principles of surgery Flashcards
(200 cards)
1
Q
define antisepsis
A
prevention of sepsis by destruction or inhibition of microorganisms using an agent that may be safely applied to living tissue
2
Q
define antiseptic
A
an agent that is applied to living tissue to destroy or inhibit microorganisms
3
Q
define disinfectant
A
agent that is applied to inanimate objects to kill or inhibit microorganisms
4
Q
define disinfection
A
removal of microorganisms but not necessarily the spores
5
Q
define sepsis
A
presence of pathogens or toxic products in tissue of patient
6
Q
define sterilisation
A
complete elimination of microbial viability including spores
7
Q
non-sterile barriers on person during surgery
A
- scrub suit
- face mask
- surgical head masks
- shoes/shoe covers
8
Q
scrud suit in surgery
A
a permeable barrier to microorganisms that reduces particulate shedding during surgery
9
Q
surgical head covers
A
reduce shedding of bacteria from the hair
10
Q
face masks
A
protect the wound from saliva droplets during speaking
11
Q
3 physical methods of sterilisation
A
- heat
- irradiation
- filtration
12
Q
heat sterilisation is dependent on
A
time and temperature
13
Q
3 methods of heat sterilisation
A
- steam
- moist heat (boiling)
- dry heat
14
Q
most widely used method of heat sterilisation
A
steam
15
Q
moist boiling cons
A
can only reach 100* which is not sufficient to kill most spores
16
Q
dry heat sterilisation how to
A
kills microorganisms by oxidative destruction
17
Q
dry heat sterilisation can be used on
A
- glassware
- cutting instruments
- opthalmic instruments
- drill bits
- powders
- oils
18
Q
3 methods of irradiation sterilisation
A
- gamma rays
- UV light
- high energy electrons
19
Q
most effective sterilisation irradiation technique
A
gamma irradiation
20
Q
filtration sterilisation used on what
A
- liquids
- gases
21
Q
3 methods of chemical sterilisation
A
- ethylene oxide
- hydrogen peroxide gas plasma
- cold sterilisation
22
Q
ethylene oxide can
A
destroy all bacteria, fungi and spores
23
Q
ethylene oxide action
A
inactives cellular DNA stopping cellular reproduction
24
Q
ethylene oxide cons
A
toxic, inflammable and irritant to tissues
25
ethylene oxide sterilisation how to
- soak at room temperature for 12 hours
| - aerate and ventilate for 24 hours to allow ethylene oxide dissipation
26
hydrogen peroxide gas plasma action
- uses UV photons and radicals
| - 50* temperature for 45 min
27
hydrogen peroxide gas plasma pros
nontoxic and quick
28
cold sterilisation cons
usually only disinfects
29
cold sterilisation how to
soak in disinfectant for 24 hours
30
3 ways to indicate sterilisation
- chemical
- biological
- temperature and pressure recordings
31
chemical indicators of sterilisation how
colour changes on exposure to a certain temperature or chemical
32
chemical indicators of sterilisation cons
dont show exposure time
33
biological indicators of sterilisation
spores which are more resistant to sterilisation than bacteria are put in as well then cultured to see if killed or not
34
biological indicators of sterilisation cons
take time to show if machine functional or not
35
temperature/pressure indicator of sterilisation
the temps/pressures are plotted on a graph during machine operation to show that requirements are met
36
prep of surgical site 3 steps
- hair removal
- prep of skin
- draping of patient
37
hair removal in patient prep is to
reduce bacterial contamination
38
sterile areas of the gown
- from chest to table height
| - from above elbow to cuff
39
wounds are classified as
- clean
- clean-contaminated
- contaminated
- dirty
40
clean contaminated wound example
going into GIT without significant spillage
41
contaminated wound example
- major break in aseptic technique or major GIT spillage
42
dirty wound example
foreign body
43
3 grips for holding a scalpel
- pencil grip
- fingertip grip
- palm grip
44
mayo scissors
used for dense collagen rich tissue
45
metzenbaum scissors
used for delicate dissection
46
surgical haemorrhage can be
- primary
- delayed intermediate
- delayed secondary
47
primary surgical haemorrhage
bleeding starts immediately
48
delayed intermediate haemorrhage
bleeding within 24 hours of surgery, e.g ligature slipped
49
delayed secondary haemorrhage
bleeding after 24 hours post surgery. can be due to necrosis of blood vessles
50
4 types of haemostatic forceps
- halsted mosquito (small)
- kelly (medium)
- carmalt (large)
- kocher (large with rat tooth tip)
51
define electrosurgery
- diathermy
| - electric current passed through tissue produces heat due to the tissue resistance
52
2 types of diathermy
- bipolar
| - monopolar
53
monopolar diathermy
