should be used
Clean operations firstContaminated operations lastDisinfect table between patientsDirty operations in a separate room
70
What are the five results of inappropriate antimicrobial use?
Increased costIdiosyncratic drug reactionsSuppression of normal bacterial floraDevelopment of bacterial drug resistanceIncreased risk of hospital acquired infection
71
Of the four categories of wound classifications which are antibiotics indicated for?
Clean-contaminated - controversially indicatedContaminatedDirty - therapeutic use
72
When are antimicrobials indicated in clean surgery?
Longer surgery (\>90 minutes)Implant placedIf infection would be catastrophic to the outcomeImmuno-compromised patients
73
What are the seven basic principles of surgery?
Surgical asepsisGentle tissue handlingAccurate haemostasisPreservation of vascularityCareful approximation of tissuesObliteration of dead spaceNo tension on tissues
74
What are the four basic steps in surgery?
Incision and excision of tissueHaemostaissHandling and care of tissuesClosing with sutures
75
What are four ways we can incise into tissues?
ScissorsScalpelElectrosurgeryLaser
76
What is usually used to incise through skin?
Scalpels
77
Which scalpel blade is used for most small animal surgery?
#10 scalpel blade
78
What is a #11 scalpel blade used for?
Stab incisions and opening up organs
79
What tissues is a scalpel used for?
Tough tissueFor tissues held under tension
80
Describe the action of using a scalpel
Single, bold incisionCorrect length and depth
81
How should a scalpel be held normally?
Pencil grip
82
What can scissors be used for?
IncisionsCutting of tissue
83
What are the three most common types of scissors used?
Suture removal scissorsMayo scissorsMetzenbaum scissors
84
What are mayo scissors used for?
Bigger tissues
85
What are metzenbaum tissues used for?
Smaller tissues that require a gentler handling
86
What are the advantages and disadvantages of using scissors?
Advantages: controlled cutting and good for flaccid tissuesDisadvantages: shearing tissue trauma
87
What are the three things scissors can be used for?
Cutting tissue below the skinBlunt dissectionUndermining tissue
88
How should scissors be held?
Thumb and ring-finger grip
89
What are the advantages of using other cutting instruments (laser etc.)
Improved haemostasisDecreased need for ligaturesReduced operating timeImproved accessNo-touch technique
90
What are the disadvantages to using other cutting instruments e.g. laser?
Tissue trauma causedExpensiveRisk of burns and fires
91
Why is haemostasis important?
Severe blood loss results in hypovolaemiaObscures the surgical fieldStains tissues redBlood irritates tissuesIncreases wound infectionAvoids surgical panic
92
What four ways can we use preventive haemostasis?
Plan the approachIdentify blood vessels in surgical fieldLigate vessels before transectionGentle dissection
93
What 9 things can be used as haemostasis?
PressurePackingWound closureHaemostatic forcepsDiathermyLigaturesTopical agentsTourniquetVascular clips and staples
94
What is the maximum time a tourniquet should be left on for?
Twenty minutes
95
What five things determine the choice of haemostasis used?
Least traumaticLeast foreign materialLeast necrotic tissueQuickestDepends on tissue a vessel
96
What are the two actions of haemostats?
PressureCrushing
97
How are haemostats used on small superficial vessels?
Use tip of the forcepsApply tip down
98
How are haemostats used for large tissue pedicles?
Use the jawPerpendicular to blood vessel
99
What is the most secure method of haemostasis?
Ligatures
100
What is the main disadvantage of ligatures?
Leave foreign material in the wound
101
WHere should a ligature be placed in relation to your clamps?
1.5 to 2 cm below them (in opposite direction to blood flow)
102
What are the three basic grips for scalpels?
Pencil gripFingertip gripPalm grip
103
What are the three types of surgical haemorrhage?
Primary - immediate bleedingDelayed intermediate - bleeding within 24 hoursDelayed secondary - bleeding more than 24 hours later
104
Describe the correct use of swabs
Use woven cotton swabsUse swabs with a radio-opaque markerUse singlyOpen swab out if performing delicate manoeuvresUse large laparotomy swabs in body cavitiesBlot tissue - don't wipe
105
What are the four main types of haemostatic forceps?
HalstedKellyCarmaltKocher
106
What are the five knots that surgeons should be aware of?
