Principles of surgery Flashcards
(46 cards)
Where do we make surgical incisions?
Inguinal, Paracostal Sublumbar Parapenile Flank Ventral midline
What is the critical layer to close on the ventral midline?
External sheath of rectus abdominus muscle is the critical layer
If you cut high up on the ventral midline then what can you excise?
The falciform fat
What does the duodenal manoeuvre allow you to get access to?
Duodenum normally ventrally on right side – retract it across the abdominal cavity, which enables the small and large intestine to be retracted, exposing:
right urogenital structures
vena cava and portal system
What does the colonic manoeuvre allow you to get access to?
Retraction of the descending colon provides exposure of the left side of the abdomen
What should you give after GI surgery?
Avoid spillage of contents – laparotomy swabs, Lavage + suction
Peri-operative antibiotics - contaminated surgery
What kind of clamp should you use in H
GI surgery?
Use Doyen (non-crushing) clamps
In an intussusception which end tends to go into which?
Often the oral end goes into the aboral end
What suture material should you use to close the GI tract?
Polydioxanone (PDS), polyglyconate (Maxon), Glycomer 631 (Biosyn), Poliglecaprone 25 (Monocryl) 3/0 or 4/0 Good early tensile strength (days 5-7) Resist absorption for > 21 days Simple interrupted appositional sutures 2-3mm apart, 2-3mm from edge Use a thread-attatched needle
Should you starve an animal after GI surgery?
Starvation after GI surgery detrimental.
Ð Villous atrophy
Ð Ulceration
Ð Breakdown in gut barrier
Early enteral nutrition indicated in most circumstances
Oral route best but other routes in different circumstances
What should you do before closing the abdomen post Gi surgery?
Omentum is draped over the site of incision
How do you close a Cystotomy?
Full thickness, generally single layer, simple continuous or interrupted
Avoid non-absorbable sutures nidus formation
Weak tissue, but regains ≈ 100% strength within 14-21d
PDS, monocryl and vicryl, 3-0 to 5-0, swaged on taper-point needle
More rapid loss of strength in contact with urine esp. infected (PDS best)
Two layer closure if worried by a thin bladder
To close the external rectus sheath should you go through the muscle?
In the cranial two thirds yes but in the lower 3rd don’t go full thickness though just scoop it up
When closing the abdomen should you do interrupted or continuous sutures?
Continuous suture patterns preferable
- even distribution of tension along length of closure
- more rapid closure
- less suture material (= less foreign material)
- 6 throws at each end
How many layers should you close in the abdomen?
- Subcutaneous layer
- simple continuous, PDS or monocryl
- eliminate dead space - use tacking sutures if necessary - Intra-dermal layer
- simple continuous, PDS or monocryl - Skin sutures
- non-absorbable, usually nylon
- interrupted or continuous pattern
Define Asepsis
absence of pathogenic microbes or infection in living tissue
Define Antisepsis
use of antimicrobial chemicals on living tissue
Define Disinfection
destruction of pathogenic microbes, e.g.use of germicidal substances on inanimate objects
Define Sterilization
destruction of all microorganisms (only possible in inanimate objects)
Are surgical wounds sterile?
Surgical wounds are not sterile – all become contaminated with bacteria, but not all contamination infection
What are the pros and cons of removing hair prior to surgery?
Hair is gross contaminant and significant reservoir for microbes and organic debris
All methods of hair removal some trauma = bacterial multiplication:
How do you clip around wounds?
first flush and cover with sterile gel
Why do we not use hair removal creams (depilatories)?
Depilatories: atraumatic, but can be messy, irritant and expensive, not good on coarse hair
- frequent skin reactions esp. cats
- good for rabbits
How do we deal with paws?
Cover it with a drape or a glove