current flows between handpiece to the ground plate
54
bipolar diathermy
current flows between 2 bipolar forceps
55
monopolar diathermy pros
- can cut through tissue as well as coagulation
| - can attach to a metal instrument
56
bipolar diathermy pros
- use less current
- reduced local tissue trauma
- reduced incidence of distant tissue trauma
- can be used in a wet surgical field
57
half hitch ligature
do 1 throw then another (square knot) tightened by sliding
58
natural fibre suture material con
- more likely to get an inflammatory reaction
| - variable absorption
59
synthetic suture material pros
- less reaction
| - predictable absorption
60
multifilament suture material pros
better handling and knot security
61
multifilament suture material cons
capillary action for bacteria
62
monofilament suture material pros
less tissue drag
63
monofilament suture material cons
weakens when crushed
64
example of synthetic absorbable multifilament suture material
vicryl
65
vicryl is made from
polyglactin 90
66
when synthetic multifilament suture material absorbed by
day 60-90
67
when does vicryl loose strength
- day 7 33%
- day 14 80%
- day 21 100%
68
2 examples of synthetic absorbable monofilament
- monocryl
| - PDS 2
69
monocryl is made of
polyglecapron
70
monocryl absorbed at
90-120 days
71
monocryl strength lost days
- 7 days 50%
- 14 days 60%
- 21 days 100%
72
PDS 2 is different from monocryl as it has a
longer duration
73
PDS 2 adsorbed at
day 110-210
74
strength lost PDS2 when
- day 14 26%
- day 28 40%
- day 42 75%
75
synthetic nonabsorbable monofilament 3 examples
- prolene
- ethilon
- flexon
76
nylon % strength lost at 2 years
25%
77
nylon memory
high
78
high memory means (knot)
low knot security
79
synthetic nonabsorbable multifilament example 2
- catgut
| - collagen
80
absobed time natural absorbable mutlifilament suture material
60-70 days
81
absorption of natural absorbable multifilament materials is sped up by
infection
82
strength lost of natural absorbable multifilament material
day 7 33%
| day 14 67%
83
example of natural nonabsorbable multifilament
silk
84
absorption time of silk
2 years
85
suture material size for dog
3 metric
86
suture material size for cat
2 metric
87
define simple suture
material goes over and under wound edges
88
define mattress suture
material either just goes under wound or above wound
89
continuous suture pros
- quicker
- use less material
- even distribution of tension
90
continuous suture cons
have to be sure of knot security
91
appositional suture pros
- quicker healing
| - less scar tissue
92
inverting suture pros
stronger bursting strength
93
inverting suture cons
- necrosis of inverted tissue
| - narrow lumen
94
everting suture pros
strong tensile strength
95
everting suture cons
- prolonged inflammation
- vascular compromise
- narrow lumen
96
partial thickness suture pros
not entering lumen so no wicking
97
full thickness suture pros
- better apposition
| - ensures submucosa is engaged
98
1 layer closure pros
- quick
| - less suture material
99
2 layer closure pros
- better apposition
| - more water tight seal
100
simple interupted suture pattern type
appositional though inverts if too tight
101
modified gambee cons
difficult to place
102
modified gambee how to
- place material full thickness
- come back up partial thickness on smae side
- across wound and into other side
- down into lumen partial thickness
- up same side full thickness
- tie off
- should have a bubble writing n shape
103
cruciate mattress pros
- quicker than simple interupted
| - stronger than simple interupted
104
horizontal mattress suture type
appositional/everting depending on tension
105
half buried horizontal mattress suture
used in complicated skin surgery
106
vertical mattress pattern how to
far-far-near-near
107
simple interupted echelon suture appearance
- alternating sizes of simple interupted
- wide bite for tension
- narrow bite for apposition
108
2 things used to spread tension when suturing
- quills
| - stents
109
mesengenesis define
undifferentiated multipotent cells differntiate into a range of cells
110
3 classic stages of wound healing
- inflammation
- new tissue formation/proliferation
- remodelling
111
inflammation in wound healing is seen (time)
first 48 hours
112
environment of wound healing in inflammation
hypoxic with fibrin clot
113
cells of inflammation wound healing
- bacteria
- neutrophils
- platelets
114
new tissue formation wound healing (time)
2-10 days
115
new tissue formation wound healing appearance
- scab on surface
- angiogenesis
- fibroplasia
116
macrophages in wound healing
- remove wound debris
- produce collagenases and elastases