Simple knot: 1 single throwSquare knot: 1 single throw then another in the opposite directionSurgeon's knot: 1 double throw then a single throw in the opposite directionHalf-hitch: 1 single throw, then another but tightened by slidingGranny knot: 1 single knot, followed by another in the same orientation
107
What are the six ligature methods?
Simple encirclingDouble ligationHalsted's transfixing ligatureModified transfixing ligatureTissue ligatureStick ties
108
What do stick ties incorporate?
Organ vessels are attached to
109
What are the four ligatures for vascular pedicles?
Triple clamp techniqueModified Miller's knotTransfixing ligatureDivision of pedicle
110
Describe a triple clamp technique
Three clamps put into place and ligature tied into crushed area left by proximal clamp
111
What are the two types of diathermy?
Monopolar and bipolar
112
What are the advantages of monopolar diathermy?
Cut tissues as well as coagulate themApply current ot instruments in contact with patients
113
What are the advantages of bipolar diathermy?
Lower current so reduced local tissue traumaReduced incidence of distant tissue traumaBurns unlikelyCan be used in wet surgical field
114
What is the main difference between monopolar and bipolar diathermy?
Monopolar can be used to cut as well as coagulateBipolar is just coagulation
115
What are the three main types of topical haemostatic agents?
VasoconstrictorsClotting promotersProvide a physical barrier
116
What are the two physical barriers used as haemostatic agents?
Bone wax and glue
117
What are some examples of haemostatic agents causing vasoconstriction?
Ice salinePhyenylephrineAdrenaline
118
What are some examples of haemostatic agents that promote clotting?
FibrinCollagenCelluloseGelatinPolysaccharides
119
What should be used if repeated manipulation of tissues is needed?
Stay sutures
120
What are some examples of excessive trauma in handling tissue?
Inadequate excision lengthExcessive retractionDull surgical instrumentsExcessive undermining of tissueSwab traumaFailure to dissect along tissue planesAllowing tissue to dry out
121
What four things can help reduce operative tissue trauma?
Gentle handlingGentle retractionKeep tissues moistSuction rather than swabs
122
What are used most often to manipulate tissues?
Thumb forceps (Adson-Browns
123
Which thumb forceps are used for more delicate tissues?
DeBakey forceps
124
How are tissue forceps held?
Pencil grip
125
Which tissue forceps are used to stabilise and retract tissues?
Allis (with teeth)Babcock (without teeth)
126
What tissue forceps are used to dissect neurovascular structures from other tissues?
MixterLahey
127
What tissue forceps are used for occlusion of hollow organs?
Doyens (intestine)Rochester-Carmalt (uterus)
128
What tissue forceps are used to occlude blood vessels after incision?
CooleySantinsky
129
What is the major disadvantage to using retractors?
Tissue trauma or ischaemia at point of contact
130
What are some commonly used hand-held retractors?
SennLangenbeckArmy-NavyMalleable retractors
131
What are some commonly used self-retaining retractors?
Gelpi (general)Weitlaner (general)Finochietto (thorax)Gosset (abdomen)Balfour (abdomen)
132
What are the two types of towel clamp?
BackhausCross-action
133
What are the six major benefits of wound lavage?
Removes bacteria and foreign materialDilutes toxinsReduces wound infectionHydration of tissuesImproved visibilityWarms the patient
134
What is an ideal lavage agent?
Sterile, isotonic, non-toxic and normothermic solution
135
What are the three types of suction tip used to remove fluid?
Frazier (fine)Yankauer (wide bore)Poole (multiple holes)
136
What must be done if lavage is used?
Fluid must be completely removed
137
What are the five different types of needle holders?
Mayo (ratchet)Mayo-Hegar (ratchet)Olsen-Hegar (ratchet and scissors)Gillies (scissors)Castroviejo (fine ratchets)
138
What are the three ways that surgeons should be aware of when tying knots?
One-hand tieTwo-hand tieInstrument tie
139
What are the principles of successful suture use? (6)
Knot security is inversely proportional to suture diameterTighten each throw separately with even tension on both handsUse absorbable multifilament suture for ligaturesPlace the minimum number of throws to reduce knot bulkCut the ends short to minimise foreign material in the woundAvoid including frayed or damaged suture in the loop
140
Why is an elective ovariohysterectomy technically a clean-contaminated surgery?
