surgery Flashcards
(25 cards)
what artery do you ligate (bilaterally) before hysterectomy for placenta accreta?
internal iliac arteries
what ligaments are brought together in colpopexy? (for vaginal vault prolapse)
(ileo)pectineal to sacral to uterosacral
what is the pectineal ligament
an extension of the lacunar ligament, hence is connected to the inguinal ligament through this
it extends internally down the pectineal line of the pubic bone
It connects to the pectineus muscle on its ventral and superior aspects. It connects to the rectus abdominis muscle, and the abdominal internal oblique muscle, of the anterior abdominal wall
It is strong and holds sutures well
Boundaries of the femoral ring
The femoral ring is bounded as follows:
anteriorly - inguinal ligament.
posteriorly - pectineal ligament.
medially - crescentic base of the lacunar ligament.
laterally - the fibrous septum on the medial side of the femoral vein.
what instrument would you use to hold the pregnant cervix when inspecting for tears after delivery
or during cerclage insertion (according to this youtube video)
Green Armitage
what forceps do you use to grasp the cervix during IUCD insertion or pipelle?
Vulsellum forceps
the ones with little teeth at the end that make me grimace
brand name for polyglactin
Vicryl
difference between Joel Cohen and Pfannensteil
JC relies more on blunt dissection after opening only the medial 3cm of sc fat under the skin incision
fascia is dissected bluntly
thought to have less post-op pain
the skin incision is placed slightly higher than pfannensteil
difference between vicryl and vicryl rapide
Vicryl and Vicryl Rapide are both synthetic, absorbable sutures used in surgery, but Vicryl Rapide is designed to be absorbed more quickly (and thus also lose its tensile strength more quickly) than standard Vicryl.
complete absorption time of vicryl rapide
42 days
complete absorption time of vicryl
60 days
complete absorption time of monocryl
100 days
complete absorption time of PDS (PolyDioxanone Suture)
N.B. the ‘P’ in PDS is NOT prolene. Prolene is NON-ABSORBABLE
PDS is absorbable
200 days
difference between cutting needle and reverse cutting needle
Cutting needles are triangular in shape, and have 3 cutting edges to penetrate tough tissue such as the skin and sternum, and have a cutting surface on the concave edge
Reverse cutting needles have a cutting surface on the convex edge, and are ideal for tough tissue such as tendon or subcuticular sutures, and have reduced risk of cutting through tissue
difference between needle body/shaft, and needle point and needle shape. How are they defined.
needle point is just the bit that pierces the tissue: sharp or blunt
needle body is the region that’s grasped by the needle holder. Round-bodied, cutting, reverse-cutting
needle shape is the curvature, described as the proportion of a circle completed - 1/4, 3/8, 1/2, 5/8
is vicryl monofilament or multifilament
multifilament
pros and cons of monofilament and multifilament
monofilament lower infection risk. but worse knot security.
when might you use prolene
vascular anastomosis
what suture might you use to secure a drain
silk (non-absorbable so retains its strength and external so easy to remove - but also multifilament so holds the knot well)
when to choose a blunt needle or a sharp needle
blunt - friable tissue and abdominal wall closure
sharp - in areas where leakage must be prevented
what forceps might you use to grasp the fallopian tubes
babcocks
Babcock Tissue Forceps are finger ring, ratcheted, non-perforating forceps similar to allis forceps but with wider & rounded grasping surface that have small, delicate teeth on one or both jaws that allow them to grip tissue without causing any damage to the tissue.
which one is the tenaculum
the one with just a single tooth on each end, that they used to give me in gynae clinic in NZ
in the proliferation phase of wound healing, what do macrophages emit, and what effect does that have?
nitrous oxide
dilates vessels to accommodate influx of new cells
at one week, what percentage of final strength does a wound have
3%