- produce growth factors
- coordinate angiogenesis
117
how macrophages coordinate angiogenesis
secrete vascular endothelial growth factor
118
keratinocytes role in wound healing
- migrate under fibrin clot
- reconstitute wound margin
- ECM production
- angiogenesis
119
define pericytes
- cells that sit around blood vessels
| - have a role in angiogenesis
120
fibroblast and wound healing
days 3-5 migrate into wound and produce ECM
| - differentiate into myofibroblast
121
myofibroblast and wound healing
make contractile proteins to help wound closure
122
exmarchs 5 principles of wound management
- non-introduction of anything harmful
- tissue rest
- wound drainage
- avoidance of venous stasis
- cleanliness
123
swelling at incision site 6 ddx
- acute haemorrhage/haematoma
- incisional swellin/oedema
- acute infection
- seroma
- abcess
- dehiscence of underlying body wall
124
tx of acute haemorrhage of wound post surgery
pressure dressing
125
2 causes of wound dehiscence
- excessive force on incision
| - poor wound holding strength
126
3 reasons for excessive force on incission
- activity level
- skin tension
- trauma
127
5 resons for poor wound holding strength
- suture selection
- knot security
- wound edge compromised
- wound infection
- neoplastic tissue in wound or around wound edge
128
tx wound infection
manage as an open wound. therefore remove sutures, debribe devitalised tissue, lavage and drain
129
define sinus
blind ending tract from an epithelial surface
130
define fistula
communicating tract from one epithelial surface to another
131
4 reasons impaired granulation tissue formation
- necrosis/devitalised tissue
- wound infection
- ischaemia
- movement
132
2 reasons for inadequate wound contraction
- peripheral countertension due to lack of loose skin around the edge
- restrictive fibrosis
133
8 reasons for failure of tissue epithelialisation
- necrotic tissue
- wound infection
- fibrotic scar tissue
- poor quality chronic granulation tissue
- repeated trauma to wound surface
- loose bandages that abrade the wound
- tissue desiccation
- movement of wound site
134
indolent pocket wounds define
where the skin is elevated around the granulation tissue creating a pit. so will not close
135
steps on how indolent pocket wounds form
- surrounding tissue becomes elevated and does not adhere to margins of defect
- epithelial cells migrate to line the dermal surface
- no skin edge advancement but instead it curls under
136
3 places where indolent pocket wounds form
- inguinal region
- axillary region
- flank region
137
tx of indolent pocket wounds
- excise scar border and restrictive dermal scar
- close wound and attach to underlying granulation tissue
- manage dead space with drains
138
4 aims of wound management
- achieve a healed wound
- minimise scar formation
- preserve function
- prevent infection
139
initial wound management steps
cover with a sterile dressing
140
assessment of patient in wound managment
- ABC
| - throrough physical exam and history
141
during assesment of wound establish
- aetiology (cause)
- location
- nature
- extent and degree of contamination
142
antibiotic therapy is not needed in wound management once
a healthy bed of granulation tissue forms
143
7 steps to promote a healthy bed of granulation tissue
1) protect from dessication and contamination
2) preparation and clipping
3) debride necrotic tissue
4) lavage to remove foreign material and contaminants
5) provide adequate wound drainage
6) promote a viable vascular bed
7) select appropriate method of closure
144
wound prep and clipping in wound management 4 steps
- wound protection
- tissue handling
- clipping of hair
- surgical prep
145
wound protection can be with (3)
- KJ jelly
- saline soaked swabs
- temporary closure of wound with sutures or towel clips
146
tissue handling in the prep stage of wound management should be
- atraumatic
- do not probe or replace bone fragments
- stabilize with a splint if necessary
147
clipping hair is easier with (3)
- sharp blades
- moist hair
- wet blades
148
surgical prep of wound (2)
- prepared aseptically
| - do not get antiseptic in the wound
149
3 things to do in debridement of necrotic skin/fascia
- excise liberally
- back to bleeding tissue
- preserve vessles
150
2 debridement techniques
- en bloc
| - layered
151
layered debridement define
begin at wound edges and work down through the tissue layers
152
layered debridement pros
can assess each individual tissue layer in a wound
153
layered debridement cons
all of the necrotic tissue may not be removed
154
en bloc debridement define
complete excision of wound with no entry into the wound
155