Genital tract is entered at the junction of uterus and cervixRisk of contamination is low as surgery is usually short
141
With a foreign body removal surgery in the small intestine why is prophylactic antimicrobial use recommended?
Do not know whether there will be subsequent spillage of intestinal contentsAt start surgery is clean-contaminated for which antimicrobial use is controversial
142
Why is surgery in the perineal region associated with a higher rate of infection?
Proximity of anus and faecal bacteria
143
Why is surgery involving an abscess dirty?
Means established infection already present
144
When is the placement of a tube to drain the bladder a contaminated procedure?
If the animal has a urinary tract infection
145
When is an open traumatic wound regarded as dirty?
If it has been more than 4-6 hours before treatment
146
Why are wound infections rare in the oral cavity?
Excellent blood supplyAntibacterial effects of salivaWarmth of oral cavity
147
What are the four functions of suture material?
Wound closure Ligation Attachment of tubes Stay sutures
148
How should the ideal suture material interact with the tissue?
Maintain strength until wound strength develops Rapid resorption when no longer required Encapsulated without post-op complications Easily removed Minimal tissue reaction Doesn't favour bacterial growth Minimal drag Suitable for all wounds
149
How should the ideal suture material interact with the surgeon?
Easy to handle Good knot security
150
What are the material properties of the ideal suture material?
Easy to sterilise Non-capillary Non-electrolytic Non-corrosive Non-allergenic Non-carcinogenic
151
What are the three practical considerations for the ideal suture material?
Inexpensive Readily available Available in a range of sizes
152
What are the six classifications of suture material?
Natural Synthetic Absorbable Non-absorbable Multifilament Monofilament
153
What are the differences between natural and synthetic fibre suture materials?
Natural - tissue inflammatory reaction, variable absorption Synthetic - less reaction, predictable absorption
154
How do absorbable suture materials differ to non-absorbable?
Absorbable - provide temporary wound support, loss of strength under 60 days Non-absorbable - elicits tissue reaction leading to encapsulation, strength persists after 60 days
155
What are the interaction differences between multifilament and monofilament suture materials?
Multifilament - easier to handle, better knot security, increased capillarity Monofilament - less tissue drag, can weaken when crushed
156
How can coating suture material help in surgery?
Improves handling Reduces tissue drag
157
What does dying suture material help with during surgery?
Visibility
158
What are the two ways suture materials are packaged?
Cassette Individual packet
159
What are the four materials used for synthetic absorbable multifilament suture materials?
Vicryl - polyglactin 910 Dexon - polyglycolic acid Polysorb - lactomer 9-1 Panacryl - Poly(L-lactide/glycolide)
160
How does synthetic absorbable multifilament suture material interact with tissue?
Absorbed completely at 60-90 days Speed: Polysorb\>Vicryl\>Dexon
161
Describe how tensile strength is lost over time with synthetic absorbable multifilament suture materials
Loss - 33% at 7 days, 80% at 14 days, 100% at 21 days Strength: Polysorb\>Vicryl\>Dexon
162
Describe handling and knotting of synthetic absorbable multifilament suture materials
Good handling/knotting Tissue drag improved by coating
163
What is synthetic absorbable multifilament suture material used for?
Vessel ligation General soft tissue closure
164
What materials are used for short duration synthetic absorbable monofilament suture material?
Monocryl - polyglecaprone Caprosyn - polyglytone
165
How does short duration synthetic absorbable monofilament suture material interact with tissue?
Complete absorption at 90-120 days Speed: Caprosyn\>Monocryl
166
Describe the loss of tensile strength of short duration synthetic absorbable monofilament suture material
High tensile strength Loss - 50% at 7 days, 60% at 14 days, 100% at 21 days
167
Describe the handling and knotting of short duration synthetic absorbable monofilament suture material
Monocryl - soft and pliable with low memory Caprosyn - more sticky than monocryl
168
What is short duration synthetic absorbable monofilament suture material generally used for?
General soft tissue closure Visceral closure - monocryl
169
What materials are used for long duration synthetic absorbable monofilament suture material?
PDS II - polydioxanone Maxon - polyglyconate Biosyn - glycomer 631
170
How does long duration synthetic absorbable monofilament suture material interact with tissue?
Completely absorbed at 110-210 days
171
Describe the loss of tensile strength of long duration synthetic absorbable monofilament suture material
Strong materials Loss - 26% at 14 days, 40% at 28 days, 75% at 42 days Strength: PDS II\>Maxon\>Biosyn
172
How does PDS tend to handle and knot?
Memory Tendency to coil 7 knots
173
What is long duration synthetic absorbable monofilament suture material generally used for?
Soft tissues needing long support Muscle Fascia Linea alba Viscera
174
What materials are used to make synthetic non-absorbable monofilament suture materials?
Prolene/SurgiPro - polypropylene Ethilon/Monosof - polyamide Flexon -steel
175
How does synthetic non-absorbable monofilament suture materials interact with tissue?
Minimal reaction Inert
176
Describe the tensile strength of synthetic non-absorbable monofilament suture materials
Strong 25% lost after 2 years
177
How does synthetic non-absorbable monofilament suture material handle and knot?
Memory Good knot security
178
What are synthetic non-absorbable monofilament suture materials generally used for?
Inert - skin, stoma and vessels Prolonged support - hernia and tendon
179
What materials are used for synthetic non-absorbable multifilament suture materials?
Mersilene/Ethibond - polyester Novafil - polybutester Supramid - caprolactam
180
How do synthetic non-absorbable multifilament suture materials interact with tissue?
Cause moderate inflammation
181
Describe the tensile strength of synthetic non-absorbable multifilament suture material
Stronger than nylon Very little loss of strength
182
How does synthetic non-absorbable multifilament suture material handle and knot?
Fair handling Slight elasticity Sheath cracks on knotting
183
What are synthetic non-absorbable multifilament suture materials generally used for?
Ligament prosthesis Skin closure (occasionally)
184
What materials are used to make natural absorbable multifilament suture materials?
Catgut - plain or chromic Collagen
185
How do natural absorbable multifilament suture materials interact with tissue?
Completely absorbed at 60-70 days Marked tissue reaction Faster absorption in infected, vascular or acidic wounds Unpredictable absorption
186
Describe the loss of tensile strength in natural absorbable multifilament suture materials
33% loss at 7 days 67% lost at 14 days
187
How do natural absorbable multifilament suture materials handle and knot?
Knots become weaker when wet Poor knot security so leave ends long Good handling
188
What are natural absorbable multifilament suture materials generally used for?
Vessel ligation Ophthalmic surgery
189
What material is used to make natural non-absorbable multifilament suture material?
Mersilk, PermaHand - Silk
190
How does natural non-absorbable multifilament suture material interact with tissues?
Moderate-marked inflammation Encapsulated in fibrous tissue
191
Describe the tensile strength of natural non-absorbable multifilament suture material
Weak - will break! Very slow absorption (2 years)
192
How does natural non-absorbable multifilament suture material handle?
Well
193
What are natural non-absorbable multifilament suture materials used for generally?
Large vessel ligation NOT in viscera
194
What should tensile strength match when selecting suture materials?
Strength of the tissue - depends on collagen
195
What should the rate of loss of strength of the suture material match?
Gain in wound strength - match with rate of healing (viscera\>skin\>fascia)
196
What four ways can sutures alter biological healing?
Reaction with tissues Potentiation of infection Formation of sinuses Potentiation of calculi, thrombi and ulcers
197
What are the seven general rules to avoid complications with suture materials?
Avoid multifilament material in contaminated wounds Avoid non-absorbable sutures in hollow organs Use inert material in the skin Avoid reactive material for stoma creation Use slowly/non-absorbable material in fascia/tendons Avoid burying any suture from a multi-use cassette Avoid catgut in inflamed, infected or acidic wounds
198
What is the size of suture material measured in?
1/10ths of a mm in the metric system
199
What size of suture material should be chosen and why?
Smallest size possible - less tissue trauma, less suture material volume, smaller knots, greater knot security and encourages gentle handling
200
Generally what size of suture material should be used in dogs?
3 metric
201
Generally what size of suture material should be used in cats?
2 metric
202
How much should the size of suture material generally be reduced by for delicate tissue?
Reduce by 1 to 2 metric
203
How much should the size of suture material generally be increased by for tough tissue?