en bloc debridement cons
larger wound, and may damage the surrounding structures
156
en bloc debridement pros
make it into a clean wound
157
in lavage use
sterile isotonic fluid
158
lavage of wounds is performed when
daily after changing dressing
159
6 reasons for closing a wound
- can convert to a clean wwound
- no skin tension
- wound is not a crush wound
- wound is not infected
- granulating wound
- wound wont heal by second intention
160
4 reasons for not closing a wound
- puncture wound
- cant debride or lavage
- infected wound
- tension on closure
161
4 options for wound closure
- primary closure
- delayed primary closure
- secondary closure
- second intention healing
162
primary wound closure define
direct apposition of wound edges if clean
163
delayed primary wound closure define
apposition of wound edges 2-5 days post wounding
164
when delayed primary wound closure is used
- when wound is contaminated
| - if judgment on wound cannot be made straight away
165
define secondary wound closure
wound closure in presence of granulation tissue 5 -10 days post wounding
166
2 methods of secondary wound closure
- direct apposition of granulating surfaces
| - excision of granulation tissue then primary closure
167
secondary wound closure indications
when there is superficial contamination or invasive infection
168
indication for secondary intention wound healing
large wounds that have a lack of adjacent skin
169
layered debridement define
begin at wound edges and work down through the tissue layers
170
layered debridement pros
can assess each individual tissue layer in a wound
171
layered debridement cons
all of the necrotic tissue may not be removed
172
en bloc debridement define
complete excision of wound with no entry into the wound
173
en bloc debridement cons
larger wound, and may damage the surrounding structures
174
en bloc debridement pros
make it into a clean wound
175
in lavage use
sterile isotonic fluid
176
lavage of wounds is performed when
daily after changing dressing
177
6 reasons for closing a wound
- can convert to a clean wwound
- no skin tension
- wound is not a crush wound
- wound is not infected
- granulating wound
- wound wont heal by second intention
178
4 reasons for not closing a wound
- puncture wound
- cant debride or lavage
- infected wound
- tension on closure
179
4 options for wound closure
- primary closure
- delayed primary closure
- secondary closure
- second intention healing
180
primary wound closure define
direct apposition of wound edges if clean
181
delayed primary wound closure define
apposition of wound edges 2-5 days post wounding
182
when delayed primary wound closure is used
- when wound is contaminated
| - if judgment on wound cannot be made straight away
183
define secondary wound closure
wound closure in presence of granulation tissue 5 -10 days post wounding
184
2 methods of secondary wound closure
- direct apposition of granulating surfaces
| - excision of granulation tissue then primary closure
185
secondary wound closure indications
when there is superficial contamination or invasive infection
186
indication for secondary intention wound healing
large wounds that have a lack of adjacent skin
187
3 types of wound
- elective incisional
- elective excisional
- traumatic
188
6 things to consider in wound reconstruction
- evaluate tissue elasticity
- identify skin tension lines and likely effect
- position and importance of local structures
- location of adjacent direct cutaneous arteries
- previous surgical or traumatic wounds in region
- evaluation of viability and vascularity of local skin
189
mobilise local skin to wound edge by
undermining skin edges
190
3 ways to increase local skin by skin stretching
- pre-suturing
- skin stretchers
- skin expanders
191
pre-suturing skin expanding how to
vertical mattress tension sutures used to stretch the skin
192
pre-sutuing skin stretching cons
- requires 2 surgical procedures
| - skin stretch is focal and not adjustable
193
skin stretchers action
external device that stretches the skin
194
skin stretchers pros
adjustable
| can use over large areas
195
skin expanders for skin stretching define
an expandable implant placed under skin
196
a way to releive tension on a wound
relaxing incision
197
define relaxing incision
skin incision adjacent and parallel to primary wound to relieve tension
198
4 basic skin flaps
- advancement flap
- transposition flap
- rotating flap
- flank folds
199
adjacent flaps in wound reconstruction define
use loose skin near wound and advance it over wound
200
transposition flap wound reconstruction define
rectangular flap within a 90* angle of the long axis of defect