Increase by 0.5 to 1 metric
204
What are the advantages of swaged-on needles?
Immediate use Unlikely to detach from material Less handling of material Less fraying of material Less tissue trauma Likely to be sharper Guaranteed sterile Greater range of needles available
205
What are the 5 shapes of surgical needles?
Straight Curved Curved on straight Compound curve J-shape
206
What are the two points of non-cutting surgical needles?
Round bodied Taper point
207
What are the four points of cutting surgical needles?
Taper cut Standard cutting Reverse cutting Side-cutting (spatula)
208
What are the advantages of using reverse cutting needles compared to cutting needles?
Generally stronger Danger of tissue cutout is reduced Hole left by needle leaves wall of tissue against which suture can be tied
209
What are the four requirements for surgical needles?
Sharp enough to pass through tissue No change to tissue architecture Needle resists bending/breakage Needle hole just big enough for suture
210
What are the five rules for wound closure?
Close tissue in same number of layers as incised Appositional pattern unless good reason not to Choose simplest pattern Avoid closure under tension Careful suturing more important than pattern choice
211
What type of suture is this?
Simple suture
212
What type of suture is this?
Mattress suture
213
What are the advantages for interrupted and continuous suture patterns?
**Interrupted**
* If 1 knot fails then whole line won't fail
* More accurate approximation
* Adjust tension at each suture
**Continuous**
* Quicker
* Less suture material in wound
* More even distribution of tension
* More air-tight and water-tight
* Cheaper
214
Describe the benefits of appositional suturing?
Easy to perform
Accurate alignment of wall layers
Quicker regeneration of mucosa
Less inflammation and fibrous scar tissue
215
What are the advantages and disadvantages of inverting suturing?
**Advantages**
* Similar tensile strength
* Reduced risk of adhesions
**Disadvantages**
* Greater bursting strength
* Necrosis of tissue cuff can occur
* Luminal compromise possible
216
What are the advantages and disadvantages of everting sutures?
**Advantages**
* Increased tensile strength
* Endothelial contact reduces thrombosis
* Easy to place
**Disadvantages**
* Prolonged inflammation and vascular compromise
* Increased incidence of adhesions
* Increased risk of stenosis
* Increased risk of leakage
217
What are the advantages of both partial thickness and full thickness sutures?
**Partial thickness**
* Not exposed to luminal contents
* Reduces wicking from lumen
**Full thickness**
* Better apposition
* Suture holding layer engaged
218
What are the advantages of one layer and two layer closures?
**One layer**
* Simple
* Quick
* Less suture material
**Two layer**
* More accurate apposition
* Easier in some tissues
* More watertight?
* Stronger?
219
What are the main features of a simple interrupted suture pattern?
Secure anatomical closure
Precise adjustment of tension possible
Easily applied
Can cause inversion if tight
220
What tissues would you generally use a simple interrupted pattern in?
Skin
GI tract
Fascia
221
What type of suture pattern is this?
Simple interrupted
222
What are the features of an intradermal/subcuticular suture?
Upside down simple interrupted - buried knot
223
What type of suture pattern is this?
Intradermal/subcuticular
224
What are the features of a cruciate mattress suture pattern?
Stronger than simple interrupted
Resists tension
Prevents eversion
Quicker than simple interrupted
Poorer apposition
225
Where would you generally use a cruciate mattress suture pattern?
Skin
Tail
Digit amputation
226
What type of suture pattern is this?
Cruciate mattress suture
227
What are the features of a horizontal mattress suture?
Apposotional to everting
Strangulate tissue
Edge ischaemia
228
What tissues would you generally use a horizontal mattress suture in?
Skin
Muscle
Tendon
229
What suture pattern is this?
Horizontal mattress suture
230
What are the features of a half-buried horizontal mattress?
Composite of horizontal mattress and subdermal/subcuticular
Avoids trauma to tip of flap
231
When would you generally use a half-buried horizontal mattress?
Skin closure
232
What type of suture is this?
Half-buried horizontal mattress
233
What are the features of a vertical mattress suture?
Appositional to everting
Resists tension
234
When do you generally use a vertical mattress suture?
For tension relieving sutures in the skin
235
What type of suture is this?
Vertical mattress
236
What are the features of a Mayo mattress suture?
Overlap tissue planes
Tighten tissue planes
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When would you generally use a Mayo mattress suture?
Imbrication of fascia lata
Hernia closure
238
What type of suture is this?
Mayo mattress suture
239
What are the features of a simple continuous suture pattern?
Series of linked interrupted sutures
Suture line advances on one side of the wound
Good for areas under low tension
240
When would you generally use a simple continuous suture pattern?
Subcutis
Fascia
Vessels
GI tract
241
What type of suture pattern is this?
Simple continuous
242
What are the features of a running suture (baseball stitch)?
Series of linked interrupted sutures
Suture line advances on both sides of the wound
Rapid closure
Less accurate approximation
243
What type of suture pattern is this?
Running suture (baseball stitch)
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What is the difference between subcutaneous and subcuticular continuous suture patterns?
**Subcutaneous**
* Simple continuous
* Perpendicular
**Subcuticular**
* Continuous horizontal mattress
* Parallel
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What are the features of a Ford interlocking suture?
Greater security than simple continuous
Better apposition than simple continuous
More difficult to place and finish
246
When would you generally use a Ford interlocking suture pattern?
On the skin
247
What type of suture pattern is this?
Ford interlocking suture
248
What are the seven inverting suture patterns?
Cushing
Connell
Lembert
Halsted
Czerny
Parker-Kerr
Purse-string
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Which suture pattern is used for everting?
Horizontal mattress
250
What are the features of the Lembert suture pattern?
Variation of vertical mattress
Tissue bites perpendicular to wound edge
Can be interrupted or continuous
251
Which tissues do you generally use a Lembert suture pattern for?
Tissues with a hollow viscus
252
What type of suture pattern is this?
Interrupted Lembert suture pattern
253
What type of suture pattern is this?
Continuous Lembert suture pattern
254
What are the features of a Halsted suture pattern?
Modification of the Lembert
Two interrupted Lemberts as a mattress suture
255
What type of suture pattern is this?
Halsted suture pattern
256
What are the features of a Cushing suture pattern?
Variation of the continuous horizontal mattress
Tissue bites parallel to wound edge
Penetrates submucosa but not lumen
Less inversion
257
What type of suture pattern is this?
Cushing suture pattern
258
What are the features of a Connell suture pattern?
Like a Cushing
Penetrates lumen
259
What type of suture pattern is this?
Connell suture pattern
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What are the features of a Czerny suture pattern?
Generally: simple continuous partial thickness
1st layer:
* Appositional: simple continuous, running
* Inverting: Cushing or Connell
2nd layer: Lembert
261
What type of suture pattern is this?
Czerny suture pattern
262
What are the features of the Parker-Kerr oversew?
1st layer: Cushing
2nd layer: Lembert
263
What would a Parker-Kerr oversew generally be used for?
Closure of a visceral stump
264
What type of suture pattern is this?
Parker-Kerr oversew
265
What are the features of a Purse-string suture pattern?
Circular Lembert
266
What are purse-string suture patterns generally used for?
Stump inversion
Feeding tubes
267
What type of suture pattern is this?
Purse-string pattern
268
What are the features of a continuous horizontal mattress suture pattern?
Causes appositional to everting
269
When would you generally use a continuous horizontal mattress suture?
Cardiac surgery
You would generally oversew with simple continuous
270
What type of suture pattern is this?
Continuous horizontal mattress suture
271
What are the two solutions to resolving tension in sutures?
Remove tension
Fight tension
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What are the six tension-relieving suture patterns?
Vertical mattress
Horizontal mattress
Far-far-near-near
Far-near-near-far
Echelon structures
Quills, bolsters, stents and pledgets
273
What type of suture pattern is this?
Far-near-near-far
274
What type of suture pattern is this?
Far-far-near-near
275
What are the features of a simple interrupted echelon suture?
Alternating simple interrupted sutures
* Narrow bite - apposition
* Wide bite - tension
Can use with quills/stents
276
What type of suture pattern is this?
Simple interrupted echelon suture
277
What are the features of quills with a horizontal mattress?
Quills or bolsters
Distributes tension
Everting
278
What type of suture pattern is this?
Quill with horizontal mattress
279
What type of suture pattern is this?
Quills with vertical mattress suture
